Anthem Blue Cross and Blue Shield Virginia policy
CG-MED-101 Home Hospice
CG-MED-101 Home Hospice is a public Anthem Blue Cross and Blue Shield Virginia policy (policy CG-MED-101). It lists 29 CPT or HCPCS codes, 16 of them on the Anthem Blue Cross and Blue Shield Virginia prior authorization list. Not a coverage decision; the payer's own document governs.
- Policy number
- CG-MED-101
- Line of business
- Commercial
- Source
- www.anthem.com
Codes in this policy
The CPT and HCPCS codes the policy names. A policy can name a code it excludes. Prior authorization status is from the Anthem Blue Cross and Blue Shield Virginia prior authorization list.
| Code | Prior authorization | Description on the prior authorization list | Other Anthem Blue Cross and Blue Shield Virginia policies |
|---|---|---|---|
| G0151 | On the list | Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes | Policies naming G0151 |
| G0152 | On the list | Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes | Policies naming G0152 |
| G0153 | On the list | Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes | Policies naming G0153 |
| G0155 | On the list | Services Of Clinical Social Worker In Home Health Or Hospice Settings, Each 15 Minutes | Policies naming G0155 |
| G0156 | On the list | Services Of Home Health/Hospice Aide In Home Health Or Hospice Settings, Each 15 Minutes | Policies naming G0156 |
| G0157 | On the list | Services performed by a qualified physical therapist assistant in the home health or hospice setting, each 15 minutes | Policies naming G0157 |
| G0158 | On the list | Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes | Policies naming G0158 |
| G0162 | On the list | Skilled services by a registered nurse (RN) for management & evaluation of the plan of care; each 15 minutes (the patient's underlying condition or complication requires an RN | Policies naming G0162 |
| G0299 | On the list | Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting, each 15 minutes | Policies naming G0299 |
| G0300 | On the list | Direct skilled nursing services of a license practical nurse (LPN) in the home health or hospice setting, each 15 minutes | Policies naming G0300 |
| G0493 | Not listed | Policies naming G0493 | |
| G0494 | On the list | Skilled services of a licensed practical nurse (lpn) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requ | Policies naming G0494 |
| G0495 | On the list | Skilled services of a registered nurse (rn), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes | Policies naming G0495 |
| G0496 | On the list | Skilled services of a licensed practical nurse (lpn), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes | Policies naming G0496 |
| G9473 | Not listed | Policies naming G9473 | |
| G9474 | Not listed | Policies naming G9474 | |
| G9475 | Not listed | Policies naming G9475 | |
| G9476 | Not listed | Policies naming G9476 | |
| G9477 | Not listed | Policies naming G9477 | |
| G9478 | Not listed | Policies naming G9478 | |
| G9479 | Not listed | Policies naming G9479 | |
| Q5001 | On the list | Hospice or home health care provided in patient's home/residence | Policies naming Q5001 |
| Q5002 | On the list | Hospice or home health care provided in assisted living facility | Policies naming Q5002 |
| Q5003 | Not listed | Policies naming Q5003 | |
| Q5007 | Not listed | Policies naming Q5007 | |
| Q5009 | On the list | Hospice or home health care provided in place not otherwise specified (nos) | Policies naming Q5009 |
| S9126 | Not listed | Policies naming S9126 | |
| T2042 | Not listed | Policies naming T2042 | |
| T2043 | Not listed | Policies naming T2043 |
All Anthem Blue Cross and Blue Shield Virginia policies · Anthem Blue Cross and Blue Shield Virginia prior authorization CPT list