Anthem Blue Cross Blue Shield of Colorado policy
Global Surgical Package - Professional
Global Surgical Package - Professional is a public Anthem Blue Cross Blue Shield of Colorado policy (policy C-08007, effective Jun 14, 2023). It lists 159 CPT or HCPCS codes, 25 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
- C-08007
- Effective
- Jun 14, 2023
- Line of business
- Commercial
- States
- CO, CT, GA, IN, KY, ME, MO, NH, 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 |
|---|---|---|---|
| 0335T | On the list | Insertion of sinus tarsi implant | Policies naming 0335T |
| 0343T | Not listed | Policies naming 0343T | |
| 0344T | Not listed | Policies naming 0344T | |
| 0345T | On the list | Transcatheter mitral valve repair percutaneous approach via the coronary sinus | Policies naming 0345T |
| 0440T | On the list | Ablation, percutaneous, cryoablation, includes imaging guidance; upper extremity distal/peripheral nerve | Policies naming 0440T |
| 0441T | On the list | Ablation, percutaneous, cryoablation, includes imaging guidance; lower extremity distal/peripheral nerve | Policies naming 0441T |
| 0442T | On the list | Ablation, percutaneous, cryoablation, includes imaging guidance; nerve plexus or other truncal nerve (eg, brachial plexus, pudendal nerve) | Policies naming 0442T |
| 0444T | Not listed | Policies naming 0444T | |
| 0445T | Not listed | Policies naming 0445T | |
| 0446T | Not listed | Policies naming 0446T | |
| 0447T | Not listed | Policies naming 0447T | |
| 0448T | Not listed | Policies naming 0448T | |
| 0466T | Not listed | Policies naming 0466T | |
| 0467T | Not listed | Policies naming 0467T | |
| 0468T | Not listed | Policies naming 0468T | |
| 0510T | On the list | Removal of sinus tarsi implant | Policies naming 0510T |
| 0511T | On the list | Removal and reinsertion of sinus tarsi implant | Policies naming 0511T |
| 0567T | Not listed | Policies naming 0567T | |
| 0568T | Not listed | Policies naming 0568T | |
| 0571T | Not listed | Policies naming 0571T | |
| 0572T | Not listed | Policies naming 0572T | |
| 0573T | Not listed | Policies naming 0573T | |
| 0574T | Not listed | Policies naming 0574T | |
| 0580T | On the list | Removal of substernal implantable defibrillator pulse generator only | Policies naming 0580T |
| 0583T | Not listed | Policies naming 0583T | |
| 0585T | On the list | Islet cell transplant, includes portal vein catheterization and infusion, including all imaging, including guidance, and radiological supervision and interpretation, when perf | Policies naming 0585T |
| 0588T | On the list | Revision or removal of percutaneously placed integrated single device neurostimulation system for bladder dysfunction including electrode array and receiver or pulse generator | Policies naming 0588T |
| 0594T | Not listed | Policies naming 0594T | |
| 0596T | On the list | Temporary female intraurethral valve-pump (ie, voiding prosthesis); initial insertion, including urethral measurement | Policies naming 0596T |
| 0597T | On the list | Temporary female intraurethral valve-pump (ie, voiding prosthesis); replacement | Policies naming 0597T |
| 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 per organ, including fluoroscopic and ultrasound guidance, when performed, open | Policies naming 0601T |
| 0614T | Not listed | Policies naming 0614T | |
| 0619T | Not listed | Policies naming 0619T | |
| 0621T | Not listed | Policies naming 0621T | |
| 0622T | Not listed | Policies naming 0622T | |
| 0627T | On the list | Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with fluoroscopic guidance, lumbar; first le | Policies naming 0627T |
| 0629T | On the list | Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with CT guidance, lumbar; first level | Policies naming 0629T |
| 0644T | Not listed | Policies naming 0644T | |
| 0647T | Not listed | Policies naming 0647T | |
| 0655T | On the list | Transperineal focal laser ablation of malignant prostate tissue, inclu | Policies naming 0655T |
| 0660T | Not listed | Policies naming 0660T | |
| 0661T | Not listed | Policies naming 0661T | |
| 0672T | On the list | Endovaginal cryogen-cooled, monopolar radiofrequency remodeling of the tissues surrounding the female bladder neck and proximal urethra for urinary incontinence | Policies naming 0672T |
| 0673T | On the list | Ablation, benign thyroid nodule(s), percutaneous, laser, including imaging guidance | Policies naming 0673T |
| 0677T | Not listed | Policies naming 0677T | |
| 0679T | Not listed | Policies naming 0679T | |
| 0680T | Not listed | Policies naming 0680T | |
| 0681T | Not listed | Policies naming 0681T | |
| 0682T | Not listed | Policies naming 0682T | |
| 0699T | Not listed | Policies naming 0699T | |
| 0714T | Not listed | Policies naming 0714T | |
| 0730T | Not listed | Policies naming 0730T | |
| 0737T | Not listed | Policies naming 0737T | |
| 08007 | Not listed | Policies naming 08007 | |
| 10060 | On the list | Incision & Drainage, Abscess; Simple/Single | Policies naming 10060 |
| 10061 | On the list | Incision & Drainage, Abscess; Complicated/Multiple | Policies naming 10061 |
| 10140 | On the list | Incision & Drainage, Hematoma, Seroma/Fluid Collection | Policies naming 10140 |
| 10160 | On the list | Puncture Aspiration, Abscess, Hematoma, Bulla/Cyst | Policies naming 10160 |
| 10180 | On the list | Incision & Drainage, Complex, Postoperative Wound Infection | Policies naming 10180 |
| 15999 | Not listed | Policies naming 15999 | |
| 17999 | Not listed | Policies naming 17999 | |
| 19499 | Not listed | Policies naming 19499 | |
| 20999 | Not listed | Policies naming 20999 | |
| 21089 | Not listed | Policies naming 21089 | |
| 21299 | Not listed | Policies naming 21299 | |
| 21499 | Not listed | Policies naming 21499 | |
| 21899 | Not listed | Policies naming 21899 | |
| 22899 | Not listed | Policies naming 22899 | |
| 22999 | Not listed | Policies naming 22999 | |
| 23004 | Not listed | Policies naming 23004 | |
| 23929 | Not listed | Policies naming 23929 | |
| 24999 | Not listed | Policies naming 24999 | |
| 25999 | Not listed | Policies naming 25999 | |
| 26989 | Not listed | Policies naming 26989 | |
| 27299 | Not listed | Policies naming 27299 | |
| 27599 | Not listed | Policies naming 27599 | |
| 27899 | Not listed | Policies naming 27899 | |
| 28899 | Not listed | Policies naming 28899 | |
| 29999 | Not listed | Policies naming 29999 | |
| 30999 | Not listed | Policies naming 30999 | |
| 31299 | Not listed | Policies naming 31299 | |
| 32999 | Not listed | Policies naming 32999 | |
| 33999 | Not listed | Policies naming 33999 | |
| 34841 | Not listed | Policies naming 34841 | |
| 34842 | Not listed | Policies naming 34842 | |
| 34843 | Not listed | Policies naming 34843 | |
| 34844 | Not listed | Policies naming 34844 | |
| 34845 | Not listed | Policies naming 34845 | |
| 34846 | Not listed | Policies naming 34846 | |
| 34847 | Not listed | Policies naming 34847 | |
| 34848 | Not listed | Policies naming 34848 | |
| 36299 | Not listed | Policies naming 36299 | |
| 37501 | Not listed | Policies naming 37501 | |
| 37799 | Not listed | Policies naming 37799 | |
| 38129 | Not listed | Policies naming 38129 | |
| 38589 | Not listed | Policies naming 38589 | |
| 38999 | Not listed | Policies naming 38999 | |
| 39499 | Not listed | Policies naming 39499 | |
| 39599 | Not listed | Policies naming 39599 | |
| 40799 | Not listed | Policies naming 40799 | |
| 40899 | Not listed | Policies naming 40899 | |
| 41599 | Not listed | Policies naming 41599 | |
| 41899 | Not listed | Policies naming 41899 | |
| 42299 | Not listed | Policies naming 42299 | |
| 42699 | Not listed | Policies naming 42699 | |
| 42999 | Not listed | Policies naming 42999 | |
| 43659 | Not listed | Policies naming 43659 | |
| 43999 | On the list | Unlisted Proc, Stomach | Policies naming 43999 |
| 44238 | Not listed | Policies naming 44238 | |
| 44799 | Not listed | Policies naming 44799 | |
| 44899 | Not listed | Policies naming 44899 | |
| 44979 | Not listed | Policies naming 44979 | |
| 45499 | Not listed | Policies naming 45499 | |
| 46999 | Not listed | Policies naming 46999 | |
| 47379 | Not listed | Policies naming 47379 | |
| 47399 | Not listed | Policies naming 47399 | |
| 47579 | Not listed | Policies naming 47579 | |
| 47999 | Not listed | Policies naming 47999 | |
| 48999 | Not listed | Policies naming 48999 | |
| 49329 | Not listed | Policies naming 49329 | |
| 49659 | Not listed | Policies naming 49659 | |
| 49999 | Not listed | Policies naming 49999 | |
| 50549 | Not listed | Policies naming 50549 | |
| 50949 | Not listed | Policies naming 50949 | |
| 51700 | Not listed | Policies naming 51700 | |
| 51999 | Not listed | Policies naming 51999 | |
| 53899 | Not listed | Policies naming 53899 | |
| 55559 | Not listed | Policies naming 55559 | |
| 55899 | Not listed | Policies naming 55899 | |
| 58578 | Not listed | Policies naming 58578 | |
| 58679 | Not listed | Policies naming 58679 | |
| 58999 | Not listed | Policies naming 58999 | |
| 59400 | Not listed | Policies naming 59400 | |
| 59410 | Not listed | Policies naming 59410 | |
| 59510 | Not listed | Policies naming 59510 | |
| 59515 | Not listed | Policies naming 59515 | |
| 59610 | Not listed | Policies naming 59610 | |
| 59614 | Not listed | Policies naming 59614 | |
| 59618 | Not listed | Policies naming 59618 | |
| 59622 | Not listed | Policies naming 59622 | |
| 59898 | Not listed | Policies naming 59898 | |
| 59899 | Not listed | Policies naming 59899 | |
| 60659 | Not listed | Policies naming 60659 | |
| 60699 | Not listed | Policies naming 60699 | |
| 64999 | Not listed | Policies naming 64999 | |
| 66999 | Not listed | Policies naming 66999 | |
| 67299 | Not listed | Policies naming 67299 | |
| 67599 | Not listed | Policies naming 67599 | |
| 67999 | Not listed | Policies naming 67999 | |
| 68399 | Not listed | Policies naming 68399 | |
| 68899 | Not listed | Policies naming 68899 | |
| 69399 | Not listed | Policies naming 69399 | |
| 69799 | Not listed | Policies naming 69799 | |
| 69949 | Not listed | Policies naming 69949 | |
| 69979 | Not listed | Policies naming 69979 | |
| G0308 | Not listed | Policies naming G0308 | |
| G0309 | Not listed | Policies naming G0309 | |
| S2083 | Not listed | Policies naming S2083 |
All Anthem Blue Cross Blue Shield of Colorado policies · Anthem Blue Cross Blue Shield of Colorado prior authorization CPT list