Anthem Blue Cross Blue Shield of California policy
SURG.00113 Artificial Retinal Devices
SURG.00113 Artificial Retinal Devices is a public Anthem Blue Cross Blue Shield of California policy (policy SURG.00113). It lists 4 CPT or HCPCS codes, 3 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
- SURG.00113
- 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 |
|---|---|---|---|
| 0100T | On the list | Placement of a subconjunctival retinal prosthesis receiver and pulse generator, and implantation of intra-ocular retinal electrode array, with vitrectomy | Policies naming 0100T |
| 0472T | On the list | Device evaluation, interrogation, and initial programming of intra-ocular retinal electrode array (e.g., retinal prosthesis), in person, with iterative adjustment of the implantable device to test functionality, select optimal permanent programmed values with analysis, including visual training, with review and report by a qualified health care professional | Policies naming 0472T |
| 0473T | On the list | Device evaluation and interrogation of intra-ocular retinal electrode array (e.g., retinal prosthesis), in person, including reprogramming and visual training, when performed, with review and report by a qualified health care professional | Policies naming 0473T |
| L8608 | Not listed | Policies naming L8608 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list