Anthem Blue Cross Blue Shield of California policy
Deep Brain Stimulation and Responsive Neurostimulation
Deep Brain Stimulation and Responsive Neurostimulation is a public Anthem Blue Cross Blue Shield of California policy (policy SURG.00026). It lists 22 CPT or HCPCS codes, 22 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
- SURG.00026
- 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 |
|---|---|---|---|
| 61850 | On the list | Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical | Policies naming 61850 |
| 61860 | On the list | Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical | Policies naming 61860 |
| 61863 | On the list | Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperattive microelectrode recording | Policies naming 61863 |
| 61864 | On the list | Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperattive microelectrode recording; each additional array | Policies naming 61864 |
| 61867 | On the list | Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array | Policies naming 61867 |
| 61868 | On the list | Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; each additional array | Policies naming 61868 |
| 61885 | On the list | Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array | Policies naming 61885 |
| 61886 | On the list | Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to 2 or more electrode arrays | Policies naming 61886 |
| 61889 | On the list | Insertion of skull-mounted cranial neurostimulator pulse generator or receiver, including craniectomy or craniotomy, when performed, with direct or inductive coupling, with connection to depth and/or cortical strip electrode array(s) | Policies naming 61889 |
| 61891 | On the list | Revision or replacement of skull-mounted cranial neurostimulator pulse generator or receiver with connection to depth and/or cortical strip electrode array(s) | Policies naming 61891 |
| C1767 | On the list | Generator, neurostimulator (implantable), nonrechargeable | Policies naming C1767 |
| C1778 | On the list | Lead, neurostimulator (implantable) | Policies naming C1778 |
| C1787 | On the list | Patient programmer, neurostimulator | Policies naming C1787 |
| C1820 | On the list | Generator, neurostimulator (implantable), with rechargeable battery and charging system | Policies naming C1820 |
| L8679 | On the list | Neurostimulator Implantation - Implantable neurostimulator, pulse generator, any type | Policies naming L8679 |
| L8680 | On the list | Neurostimulator Implantation - Implantable heurostimulator electrode, each | Policies naming L8680 |
| L8682 | On the list | Implantable neurostimulator radiofrequency receiver | Policies naming L8682 |
| L8683 | On the list | Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver | Policies naming L8683 |
| L8685 | On the list | Implantable neurostimulator pulse generator, single array, rechargeable, includes extension | Policies naming L8685 |
| L8686 | On the list | Implantable neurostimulator pulse generator, single array, non- rechargeable, includes extension | Policies naming L8686 |
| L8687 | On the list | Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension | Policies naming L8687 |
| L8688 | On the list | Implantable neurostimulator pulse generator, dual array, non- rechargeable, includes extension | Policies naming L8688 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list