Anthem Blue Cross and Blue Shield Virginia policy
CG-SURG-118 Intraocular Anterior Segment Aqueous Drainage Devices (without extraocular reservoir)
CG-SURG-118 Intraocular Anterior Segment Aqueous Drainage Devices (without extraocular reservoir) is a public Anthem Blue Cross and Blue Shield Virginia policy (policy CG-SURG-118). It lists 8 CPT or HCPCS codes, 7 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-SURG-118
- 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 |
|---|---|---|---|
| 0253T | On the list | Insertion of anterior segment aqueous drainage device, without extraocular reservoir; internal approach, into the suprachoroidal space | Policies naming 0253T |
| 0449T | On the list | Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space; initial device | Policies naming 0449T |
| 0450T | Not listed | Policies naming 0450T | |
| 0474T | On the list | Insertion of anterior segment aqueous drainage device, with creation of intraocular reservoir, internal approach, into the supraciliary space | Policies naming 0474T |
| 0671T | On the list | Insertion of anterior segment aqueous drainage device into the trabecular meshwork, without external reservoir, and without concomitant cataract removal, one or more | Policies naming 0671T |
| 66183 | On the list | Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach | Policies naming 66183 |
| 66989 | On the list | Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsif | Policies naming 66989 |
| 66991 | On the list | Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsif | Policies naming 66991 |
All Anthem Blue Cross and Blue Shield Virginia policies · Anthem Blue Cross and Blue Shield Virginia prior authorization CPT list