Anthem Blue Cross Blue Shield of Colorado policy

CG-MED-21 Anesthesia Services and Moderate (“Conscious”) Sedation

CG-MED-21 Anesthesia Services and Moderate (“Conscious”) Sedation is a public Anthem Blue Cross Blue Shield of Colorado policy (policy CG-MED-21). It lists 276 CPT or HCPCS codes, 10 of them on the Anthem Blue Cross Blue Shield of Colorado prior authorization list. Not a coverage decision; the payer's own document governs.

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Payer
Anthem Blue Cross Blue Shield of Colorado
Policy number
CG-MED-21
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 Colorado prior authorization list.

CodePrior authorizationDescription on the prior authorization listOther Anthem Blue Cross Blue Shield of Colorado policies
00100Not listedPolicies naming 00100
00102Not listedPolicies naming 00102
00103Not listedPolicies naming 00103
00104Not listedPolicies naming 00104
00120Not listedPolicies naming 00120
00124Not listedPolicies naming 00124
00126Not listedPolicies naming 00126
00140Not listedPolicies naming 00140
00142Not listedPolicies naming 00142
00144Not listedPolicies naming 00144
00145Not listedPolicies naming 00145
00147Not listedPolicies naming 00147
00148Not listedPolicies naming 00148
00160Not listedPolicies naming 00160
00162Not listedPolicies naming 00162
00164Not listedPolicies naming 00164
00170On the listAnesthesia, Intraoral Proc, W/Bx; NosPolicies naming 00170
00172Not listedPolicies naming 00172
00174Not listedPolicies naming 00174
00176Not listedPolicies naming 00176
00190Not listedPolicies naming 00190
00192Not listedPolicies naming 00192
00210Not listedPolicies naming 00210
00211Not listedPolicies naming 00211
00212Not listedPolicies naming 00212
00214Not listedPolicies naming 00214
00215Not listedPolicies naming 00215
00216Not listedPolicies naming 00216
00218Not listedPolicies naming 00218
00220Not listedPolicies naming 00220
00222Not listedPolicies naming 00222
00300Not listedPolicies naming 00300
00320Not listedPolicies naming 00320
00322Not listedPolicies naming 00322
00326Not listedPolicies naming 00326
00350Not listedPolicies naming 00350
00352Not listedPolicies naming 00352
00400Not listedPolicies naming 00400
00402Not listedPolicies naming 00402
00404Not listedPolicies naming 00404
00406Not listedPolicies naming 00406
00410Not listedPolicies naming 00410
00450Not listedPolicies naming 00450
00454Not listedPolicies naming 00454
00470Not listedPolicies naming 00470
00472Not listedPolicies naming 00472
00474Not listedPolicies naming 00474
00500Not listedPolicies naming 00500
00520Not listedPolicies naming 00520
00522Not listedPolicies naming 00522
00524Not listedPolicies naming 00524
00528Not listedPolicies naming 00528
00529Not listedPolicies naming 00529
00530Not listedPolicies naming 00530
00532Not listedPolicies naming 00532
00534Not listedPolicies naming 00534
00537Not listedPolicies naming 00537
00539Not listedPolicies naming 00539
00540Not listedPolicies naming 00540
00541Not listedPolicies naming 00541
00542Not listedPolicies naming 00542
00546Not listedPolicies naming 00546
00548Not listedPolicies naming 00548
00550Not listedPolicies naming 00550
00560Not listedPolicies naming 00560
00561Not listedPolicies naming 00561
00562Not listedPolicies naming 00562
00563Not listedPolicies naming 00563
00566Not listedPolicies naming 00566
00567Not listedPolicies naming 00567
00580On the listAnesthesia, Heart Transplant/Heart & Lung TransplantPolicies naming 00580
00600Not listedPolicies naming 00600
00604Not listedPolicies naming 00604
00620Not listedPolicies naming 00620
00625Not listedPolicies naming 00625
00626Not listedPolicies naming 00626
00630Not listedPolicies naming 00630
00632Not listedPolicies naming 00632
00635Not listedPolicies naming 00635
00640Not listedPolicies naming 00640
00670Not listedPolicies naming 00670
00700Not listedPolicies naming 00700
00702Not listedPolicies naming 00702
00730Not listedPolicies naming 00730
00750Not listedPolicies naming 00750
00752Not listedPolicies naming 00752
00754Not listedPolicies naming 00754
00756Not listedPolicies naming 00756
00770Not listedPolicies naming 00770
00790Not listedPolicies naming 00790
00792Not listedPolicies naming 00792
00794Not listedPolicies naming 00794
00796On the listAnesthesia, Intraperitoneal Proc, Upper Abdomen, W/Laparoscopy; Liver Transplant, RecipientPolicies naming 00796
00797Not listedPolicies naming 00797
00800Not listedPolicies naming 00800
00802Not listedPolicies naming 00802
00820Not listedPolicies naming 00820
00830Not listedPolicies naming 00830
00832Not listedPolicies naming 00832
00834Not listedPolicies naming 00834
00836Not listedPolicies naming 00836
00840Not listedPolicies naming 00840
00842Not listedPolicies naming 00842
00844Not listedPolicies naming 00844
00846Not listedPolicies naming 00846
00848Not listedPolicies naming 00848
00851Not listedPolicies naming 00851
00860Not listedPolicies naming 00860
00862Not listedPolicies naming 00862
00864Not listedPolicies naming 00864
00865Not listedPolicies naming 00865
00866Not listedPolicies naming 00866
00868On the listAnesthesia, Extraperitoneal Proc, Lower Abdomen, W/Urinary Tract; Renal Transplant, RecipientPolicies naming 00868
00870Not listedPolicies naming 00870
00872Not listedPolicies naming 00872
00873Not listedPolicies naming 00873
00880Not listedPolicies naming 00880
00882Not listedPolicies naming 00882
00902Not listedPolicies naming 00902
00904Not listedPolicies naming 00904
00906Not listedPolicies naming 00906
00908Not listedPolicies naming 00908
00910Not listedPolicies naming 00910
00912Not listedPolicies naming 00912
00914Not listedPolicies naming 00914
00916Not listedPolicies naming 00916
00918Not listedPolicies naming 00918
00920Not listedPolicies naming 00920
00921Not listedPolicies naming 00921
00922Not listedPolicies naming 00922
00924Not listedPolicies naming 00924
00926Not listedPolicies naming 00926
00928Not listedPolicies naming 00928
00930Not listedPolicies naming 00930
00932Not listedPolicies naming 00932
00934Not listedPolicies naming 00934
00936Not listedPolicies naming 00936
00938Not listedPolicies naming 00938
00940Not listedPolicies naming 00940
00942Not listedPolicies naming 00942
00944Not listedPolicies naming 00944
00948Not listedPolicies naming 00948
00950Not listedPolicies naming 00950
00952Not listedPolicies naming 00952
01112Not listedPolicies naming 01112
01120Not listedPolicies naming 01120
01130Not listedPolicies naming 01130
01140Not listedPolicies naming 01140
01150Not listedPolicies naming 01150
01160Not listedPolicies naming 01160
01170Not listedPolicies naming 01170
01173Not listedPolicies naming 01173
01200Not listedPolicies naming 01200
01202Not listedPolicies naming 01202
01210Not listedPolicies naming 01210
01212Not listedPolicies naming 01212
01214Not listedPolicies naming 01214
01215Not listedPolicies naming 01215
01220Not listedPolicies naming 01220
01230Not listedPolicies naming 01230
01232Not listedPolicies naming 01232
01234Not listedPolicies naming 01234
01250Not listedPolicies naming 01250
01260Not listedPolicies naming 01260
01270Not listedPolicies naming 01270
01272Not listedPolicies naming 01272
01274Not listedPolicies naming 01274
01320Not listedPolicies naming 01320
01340Not listedPolicies naming 01340
01360Not listedPolicies naming 01360
01380Not listedPolicies naming 01380
01382Not listedPolicies naming 01382
01390Not listedPolicies naming 01390
01392Not listedPolicies naming 01392
01400Not listedPolicies naming 01400
01402Not listedPolicies naming 01402
01404Not listedPolicies naming 01404
01420Not listedPolicies naming 01420
01430Not listedPolicies naming 01430
01432Not listedPolicies naming 01432
01440Not listedPolicies naming 01440
01442Not listedPolicies naming 01442
01444Not listedPolicies naming 01444
01462Not listedPolicies naming 01462
01464Not listedPolicies naming 01464
01470Not listedPolicies naming 01470
01472Not listedPolicies naming 01472
01474Not listedPolicies naming 01474
01480Not listedPolicies naming 01480
01482Not listedPolicies naming 01482
01484Not listedPolicies naming 01484
01486Not listedPolicies naming 01486
01490Not listedPolicies naming 01490
01500Not listedPolicies naming 01500
01502Not listedPolicies naming 01502
01520Not listedPolicies naming 01520
01522Not listedPolicies naming 01522
01610Not listedPolicies naming 01610
01620Not listedPolicies naming 01620
01622Not listedPolicies naming 01622
01630Not listedPolicies naming 01630
01634Not listedPolicies naming 01634
01636Not listedPolicies naming 01636
01638Not listedPolicies naming 01638
01650Not listedPolicies naming 01650
01652Not listedPolicies naming 01652
01654Not listedPolicies naming 01654
01656Not listedPolicies naming 01656
01670Not listedPolicies naming 01670
01680Not listedPolicies naming 01680
01710Not listedPolicies naming 01710
01712Not listedPolicies naming 01712
01714Not listedPolicies naming 01714
01716Not listedPolicies naming 01716
01730Not listedPolicies naming 01730
01732Not listedPolicies naming 01732
01740Not listedPolicies naming 01740
01742Not listedPolicies naming 01742
01744Not listedPolicies naming 01744
01756Not listedPolicies naming 01756
01758Not listedPolicies naming 01758
01760Not listedPolicies naming 01760
01770Not listedPolicies naming 01770
01772Not listedPolicies naming 01772
01780Not listedPolicies naming 01780
01782Not listedPolicies naming 01782
01810Not listedPolicies naming 01810
01820Not listedPolicies naming 01820
01829Not listedPolicies naming 01829
01830Not listedPolicies naming 01830
01832Not listedPolicies naming 01832
01840Not listedPolicies naming 01840
01842Not listedPolicies naming 01842
01844Not listedPolicies naming 01844
01850Not listedPolicies naming 01850
01852Not listedPolicies naming 01852
01860Not listedPolicies naming 01860
01916Not listedPolicies naming 01916
01920Not listedPolicies naming 01920
01922Not listedPolicies naming 01922
01924Not listedPolicies naming 01924
01925Not listedPolicies naming 01925
01926Not listedPolicies naming 01926
01930Not listedPolicies naming 01930
01931Not listedPolicies naming 01931
01932Not listedPolicies naming 01932
01933Not listedPolicies naming 01933
01937On the listAnesthesia for percutaneous image-guided injection, drainage or aspiration procedures on the spine or spinal cord; cervical or thoracicPolicies naming 01937
01938On the listAnesthesia for percutaneous image-guided injection, drainage or aspiration procedures on the spine or spinal cord; lumbar or sacralPolicies naming 01938
01951Not listedPolicies naming 01951
01952Not listedPolicies naming 01952
01953Not listedPolicies naming 01953
01958Not listedPolicies naming 01958
01960Not listedPolicies naming 01960
01961Not listedPolicies naming 01961
01962Not listedPolicies naming 01962
01963Not listedPolicies naming 01963
01965Not listedPolicies naming 01965
01966Not listedPolicies naming 01966
01967Not listedPolicies naming 01967
01968Not listedPolicies naming 01968
01969Not listedPolicies naming 01969
01990Not listedPolicies naming 01990
01996Not listedPolicies naming 01996
01999Not listedPolicies naming 01999
99100Not listedPolicies naming 99100
99116Not listedPolicies naming 99116
99135Not listedPolicies naming 99135
99140Not listedPolicies naming 99140
99151On the listModerate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supporPolicies naming 99151
99152On the listModerate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supporPolicies naming 99152
99153Not listedPolicies naming 99153
99155On the listModerate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performingPolicies naming 99155
99156On the listModerate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performingPolicies naming 99156
99157Not listedPolicies naming 99157
G0500Not listedPolicies naming G0500

All Anthem Blue Cross Blue Shield of Colorado policies · Anthem Blue Cross Blue Shield of Colorado prior authorization CPT list

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.