Anthem Blue Cross Blue Shield of California policy
ANC.00007 Cosmetic and Reconstructive Services: Skin Related
ANC.00007 Cosmetic and Reconstructive Services: Skin Related is a public Anthem Blue Cross Blue Shield of California policy (policy ANC.00007). It lists 26 CPT or HCPCS codes, 21 of them on the Anthem Blue Cross Blue Shield of California prior authorization list. Not a coverage decision; the payer's own document governs.
- Policy number
- ANC.00007
- 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 Blue Shield of California prior authorization list.
| Code | Prior authorization | Description on the prior authorization list | Other Anthem Blue Cross Blue Shield of California policies |
|---|---|---|---|
| 00007 | Not listed | Policies naming 00007 | |
| 00008 | Not listed | Policies naming 00008 | |
| 00011 | Not listed | Policies naming 00011 | |
| 00023 | Not listed | Policies naming 00023 | |
| 00132 | Not listed | Policies naming 00132 | |
| 11920 | On the list | Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation | Policies naming 11920 |
| 11921 | On the list | Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation | Policies naming 11921 |
| 11922 | On the list | Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation | Policies naming 11922 |
| 15775 | On the list | Punch graft for hair transplant; 1 to 15 punch grafts | Policies naming 15775 |
| 15776 | On the list | Punch graft for hair transplant; more than 15 punch grafts | Policies naming 15776 |
| 15780 | On the list | Dermabrasion; total face (e.g., for acne scarring, fine wrinkling, rhytids, general keratosis) | Policies naming 15780 |
| 15781 | On the list | Dermabrasion; segmental, face | Policies naming 15781 |
| 15782 | On the list | Dermabrasion; regional, other than face | Policies naming 15782 |
| 15783 | On the list | Dermabrasion; superficial, any site (e.g., tattoo removal) | Policies naming 15783 |
| 15786 | On the list | Abrasion; single lesion | Policies naming 15786 |
| 15787 | On the list | Abrasion (lesions) | Policies naming 15787 |
| 15788 | On the list | Chemical peel, facial; epidermal | Policies naming 15788 |
| 15789 | On the list | Chemical peel, facial; epidermal | Policies naming 15789 |
| 15792 | On the list | Chemical peel, nonfacial; epidermal | Policies naming 15792 |
| 15793 | On the list | Chemical peel, nonfacial; dermal | Policies naming 15793 |
| 17106 | On the list | Destruction of cutaneous vascular proliferative lesions (e.g., laser technique); less than 10 sq cm | Policies naming 17106 |
| 17107 | On the list | Destruction of cutaneous vascular proliferative lesions (e.g., laser technique); 10.0 to 50.0 sq cm | Policies naming 17107 |
| 17108 | On the list | Destruction of cutaneous vascular proliferative lesions (e.g., laser technique); over 50.0 sq cm | Policies naming 17108 |
| 17380 | On the list | Electrolysis epilation, each 30 minutes | Policies naming 17380 |
| 17999 | On the list | Unlisted procedure, skin, mucous membrane and subcutaneous tissue [when specified as other abdominoplasty, excision excessive skin and subcutaneous tissue, including lipectomy, of abdomen] or [when specified as permanent hair removal by laser] or [when specified as implantation of biologic implants for soft tissue reinforcement in tissues other than breast and trunk] or [when specified as aesthetic flat chest closure or chest wall reconstruction after breast surgery] or [when specified as laser treatment of onychomycosis] or [when specified as percutaneous ultrasound ablation of subcutaneous tissue] or [when specified as application of prademagene zamikeracel (Zevaskyn) genetically engineered autologous cell therapy] or [when specified as harvesting or administration of stem cells for therapy to repair damaged cells or body tissues] | Policies naming 17999 |
| 96999 | On the list | Unlisted special dermatological service or procedure[when specified as dermatoscopy techniques such as dermoscopy, epiluminescence microscopy, or digital epiluminescence microscopy, skin surface microscopy, skin videomicroscopy, incidence light microscopy or reflectance confocal microscopy not generating mosaic images] or [when specified as ultrasonography of the skin for skin lesions] or [when specified as tunable dye or pulsed dye laser treatment for varicose veins] or [when specified as laser treatment of onychomycosis] | Policies naming 96999 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list