Anthem Blue Cross Blue Shield of California policy
SURG.00126 Irreversible Electroporation
SURG.00126 Irreversible Electroporation is a public Anthem Blue Cross Blue Shield of California policy (policy SURG.00126). It lists 4 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
- SURG.00126
- 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 |
|---|---|---|---|
| 0600T | On the list | Ablation, irreversible electroporation; 1 or more tumors per organ, other than liver or prostate, including imaging guidance, when performed, percutaneous | Policies naming 0600T |
| 0601T | On the list | Ablation, irreversible electroporation; 1 or more tumors, including fluoroscopic and ultrasound guidance, when performed, open | Policies naming 0601T |
| 47384 | On the list | Ablation, irreversible electroporation, liver, 1 or more tumors, including imaging guidance, percutaneous | Policies naming 47384 |
| 55877 | On the list | Ablation, irreversible electroporation, prostate, 1 or more tumors, including imaging guidance, percutaneous | Policies naming 55877 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list