Anthem Blue Cross Blue Shield of California policy
CG-ANC-04 Ambulance Services: Air and Water
CG-ANC-04 Ambulance Services: Air and Water is a public Anthem Blue Cross Blue Shield of California policy (policy CG-ANC-04). It lists 8 CPT or HCPCS codes, 8 of them on the Anthem Blue Cross Blue Shield of California prior authorization list. Not a coverage decision; the payer's own document governs.
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- Policy number
- CG-ANC-04
- 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 |
|---|---|---|---|
| A0430 | On the list | Ambulance service, conventional air services, transport, one way (fixed wing) | Policies naming A0430 |
| A0431 | On the list | Ambulance service, conventional air services, transport, one way (rotary wing) | Policies naming A0431 |
| A0435 | On the list | Fixed wing air mileage, per statute mile | Policies naming A0435 |
| A0436 | On the list | Rotary wing air mileage, per statute mile | Policies naming A0436 |
| A0888 | On the list | Noncovered ambulance mileage, per mile (e.g., for miles traveled beyond closest appropriate facility) | Policies naming A0888 |
| A0999 | On the list | Unlisted ambulance service | Policies naming A0999 |
| S9960 | On the list | Ambulance service, conventional air services, nonemergency transport, one way (fixed wing) | Policies naming S9960 |
| S9961 | On the list | Ambulance service, conventional air service, nonemergency transport, one way (rotary wing) | Policies naming S9961 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list