Anthem Blue Cross Blue Shield of California policy
CG-THER-RAD-07 Intravascular Coronary and Non-Coronary Brachytherapy
CG-THER-RAD-07 Intravascular Coronary and Non-Coronary Brachytherapy is a public Anthem Blue Cross Blue Shield of California policy (policy CG-THER-RAD-07). It lists 6 CPT or HCPCS codes, 4 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-THER-RAD-07
- 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 |
|---|---|---|---|
| 77770 | On the list | Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 1 channel [when specified as coronary intravascular brachytherapy] | Policies naming 77770 |
| 77771 | On the list | Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 2-12 channels [when specified as coronary intravascular brachytherapy] | Policies naming 77771 |
| 77772 | On the list | Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; over 12 channels [when specified as coronary intravascular brachytherapy] | Policies naming 77772 |
| 92974 | Not listed | Policies naming 92974 | |
| 93799 | On the list | Unlisted cardiovascular service or procedure [when specified as left ventricular filling pressure; indirect measurement by computerized calibration of the arterial waveform response to Valsalva maneuver] or [when specified as intravascular catheter-based coronary vessel or graft spectroscopy (e.g., infrared) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report, each vessel] or [when specified as insertion of left atrial hemodynamic monitor] | Policies naming 93799 |
| C7533 | Not listed | Policies naming C7533 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list