Anthem Blue Cross Blue Shield of California policy
CG-SURG-03 Blepharoplasty, Blepharoptosis Repair, and Brow Lift
CG-SURG-03 Blepharoplasty, Blepharoptosis Repair, and Brow Lift is a public Anthem Blue Cross Blue Shield of California policy (policy CG-SURG-03). It lists 11 CPT or HCPCS codes, 11 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-SURG-03
- 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 |
|---|---|---|---|
| 15820 | On the list | Blepharoplasty, lower eyelid | Policies naming 15820 |
| 15821 | On the list | Blepharoplasty, lower eyelid; with extensive herniated fat pad | Policies naming 15821 |
| 15822 | On the list | Blepharoplasty, upper eyelid | Policies naming 15822 |
| 15823 | On the list | Blepharoplasty, upper eyelid; with excessive skin weighting down lid | Policies naming 15823 |
| 67900 | On the list | Repair of brow ptosis (supraciliary, mid-forehead or coronal approach) | Policies naming 67900 |
| 67901 | On the list | Repair of blepharoptosis; frontalis muscle technique with suture or other material (e.g., banked fascia) | Policies naming 67901 |
| 67902 | On the list | Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) | Policies naming 67902 |
| 67903 | On the list | Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach | Policies naming 67903 |
| 67904 | On the list | Repair of blepharoptosis; (tarso) levator resection or advancement, external approach | Policies naming 67904 |
| 67906 | On the list | Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) | Policies naming 67906 |
| 67908 | On the list | Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle- levator resection (e.g., Fasanella-Servat type) | Policies naming 67908 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list