Anthem Blue Cross and Blue Shield Virginia policy
Portable Normothermic Organ Perfusion Systems
Portable Normothermic Organ Perfusion Systems is a public Anthem Blue Cross and Blue Shield Virginia policy (policy TRANS.00039). It lists 10 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.
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- Policy number
- TRANS.00039
- 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 |
|---|---|---|---|
| 0494T | On the list | Surgical preparation and cannulation of marginal (extended) cadaver donor lung(s) to ex vivo organ perfusion system, including decannulation, separation from the perfusion sys | Policies naming 0494T |
| 0495T | On the list | Initiation and monitoring marginal (extended) cadaver donor lung(s) organ perfusion system by physician or qualified health care professional, including physiological and labo | Policies naming 0495T |
| 0496T | Not listed | Policies naming 0496T | |
| 0894T | On the list | Cannulation of the liver allograft in preparation for connection to the normothermic perfusion device and decannulation of the liver allograft following normothermic perfusion | Policies naming 0894T |
| 0895T | On the list | Connection of liver allograft to normothermic machine perfusion device, hemostasis control; initial 4 hours of monitoring time, including hourly physiological and laboratory a | Policies naming 0895T |
| 0896T | On the list | Connection of liver allograft to normothermic machine perfusion device, hemostasis control; each additional hour, including physiological and laboratory assessments (eg, perfu | Policies naming 0896T |
| 1072T | Not listed | Policies naming 1072T | |
| 1073T | Not listed | Policies naming 1073T | |
| 33999 | Not listed | Policies naming 33999 | |
| 53899 | Not listed | Policies naming 53899 |
All Anthem Blue Cross and Blue Shield Virginia policies · Anthem Blue Cross and Blue Shield Virginia prior authorization CPT list