Anthem Blue Cross Blue Shield of California policy
Uterine Fibroid Ablation: Laparoscopic, Percutaneous or Transcervical Image Guided Techniques
Uterine Fibroid Ablation: Laparoscopic, Percutaneous or Transcervical Image Guided Techniques is a public Anthem Blue Cross Blue Shield of California policy (policy SURG.00077). 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.00077
- 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 |
|---|---|---|---|
| 58578 | On the list | Unlisted laparoscopy procedure, uterus [when specified as HALT procedure] | Policies naming 58578 |
| 58580 | On the list | Transcervical ablation of uterine fibroid(s), including intraoperative ultrasound guidance and monitoring, radiofrequency | Policies naming 58580 |
| 58674 | On the list | Laparoscopy, surgical, ablation of uterine fibroid(s) including intraoperative ultrasound guidance and monitoring, radiofrequency | Policies naming 58674 |
| 58999 | On the list | Unlisted procedure, female genital system (nonobstetrical) [when specified as any vaginal rejuvenation or tightening procedure for atrophy, including laser procedures such as MonaLisa Touch] or [when specified as cancer screening or identification using an optical detection system] or [when specified as image-guided percutaneous ablation by laser, bipolar electrodes, interstitial thermotherapy, cryotherapy, radiofrequency] | Policies naming 58999 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list