Anthem Blue Cross and Blue Shield Virginia policy
CG-MED-81 Ultrasound Ablation for Oncologic Indications
CG-MED-81 Ultrasound Ablation for Oncologic Indications is a public Anthem Blue Cross and Blue Shield Virginia policy (policy CG-MED-81). It lists 7 CPT or HCPCS codes, 5 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-81
- 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 |
|---|---|---|---|
| 19499 | Not listed | Policies naming 19499 | |
| 20999 | Not listed | Policies naming 20999 | |
| 51721 | On the list | Transurethral ablation transducer insertion for delivery of thermal ultrasound for prostate | Policies naming 51721 |
| 55880 | On the list | Ablation of malignant prostate tissue, transrectal, with high intensity-focused ultrasound (HIFU), including ultrasound guidance | Policies naming 55880 |
| 55881 | On the list | Transurethral ablation of prostate tissue, using thermal ultrasound | Policies naming 55881 |
| 55882 | On the list | Transurethral ablation of prostate tissue, using thermal ultrasound; with insertion of ultrasound transducer | Policies naming 55882 |
| C9734 | On the list | Focused ultrasound ablation/therapeutic intervention, other than uterine leiomyomata, with magnetic resonance (mr) guidance | Policies naming C9734 |
All Anthem Blue Cross and Blue Shield Virginia policies · Anthem Blue Cross and Blue Shield Virginia prior authorization CPT list