Anthem Blue Cross Blue Shield of California policy
CG-MED-96 Prefabricated External Infant Ear Molding Systems
CG-MED-96 Prefabricated External Infant Ear Molding Systems is a public Anthem Blue Cross Blue Shield of California policy (policy CG-MED-96). It lists 6 CPT or HCPCS codes, 5 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-MED-96
- 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 |
|---|---|---|---|
| 21086 | On the list | Impression and custom preparation; auricular prosthesis | Policies naming 21086 |
| 29799 | Not listed | Policies naming 29799 | |
| 69399 | On the list | Unlisted procedure, external ear [when specified as other otoplasty] | Policies naming 69399 |
| A4649 | On the list | Surgical supply, miscellaneous [no specific code for antimicrobial silver wound dressings (e.g., Acticoat, Actisorb, AQUACEL Ag, Promogran Prisma, Silversorb, Urgotul Silver)] or [when specified as supply of a medial knee implanted shock absorber] | Policies naming A4649 |
| E1399 | On the list | Durable medical equipment, miscellaneous | Policies naming E1399 |
| L8045 | On the list | Auricular prosthesis, provided by a nonphysician | Policies naming L8045 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list