Anthem Blue Cross Blue Shield of Colorado policy
Allowed Virtual Services in Addition to CPT Appendix P
Allowed Virtual Services in Addition to CPT Appendix P is a public Anthem Blue Cross Blue Shield of Colorado policy (policy MULTI-BCBS-CM-050974-24, effective Feb 17, 2024). It lists 96 CPT or HCPCS codes, 16 of them on the Anthem Blue Cross Blue Shield of Colorado prior authorization list. Not a coverage decision; the payer's own document governs.
View the original policy (PDF) ↗
- Policy number
- MULTI-BCBS-CM-050974-24
- Effective
- Feb 17, 2024
- Line of business
- Commercial
- States
- CO, CT, GA, IN, KY, MO, NV, OH, WI
- 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 Colorado prior authorization list.
| Code | Prior authorization | Description on the prior authorization list | Other Anthem Blue Cross Blue Shield of Colorado policies |
|---|---|---|---|
| 0362T | Not listed | Policies naming 0362T | |
| 0373T | Not listed | Policies naming 0373T | |
| 90853 | Not listed | Policies naming 90853 | |
| 90887 | Not listed | Policies naming 90887 | |
| 96127 | Not listed | Policies naming 96127 | |
| 96130 | Not listed | Policies naming 96130 | |
| 96131 | Not listed | Policies naming 96131 | |
| 96132 | Not listed | Policies naming 96132 | |
| 96133 | Not listed | Policies naming 96133 | |
| 96136 | Not listed | Policies naming 96136 | |
| 96137 | Not listed | Policies naming 96137 | |
| 96138 | Not listed | Policies naming 96138 | |
| 96139 | Not listed | Policies naming 96139 | |
| 96146 | Not listed | Policies naming 96146 | |
| 97151 | Not listed | Policies naming 97151 | |
| 97152 | Not listed | Policies naming 97152 | |
| 97153 | Not listed | Policies naming 97153 | |
| 97154 | Not listed | Policies naming 97154 | |
| 97155 | Not listed | Policies naming 97155 | |
| 97156 | Not listed | Policies naming 97156 | |
| 97157 | Not listed | Policies naming 97157 | |
| 97158 | Not listed | Policies naming 97158 | |
| 97163 | On the list | Physical therapy evaluation; high complexity requiring components | Policies naming 97163 |
| 97164 | On the list | Reevaluation of physical therapy established plan of care requiring components | Policies naming 97164 |
| 97167 | On the list | Occupational therapy evaluation; high complexity requiring components | Policies naming 97167 |
| 97168 | On the list | Reevaluation of occupational therapy care/established plan of care requiring components | Policies naming 97168 |
| 97542 | On the list | Wheelchair management (eg, assessment, fitting, training), each 15 minutes | Policies naming 97542 |
| 98966 | Not listed | Policies naming 98966 | |
| 98967 | Not listed | Policies naming 98967 | |
| 98968 | Not listed | Policies naming 98968 | |
| 98970 | Not listed | Policies naming 98970 | |
| 98971 | Not listed | Policies naming 98971 | |
| 98972 | Not listed | Policies naming 98972 | |
| 99205 | Not listed | Policies naming 99205 | |
| 99215 | Not listed | Policies naming 99215 | |
| 99358 | Not listed | Policies naming 99358 | |
| 99359 | Not listed | Policies naming 99359 | |
| 99381 | Not listed | Policies naming 99381 | |
| 99382 | Not listed | Policies naming 99382 | |
| 99383 | Not listed | Policies naming 99383 | |
| 99384 | Not listed | Policies naming 99384 | |
| 99385 | Not listed | Policies naming 99385 | |
| 99386 | Not listed | Policies naming 99386 | |
| 99387 | Not listed | Policies naming 99387 | |
| 99391 | Not listed | Policies naming 99391 | |
| 99392 | Not listed | Policies naming 99392 | |
| 99393 | Not listed | Policies naming 99393 | |
| 99394 | Not listed | Policies naming 99394 | |
| 99395 | Not listed | Policies naming 99395 | |
| 99396 | Not listed | Policies naming 99396 | |
| 99397 | Not listed | Policies naming 99397 | |
| 99401 | Not listed | Policies naming 99401 | |
| 99402 | Not listed | Policies naming 99402 | |
| 99403 | Not listed | Policies naming 99403 | |
| 99404 | Not listed | Policies naming 99404 | |
| 99415 | Not listed | Policies naming 99415 | |
| 99416 | Not listed | Policies naming 99416 | |
| 99421 | Not listed | Policies naming 99421 | |
| 99422 | Not listed | Policies naming 99422 | |
| 99423 | Not listed | Policies naming 99423 | |
| 99441 | Not listed | Policies naming 99441 | |
| 99442 | Not listed | Policies naming 99442 | |
| 99443 | Not listed | Policies naming 99443 | |
| 99446 | Not listed | Policies naming 99446 | |
| 99447 | Not listed | Policies naming 99447 | |
| 99448 | Not listed | Policies naming 99448 | |
| 99449 | Not listed | Policies naming 99449 | |
| 99451 | Not listed | Policies naming 99451 | |
| 99452 | Not listed | Policies naming 99452 | |
| 99453 | Not listed | Policies naming 99453 | |
| 99454 | Not listed | Policies naming 99454 | |
| 99457 | Not listed | Policies naming 99457 | |
| 99458 | Not listed | Policies naming 99458 | |
| 99483 | Not listed | Policies naming 99483 | |
| G0270 | Not listed | Policies naming G0270 | |
| G0271 | Not listed | Policies naming G0271 | |
| G2010 | Not listed | Policies naming G2010 | |
| G2012 | Not listed | Policies naming G2012 | |
| G2212 | Not listed | Policies naming G2212 | |
| H0001 | Not listed | Policies naming H0001 | |
| H0004 | On the list | Behavioral health counseling and therapy, per 15 minutes | Policies naming H0004 |
| H0005 | Not listed | Policies naming H0005 | |
| H0006 | On the list | Alcohol and/or drug services; case management | Policies naming H0006 |
| H0015 | On the list | Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment p | Policies naming H0015 |
| H0021 | Not listed | Policies naming H0021 | |
| H0023 | On the list | Behavioral health outreach service (planned approach to reach a targeted population) | Policies naming H0023 |
| H0031 | Not listed | Policies naming H0031 | |
| H0035 | On the list | Mental health partial hospitalization, treatment, less than 24 hours | Policies naming H0035 |
| H0036 | Not listed | Policies naming H0036 | |
| H0038 | On the list | Self-help/peer services, per 15 minutes | Policies naming H0038 |
| H0039 | On the list | Assertive community treatment, face-to-face, per 15 minutes | Policies naming H0039 |
| H0040 | On the list | Assertive community treatment program, per diem | Policies naming H0040 |
| H2021 | On the list | Community-based wrap-around services, per 15 minutes | Policies naming H2021 |
| H2035 | Not listed | Policies naming H2035 | |
| S0201 | On the list | Partial Hospitalization Services, Less Than 24 Hours, Per Diem | Policies naming S0201 |
| S9480 | On the list | Intensive Outpatient Psychia | Policies naming S9480 |
All Anthem Blue Cross Blue Shield of Colorado policies · Anthem Blue Cross Blue Shield of Colorado prior authorization CPT list