Anthem Blue Cross Blue Shield of California policy
CG-TRANS-02 Kidney Transplantation
CG-TRANS-02 Kidney Transplantation is a public Anthem Blue Cross Blue Shield of California policy (policy CG-TRANS-02). It lists 12 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-TRANS-02
- 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 |
|---|---|---|---|
| 00868 | Not listed | Policies naming 00868 | |
| 50300 | On the list | Donor nephrectomy (including cold preservation); from cadaver donor, unilateral or bilateral | Policies naming 50300 |
| 50320 | On the list | Donor nephrectomy (including cold preservation); open, from living donor | Policies naming 50320 |
| 50323 | On the list | Backbench standard preparation of cadaver donor renal allograft prior to transplantation, including dissection and removal of perinephric fat, diaphragmatic and retroperitoneal attachments, excision of adrenal gland, and preparation of ureter(s), renal vein(s), and renal artery(s), ligating branches, as necessary | Policies naming 50323 |
| 50325 | On the list | Backbench standard preparation of living donor renal allograft (open or laparoscopic) prior to transplantation, including dissection and removal of perinephric fat and preparation of ureter(s), renal vein(s), and renal artery(s), ligating branches, as necessary | Policies naming 50325 |
| 50327 | On the list | Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation; venous anastomosis, each | Policies naming 50327 |
| 50328 | On the list | Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation; arterial anastomosis, each | Policies naming 50328 |
| 50329 | On the list | Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation; ureteral anastomosis, each | Policies naming 50329 |
| 50340 | On the list | Recipient nephrectomy (separate procedure) | Policies naming 50340 |
| 50360 | On the list | Renal allotransplantation, implantation of graft; without recipient nephrectomy | Policies naming 50360 |
| 50365 | On the list | Renal allotransplantation, implantation of graft; with recipient nephrectomy | Policies naming 50365 |
| 50547 | On the list | Laparoscopy, surgical; donor nephrectomy (including cold preservation), from living donor | Policies naming 50547 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list