Anthem Blue Cross Blue Shield of California policy
CG-DME-46 Pneumatic Compression Devices for Prevention of Deep Vein Thrombosis of the Extremities in the Home Setting
CG-DME-46 Pneumatic Compression Devices for Prevention of Deep Vein Thrombosis of the Extremities in the Home Setting is a public Anthem Blue Cross Blue Shield of California policy (policy CG-DME-46). It lists 18 CPT or HCPCS codes, 17 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-DME-46
- 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 |
|---|---|---|---|
| A4600 | On the list | Sleeve for intermittent limb compression device, replacement only, each | Policies naming A4600 |
| E0650 | On the list | Pneumatic compressor, non-segmental home model | Policies naming E0650 |
| E0651 | On the list | Pneumatic compressor, segmental home model without calibrated gradient pressure | Policies naming E0651 |
| E0652 | On the list | Pneumatic compressor, segmental home model with calibrated gradient pressure | Policies naming E0652 |
| E0655 | On the list | Non-segmental pneumatic appliance for use with pneumatic compressor, half arm | Policies naming E0655 |
| E0658 | On the list | Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full arms and chest | Policies naming E0658 |
| E0660 | On the list | Non-segmental pneumatic appliance for use with pneumatic compressor, full leg | Policies naming E0660 |
| E0665 | On the list | Non-segmental pneumatic appliance for use with pneumatic compressor, full arm | Policies naming E0665 |
| E0666 | On the list | Non-segmental pneumatic appliance for use with pneumatic compressor, half leg | Policies naming E0666 |
| E0667 | On the list | Segmental pneumatic appliance for use with pneumatic compressor, full leg | Policies naming E0667 |
| E0668 | On the list | Segmental pneumatic appliance for use with pneumatic compressor, full arm | Policies naming E0668 |
| E0669 | On the list | Segmental pneumatic appliance for use with pneumatic compressor, helf leg | Policies naming E0669 |
| E0670 | On the list | Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full legs and trunk | Policies naming E0670 |
| E0671 | On the list | Segmental gradient pressure pneumatic appliance, full leg | Policies naming E0671 |
| E0672 | On the list | Segmental gradient pressure pneumatic appliance, full arm | Policies naming E0672 |
| E0673 | On the list | Segmental gradient pressure pneumatic appliance, half leg | Policies naming E0673 |
| E0675 | Not listed | Policies naming E0675 | |
| E0676 | On the list | Intermittent limb compression device (includes all accessories), not otherwise specified | Policies naming E0676 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list