Anthem Blue Cross and Blue Shield Virginia policy
Deep Brain Stimulation and Responsive Neurostimulation
Deep Brain Stimulation and Responsive Neurostimulation is a public Anthem Blue Cross and Blue Shield Virginia policy (policy SURG.00026). It lists 22 CPT or HCPCS codes, 20 of them on the Anthem Blue Cross and Blue Shield Virginia prior authorization list. Not a coverage decision; the payer's own document governs.
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- Policy number
- SURG.00026
- 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 |
|---|---|---|---|
| 61850 | On the list | Twist Drill/Burr Hole(S), Implantation, Neurostimulator Electrodes, Cortical | Policies naming 61850 |
| 61860 | On the list | Craniectomy/Craniotomy, Implantation, Neurostimulator Electrodes, Cerebral, Cortical | Policies naming 61860 |
| 61863 | On the list | Burr Hole Craniotomy with Implantation of Subcortical Electrode Array, wo Intraop Microelectrode Recording; First Array | Policies naming 61863 |
| 61864 | Not listed | Policies naming 61864 | |
| 61867 | On the list | Burr Hole Craniotomy with Implantation of Subcortical Electrode Array, w Intraop Microelectrode Recording; First Array | Policies naming 61867 |
| 61868 | Not listed | Policies naming 61868 | |
| 61885 | On the list | Subq Placement Cranial Neurostimulator Pulse Generator/Receiver; W/Connection Sngle Electrod Array | Policies naming 61885 |
| 61886 | On the list | Subq Placement Cranial Neurostimulator Pulse Generator/Receiver; W/Connection 2+ Electrode Arrays | Policies naming 61886 |
| 61889 | On the list | Insertion of skull-mounted cranial neurostimulator pulse generator or receiver, including craniectomy or craniotomy, when performed, with direct or inductive coupling, with co | Policies naming 61889 |
| 61891 | On the list | Revision or replacement of skull-mounted cranial neurostimulator pulse generator or receiver with connection to depth and/or cortical strip electrode array(s) | Policies naming 61891 |
| C1767 | On the list | Generator, neurostimulator (implantable), nonrechargeable | Policies naming C1767 |
| C1778 | On the list | Lead, neurostimulator (implantable) | Policies naming C1778 |
| C1787 | On the list | Patient programmer, neurostimulator | Policies naming C1787 |
| C1820 | On the list | Generator, neurostimulator (implantable), with rechargeable battery and charging system | Policies naming C1820 |
| L8679 | On the list | Implantable neurostimulator, pulse generator, any type | Policies naming L8679 |
| L8680 | On the list | Implantable neurostimulator electrode, each | Policies naming L8680 |
| L8682 | On the list | Implantable neurostimulator radiofrequency receiver | Policies naming L8682 |
| L8683 | On the list | Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver | Policies naming L8683 |
| L8685 | On the list | Implantable neurostimulator pulse generator, single array, rechargeable, includes extension | Policies naming L8685 |
| L8686 | On the list | Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension | Policies naming L8686 |
| L8687 | On the list | Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension | Policies naming L8687 |
| L8688 | On the list | Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension | Policies naming L8688 |
All Anthem Blue Cross and Blue Shield Virginia policies · Anthem Blue Cross and Blue Shield Virginia prior authorization CPT list