Anthem Blue Cross Blue Shield of California policy
CG-SURG-12 Penile Prosthesis Implantation
CG-SURG-12 Penile Prosthesis Implantation is a public Anthem Blue Cross Blue Shield of California policy (policy CG-SURG-12). It lists 10 CPT or HCPCS codes, 10 of them on the Anthem Blue Cross Blue Shield of California prior authorization list. Not a coverage decision; the payer's own document governs.
Check eligibility for free
No account required. Sign a BAA to see plan details, coordination of benefits and more
- Policy number
- CG-SURG-12
- 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 |
|---|---|---|---|
| 54400 | On the list | Insertion of penile prosthesis; non-inflatable (semi-rigid) | Policies naming 54400 |
| 54401 | On the list | Insertion of penile prosthesis; inflatable (self-contained) | Policies naming 54401 |
| 54405 | On the list | Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders, and reservoir | Policies naming 54405 |
| 54410 | On the list | Removal & Replacement, Multi-Component Inflatable Penile Prosthesis, Same Session | Policies naming 54410 |
| 54411 | On the list | Removal & Replacement, Multi-Component Inflatable Penile Prosthesis, Infected, W/ Irrig & Debride | Policies naming 54411 |
| 54416 | On the list | Removal & Replacement, Non-Inflatable (Semi- Rigid)/Inflatable (Self-Contained) Penile Prosthesis | Policies naming 54416 |
| 54417 | On the list | Removal & Replace, Non-Inflatable/Inflatable Penile Prosthesis Infect, W/Irrig & Debride | Policies naming 54417 |
| C1813 | On the list | Prosthesis, penile, inflatable | Policies naming C1813 |
| C2622 | On the list | Prosthesis, penile, non-inflatable | Policies naming C2622 |
| L8699 | On the list | Prosthetic implant, not otherwise specified [when specified as hybrid cochlear device, including all internal and external components] or [when describing replacement components of an auditory brain stem implant] or [when specified as a hyaluronic acid gel agent such as Juvederm or Restylane] or [when describing a prefabricated, custom-fitted auricular implant] or [when describing a custom-fabricated auricular implant] or [when specified as testicular or penile prosthesis] | Policies naming L8699 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list