Anthem Blue Cross Blue Shield of California policy
SURG.00153 Cardiac Contractility Modulation Therapy
SURG.00153 Cardiac Contractility Modulation Therapy is a public Anthem Blue Cross Blue Shield of California policy (policy SURG.00153). It lists 32 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
- SURG.00153
- 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 |
|---|---|---|---|
| 0408T | On the list | Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; pulse generator with transvenous electrodes | Policies naming 0408T |
| 0409T | On the list | Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; pulse generator only | Policies naming 0409T |
| 0410T | On the list | Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; atrial electrode only | Policies naming 0410T |
| 0411T | On the list | Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; ventricular electrode only | Policies naming 0411T |
| 0412T | On the list | Removal of permanent cardiac contractility modulation system; pulse generator only | Policies naming 0412T |
| 0413T | On the list | Removal of permanent cardiac contractility modulation system; transvenous electrode (atrial or ventricular) | Policies naming 0413T |
| 0414T | On the list | Removal and replacement of permanent cardiac contractility modulation system pulse generator only | Policies naming 0414T |
| 0415T | On the list | Repositioning of previously implanted cardiac contractility modulation transvenous electrode, (atrial or ventricular lead) | Policies naming 0415T |
| 0416T | On the list | Relocation of skin pocket for implanted cardiac contractility modulation pulse generator | Policies naming 0416T |
| 0417T | On the list | Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, including review and report, implantable cardiac contractility modulation system | Policies naming 0417T |
| 0418T | On the list | Interrogation device evaluation (in person) with analysis, review and report, includes connection, recording and disconnection per patient encounter; implantable cardiac contractility modulation system | Policies naming 0418T |
| 0915T | On the list | Insertion of permanent cardiac contractility modulation- defibrillation system component(s), including fluoroscopic guidance, and evaluation and programming of sensing and therapeutic parameters; pulse generator and dual transvenous electrodes/leads (pacing and defibrillation) | Policies naming 0915T |
| 0916T | Not listed | Policies naming 0916T | |
| 0917T | Not listed | Policies naming 0917T | |
| 0918T | Not listed | Policies naming 0918T | |
| 0919T | Not listed | Policies naming 0919T | |
| 0920T | Not listed | Policies naming 0920T | |
| 0921T | Not listed | Policies naming 0921T | |
| 0922T | Not listed | Policies naming 0922T | |
| 0923T | On the list | Removal and replacement of permanent cardiac contractility modulation-defibrillation pulse generator only | Policies naming 0923T |
| 0924T | Not listed | Policies naming 0924T | |
| 0925T | Not listed | Policies naming 0925T | |
| 0926T | Not listed | Policies naming 0926T | |
| 0927T | Not listed | Policies naming 0927T | |
| 0928T | Not listed | Policies naming 0928T | |
| 0929T | Not listed | Policies naming 0929T | |
| 0930T | Not listed | Policies naming 0930T | |
| 0931T | Not listed | Policies naming 0931T | |
| 0948T | On the list | Interrogation device evaluation (remote), up to 90 days, cardiac contractility modulation system with interim analysis, review and report(s) by a physician or other qualified health care professional | Policies naming 0948T |
| 0949T | On the list | Interrogation device evaluation (remote), up to 90 days, cardiac contractility modulation system, remote data acquisition(s), receipt of transmissions, technician review, technical support, and distribution of results | Policies naming 0949T |
| C1824 | On the list | Generator, cardiac contractility modulation (implantable) | Policies naming C1824 |
| K1030 | On the list | External recharging system for battery (internal) for use with implanted cardiac contractility modulation generator, replacement only | Policies naming K1030 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list