Anthem Blue Cross Blue Shield of California policy
Small Bowel, Small Bowel/Liver and Multivisceral Transplantation
Small Bowel, Small Bowel/Liver and Multivisceral Transplantation is a public Anthem Blue Cross Blue Shield of California policy (policy TRANS.00013). It lists 17 CPT or HCPCS codes, 17 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
- TRANS.00013
- 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 |
|---|---|---|---|
| 44132 | On the list | Donor enterectomy (including cold preservation), open; from cadaver donor | Policies naming 44132 |
| 44133 | On the list | Donor enterectomy (including cold preservation), open; partial, from living donor | Policies naming 44133 |
| 44135 | On the list | Intestinal allotransplantation; from cadaver donor | Policies naming 44135 |
| 44136 | On the list | Intestinal allotransplantation; from living donor | Policies naming 44136 |
| 44715 | On the list | Backbench standard preparation of cadaver or living donor intestine allograft prior to transplantation, including mobilization and fashioning of the superior mesenteric artery and vein | Policies naming 44715 |
| 44720 | On the list | Backbench reconstruction of cadaver or living donor intestine allograft prior to transplantation; venous anastomosis, each | Policies naming 44720 |
| 44721 | On the list | Backbench reconstruction of cadaver or living donor intestine allograft prior to transplantation; arterial anastomosis, each | Policies naming 44721 |
| 47143 | On the list | Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; without trisegment or lobe split | Policies naming 47143 |
| 47144 | On the list | Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; with trisegment split of whole liver graft into 2 partial liver grafts (i.e., left lateral segment [segments II and III] and right trisegment [segments I and IV through VIII]) | Policies naming 47144 |
| 47145 | On the list | Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; with lobe split of whole liver graft into 2 partial liver grafts (i.e., left lobe [segments II, III, and IV] and right lobe [segments I and V through VIII]) | Policies naming 47145 |
| 47146 | On the list | Backbench reconstruction of cadaver or living donor liver graft prior to allotransplantation; venous anastomosis, each | Policies naming 47146 |
| 47147 | On the list | Backbench reconstruction of cadaver or living donor liver graft prior to allotransplantation; arterial anastomosis, each | Policies naming 47147 |
| 48551 | On the list | Backbench standard preparation of cadaver donor pancreas allograft | Policies naming 48551 |
| 48552 | On the list | Backbench reconstruction of cadaver donor pancreas allograft prior to transplantation, venous anastomosis, each | Policies naming 48552 |
| S2053 | On the list | Transplantation of small intestine and liver allografts | Policies naming S2053 |
| S2054 | On the list | Transplantation of multivisceral organs | Policies naming S2054 |
| S2055 | On the list | Harvesting of donor multivisceral organs, with preparation and maintenance of allografts; from cadaver donor | Policies naming S2055 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list