Anthem Blue Cross and Blue Shield Virginia policy
CG-SURG-31 Treatment of Keloids and Scar Revision
CG-SURG-31 Treatment of Keloids and Scar Revision is a public Anthem Blue Cross and Blue Shield Virginia policy (policy CG-SURG-31). It lists 67 CPT or HCPCS codes, 4 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-31
- 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 |
|---|---|---|---|
| 00007 | Not listed | Policies naming 00007 | |
| 00008 | Not listed | Policies naming 00008 | |
| 00011 | Not listed | Policies naming 00011 | |
| 00110 | Not listed | Policies naming 00110 | |
| 0479T | Not listed | Policies naming 0479T | |
| 0480T | Not listed | Policies naming 0480T | |
| 11400 | Not listed | Policies naming 11400 | |
| 11401 | Not listed | Policies naming 11401 | |
| 11402 | Not listed | Policies naming 11402 | |
| 11403 | Not listed | Policies naming 11403 | |
| 11404 | Not listed | Policies naming 11404 | |
| 11406 | Not listed | Policies naming 11406 | |
| 11420 | Not listed | Policies naming 11420 | |
| 11421 | Not listed | Policies naming 11421 | |
| 11422 | Not listed | Policies naming 11422 | |
| 11423 | Not listed | Policies naming 11423 | |
| 11424 | Not listed | Policies naming 11424 | |
| 11426 | Not listed | Policies naming 11426 | |
| 11440 | Not listed | Policies naming 11440 | |
| 11441 | Not listed | Policies naming 11441 | |
| 11442 | Not listed | Policies naming 11442 | |
| 11443 | Not listed | Policies naming 11443 | |
| 11444 | Not listed | Policies naming 11444 | |
| 11446 | Not listed | Policies naming 11446 | |
| 12031 | Not listed | Policies naming 12031 | |
| 12032 | Not listed | Policies naming 12032 | |
| 12034 | Not listed | Policies naming 12034 | |
| 12035 | Not listed | Policies naming 12035 | |
| 12036 | Not listed | Policies naming 12036 | |
| 12037 | Not listed | Policies naming 12037 | |
| 12041 | Not listed | Policies naming 12041 | |
| 12042 | Not listed | Policies naming 12042 | |
| 12044 | Not listed | Policies naming 12044 | |
| 12045 | Not listed | Policies naming 12045 | |
| 12046 | Not listed | Policies naming 12046 | |
| 12047 | Not listed | Policies naming 12047 | |
| 12051 | Not listed | Policies naming 12051 | |
| 12052 | Not listed | Policies naming 12052 | |
| 12053 | Not listed | Policies naming 12053 | |
| 12054 | Not listed | Policies naming 12054 | |
| 12055 | Not listed | Policies naming 12055 | |
| 12056 | Not listed | Policies naming 12056 | |
| 12057 | Not listed | Policies naming 12057 | |
| 13100 | Not listed | Policies naming 13100 | |
| 13101 | Not listed | Policies naming 13101 | |
| 13102 | Not listed | Policies naming 13102 | |
| 13120 | Not listed | Policies naming 13120 | |
| 13121 | Not listed | Policies naming 13121 | |
| 13122 | Not listed | Policies naming 13122 | |
| 13131 | Not listed | Policies naming 13131 | |
| 13132 | Not listed | Policies naming 13132 | |
| 13133 | Not listed | Policies naming 13133 | |
| 13151 | Not listed | Policies naming 13151 | |
| 13152 | Not listed | Policies naming 13152 | |
| 13153 | Not listed | Policies naming 13153 | |
| 14000 | Not listed | Policies naming 14000 | |
| 14001 | Not listed | Policies naming 14001 | |
| 14020 | Not listed | Policies naming 14020 | |
| 14021 | Not listed | Policies naming 14021 | |
| 14040 | On the list | Adjacent Tissue Transfer, Forehead/Cheeks/Chin/Mouth/Neck/Axillae/Genitalia/Hands/Feet; 10 Sq Cm/< | Policies naming 14040 |
| 14041 | On the list | Adjacent Tissue Transfer, Forehead/Cheeks/Chin/Mouth/Neck/Axillae/Genitalia/Hands/Feet;10.1-30.0sqcm | Policies naming 14041 |
| 14060 | On the list | Adjacent Tissue Transfer/Rearrangement, Eyelids/Nose/Ears/Lips; Defect 10 Sq Cm/< | Policies naming 14060 |
| 14061 | On the list | Adjacent Tissue Transfer/Rearrangement, Eyelids/Nose/Ears/Lips; Defect 10.1-30.0 Sq Cm | Policies naming 14061 |
| 14301 | Not listed | Policies naming 14301 | |
| 14302 | Not listed | Policies naming 14302 | |
| 77436 | Not listed | Policies naming 77436 | |
| 77437 | Not listed | Policies naming 77437 |
All Anthem Blue Cross and Blue Shield Virginia policies · Anthem Blue Cross and Blue Shield Virginia prior authorization CPT list