Anthem Blue Cross and Blue Shield Virginia policy
CG-TRANS-02 Kidney Transplantation
CG-TRANS-02 Kidney Transplantation is a public Anthem Blue Cross and Blue Shield Virginia policy (policy CG-TRANS-02). It lists 12 CPT or HCPCS codes, 12 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-TRANS-02
- 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 |
|---|---|---|---|
| 00868 | On the list | Anesthesia, Extraperitoneal Proc, Lower Abdomen, W/Urinary Tract; Renal Transplant, Recipient | Policies naming 00868 |
| 50300 | On the list | Donor Nephrectomy; Cadaver Donor, Unilat/Bilat W/Prep & Maintenance, Allograft | Policies naming 50300 |
| 50320 | On the list | Donor Nephrectomy, Open, Living Donor W/O Allograft Preparation & Maintenance | Policies naming 50320 |
| 50323 | On the list | Backbench Standard Preparation Of Cadaver Donor Renal Allograft | Policies naming 50323 |
| 50325 | On the list | Backbench Standard Preparation Of Living Donor Renal Allograft (Open Or Laparoscopic) | Policies naming 50325 |
| 50327 | On the list | Backbench Reconstruction Of Cadaver Or Living Donor Renal Allograft Prior To Transplantation; Venous Anastomosis, Each | Policies naming 50327 |
| 50328 | On the list | Backbench Reconstruction Of Cadaver Or Living Donor Renal Allograft Prior To Transplantation; Arterial Anastomosis, Each | Policies naming 50328 |
| 50329 | On the list | Backbench Reconstruction Of Cadaver Or Living Donor Renal Allograft Prior To Transplantation; Ureteral Anastomosis, Each | Policies naming 50329 |
| 50340 | On the list | Recipient Nephrectomy (Sep Proc) | Policies naming 50340 |
| 50360 | On the list | Renal Allotransplantation, Implantation, Graft; W/O Donor & Recipient Nephrectomy | Policies naming 50360 |
| 50365 | On the list | Renal Allotransplantation, Implantation, Graft; W/Recipient Nephrectomy | Policies naming 50365 |
| 50547 | On the list | Laparoscopy, Surgical; Donor Nephrectomy, Living Donor W/O Allograft Prep & Maintenance | Policies naming 50547 |
All Anthem Blue Cross and Blue Shield Virginia policies · Anthem Blue Cross and Blue Shield Virginia prior authorization CPT list