Anthem Blue Cross Blue Shield of Georgia 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 Georgia policy (policy CG-MED-21). It lists 276 CPT or HCPCS codes, 8 of them on the Anthem Blue Cross Blue Shield of Georgia prior authorization list. Not a coverage decision; the payer's own document governs.
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- 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 Georgia prior authorization list.
| Code | Prior authorization | Description on the prior authorization list | Other Anthem Blue Cross Blue Shield of Georgia policies |
|---|---|---|---|
| 00100 | Not listed | Policies naming 00100 | |
| 00102 | Not listed | Policies naming 00102 | |
| 00103 | Not listed | Policies naming 00103 | |
| 00104 | Not listed | Policies naming 00104 | |
| 00120 | Not listed | Policies naming 00120 | |
| 00124 | Not listed | Policies naming 00124 | |
| 00126 | Not listed | Policies naming 00126 | |
| 00140 | Not listed | Policies naming 00140 | |
| 00142 | Not listed | Policies naming 00142 | |
| 00144 | Not listed | Policies naming 00144 | |
| 00145 | Not listed | Policies naming 00145 | |
| 00147 | Not listed | Policies naming 00147 | |
| 00148 | Not listed | Policies naming 00148 | |
| 00160 | Not listed | Policies naming 00160 | |
| 00162 | Not listed | Policies naming 00162 | |
| 00164 | Not listed | Policies naming 00164 | |
| 00170 | On the list | Anesthesia for intraoral procedures, including biopsy; not otherwise specified | Policies naming 00170 |
| 00172 | Not listed | Policies naming 00172 | |
| 00174 | Not listed | Policies naming 00174 | |
| 00176 | Not listed | Policies naming 00176 | |
| 00190 | Not listed | Policies naming 00190 | |
| 00192 | Not listed | Policies naming 00192 | |
| 00210 | Not listed | Policies naming 00210 | |
| 00211 | Not listed | Policies naming 00211 | |
| 00212 | Not listed | Policies naming 00212 | |
| 00214 | Not listed | Policies naming 00214 | |
| 00215 | Not listed | Policies naming 00215 | |
| 00216 | Not listed | Policies naming 00216 | |
| 00218 | Not listed | Policies naming 00218 | |
| 00220 | Not listed | Policies naming 00220 | |
| 00222 | Not listed | Policies naming 00222 | |
| 00300 | Not listed | Policies naming 00300 | |
| 00320 | Not listed | Policies naming 00320 | |
| 00322 | Not listed | Policies naming 00322 | |
| 00326 | Not listed | Policies naming 00326 | |
| 00350 | Not listed | Policies naming 00350 | |
| 00352 | Not listed | Policies naming 00352 | |
| 00400 | Not listed | Policies naming 00400 | |
| 00402 | Not listed | Policies naming 00402 | |
| 00404 | Not listed | Policies naming 00404 | |
| 00406 | Not listed | Policies naming 00406 | |
| 00410 | Not listed | Policies naming 00410 | |
| 00450 | Not listed | Policies naming 00450 | |
| 00454 | Not listed | Policies naming 00454 | |
| 00470 | Not listed | Policies naming 00470 | |
| 00472 | Not listed | Policies naming 00472 | |
| 00474 | Not listed | Policies naming 00474 | |
| 00500 | Not listed | Policies naming 00500 | |
| 00520 | Not listed | Policies naming 00520 | |
| 00522 | Not listed | Policies naming 00522 | |
| 00524 | Not listed | Policies naming 00524 | |
| 00528 | Not listed | Policies naming 00528 | |
| 00529 | Not listed | Policies naming 00529 | |
| 00530 | Not listed | Policies naming 00530 | |
| 00532 | Not listed | Policies naming 00532 | |
| 00534 | Not listed | Policies naming 00534 | |
| 00537 | Not listed | Policies naming 00537 | |
| 00539 | Not listed | Policies naming 00539 | |
| 00540 | Not listed | Policies naming 00540 | |
| 00541 | Not listed | Policies naming 00541 | |
| 00542 | Not listed | Policies naming 00542 | |
| 00546 | Not listed | Policies naming 00546 | |
| 00548 | Not listed | Policies naming 00548 | |
| 00550 | Not listed | Policies naming 00550 | |
| 00560 | Not listed | Policies naming 00560 | |
| 00561 | Not listed | Policies naming 00561 | |
| 00562 | Not listed | Policies naming 00562 | |
| 00563 | Not listed | Policies naming 00563 | |
| 00566 | Not listed | Policies naming 00566 | |
| 00567 | Not listed | Policies naming 00567 | |
| 00580 | On the list | Anesthesia for heart transplant or heart/lung transplant | Policies naming 00580 |
| 00600 | Not listed | Policies naming 00600 | |
| 00604 | Not listed | Policies naming 00604 | |
| 00620 | Not listed | Policies naming 00620 | |
| 00625 | Not listed | Policies naming 00625 | |
| 00626 | Not listed | Policies naming 00626 | |
| 00630 | Not listed | Policies naming 00630 | |
| 00632 | Not listed | Policies naming 00632 | |
| 00635 | Not listed | Policies naming 00635 | |
| 00640 | Not listed | Policies naming 00640 | |
| 00670 | Not listed | Policies naming 00670 | |
| 00700 | Not listed | Policies naming 00700 | |
| 00702 | Not listed | Policies naming 00702 | |
| 00730 | Not listed | Policies naming 00730 | |
| 00750 | Not listed | Policies naming 00750 | |
| 00752 | Not listed | Policies naming 00752 | |
| 00754 | Not listed | Policies naming 00754 | |
| 00756 | Not listed | Policies naming 00756 | |
| 00770 | Not listed | Policies naming 00770 | |
| 00790 | Not listed | Policies naming 00790 | |
| 00792 | Not listed | Policies naming 00792 | |
| 00794 | Not listed | Policies naming 00794 | |
| 00796 | On the list | Anesthesia, Intraperitoneal Proc, Upper Abdomen, W/Laparoscopy; Liver Transplant, Recipient | Policies naming 00796 |
| 00797 | Not listed | Policies naming 00797 | |
| 00800 | Not listed | Policies naming 00800 | |
| 00802 | Not listed | Policies naming 00802 | |
| 00820 | Not listed | Policies naming 00820 | |
| 00830 | Not listed | Policies naming 00830 | |
| 00832 | Not listed | Policies naming 00832 | |
| 00834 | Not listed | Policies naming 00834 | |
| 00836 | Not listed | Policies naming 00836 | |
| 00840 | Not listed | Policies naming 00840 | |
| 00842 | Not listed | Policies naming 00842 | |
| 00844 | Not listed | Policies naming 00844 | |
| 00846 | Not listed | Policies naming 00846 | |
| 00848 | Not listed | Policies naming 00848 | |
| 00851 | Not listed | Policies naming 00851 | |
| 00860 | Not listed | Policies naming 00860 | |
| 00862 | Not listed | Policies naming 00862 | |
| 00864 | Not listed | Policies naming 00864 | |
| 00865 | Not listed | Policies naming 00865 | |
| 00866 | Not listed | Policies naming 00866 | |
| 00868 | On the list | Anesthesia, Extraperitoneal Proc, Lower Abdomen, W/Urinary Tract; Renal Transplant, Recipient | Policies naming 00868 |
| 00870 | Not listed | Policies naming 00870 | |
| 00872 | Not listed | Policies naming 00872 | |
| 00873 | Not listed | Policies naming 00873 | |
| 00880 | Not listed | Policies naming 00880 | |
| 00882 | Not listed | Policies naming 00882 | |
| 00902 | Not listed | Policies naming 00902 | |
| 00904 | Not listed | Policies naming 00904 | |
| 00906 | Not listed | Policies naming 00906 | |
| 00908 | Not listed | Policies naming 00908 | |
| 00910 | Not listed | Policies naming 00910 | |
| 00912 | Not listed | Policies naming 00912 | |
| 00914 | Not listed | Policies naming 00914 | |
| 00916 | Not listed | Policies naming 00916 | |
| 00918 | Not listed | Policies naming 00918 | |
| 00920 | Not listed | Policies naming 00920 | |
| 00921 | Not listed | Policies naming 00921 | |
| 00922 | Not listed | Policies naming 00922 | |
| 00924 | Not listed | Policies naming 00924 | |
| 00926 | Not listed | Policies naming 00926 | |
| 00928 | Not listed | Policies naming 00928 | |
| 00930 | Not listed | Policies naming 00930 | |
| 00932 | Not listed | Policies naming 00932 | |
| 00934 | Not listed | Policies naming 00934 | |
| 00936 | Not listed | Policies naming 00936 | |
| 00938 | Not listed | Policies naming 00938 | |
| 00940 | Not listed | Policies naming 00940 | |
| 00942 | Not listed | Policies naming 00942 | |
| 00944 | Not listed | Policies naming 00944 | |
| 00948 | Not listed | Policies naming 00948 | |
| 00950 | Not listed | Policies naming 00950 | |
| 00952 | Not listed | Policies naming 00952 | |
| 01112 | Not listed | Policies naming 01112 | |
| 01120 | Not listed | Policies naming 01120 | |
| 01130 | Not listed | Policies naming 01130 | |
| 01140 | Not listed | Policies naming 01140 | |
| 01150 | Not listed | Policies naming 01150 | |
| 01160 | Not listed | Policies naming 01160 | |
| 01170 | Not listed | Policies naming 01170 | |
| 01173 | Not listed | Policies naming 01173 | |
| 01200 | Not listed | Policies naming 01200 | |
| 01202 | Not listed | Policies naming 01202 | |
| 01210 | Not listed | Policies naming 01210 | |
| 01212 | Not listed | Policies naming 01212 | |
| 01214 | Not listed | Policies naming 01214 | |
| 01215 | Not listed | Policies naming 01215 | |
| 01220 | Not listed | Policies naming 01220 | |
| 01230 | Not listed | Policies naming 01230 | |
| 01232 | Not listed | Policies naming 01232 | |
| 01234 | Not listed | Policies naming 01234 | |
| 01250 | Not listed | Policies naming 01250 | |
| 01260 | Not listed | Policies naming 01260 | |
| 01270 | Not listed | Policies naming 01270 | |
| 01272 | Not listed | Policies naming 01272 | |
| 01274 | Not listed | Policies naming 01274 | |
| 01320 | Not listed | Policies naming 01320 | |
| 01340 | Not listed | Policies naming 01340 | |
| 01360 | Not listed | Policies naming 01360 | |
| 01380 | Not listed | Policies naming 01380 | |
| 01382 | Not listed | Policies naming 01382 | |
| 01390 | Not listed | Policies naming 01390 | |
| 01392 | Not listed | Policies naming 01392 | |
| 01400 | Not listed | Policies naming 01400 | |
| 01402 | Not listed | Policies naming 01402 | |
| 01404 | Not listed | Policies naming 01404 | |
| 01420 | Not listed | Policies naming 01420 | |
| 01430 | Not listed | Policies naming 01430 | |
| 01432 | Not listed | Policies naming 01432 | |
| 01440 | Not listed | Policies naming 01440 | |
| 01442 | Not listed | Policies naming 01442 | |
| 01444 | Not listed | Policies naming 01444 | |
| 01462 | Not listed | Policies naming 01462 | |
| 01464 | Not listed | Policies naming 01464 | |
| 01470 | Not listed | Policies naming 01470 | |
| 01472 | Not listed | Policies naming 01472 | |
| 01474 | Not listed | Policies naming 01474 | |
| 01480 | Not listed | Policies naming 01480 | |
| 01482 | Not listed | Policies naming 01482 | |
| 01484 | Not listed | Policies naming 01484 | |
| 01486 | Not listed | Policies naming 01486 | |
| 01490 | Not listed | Policies naming 01490 | |
| 01500 | Not listed | Policies naming 01500 | |
| 01502 | Not listed | Policies naming 01502 | |
| 01520 | Not listed | Policies naming 01520 | |
| 01522 | Not listed | Policies naming 01522 | |
| 01610 | Not listed | Policies naming 01610 | |
| 01620 | Not listed | Policies naming 01620 | |
| 01622 | Not listed | Policies naming 01622 | |
| 01630 | Not listed | Policies naming 01630 | |
| 01634 | Not listed | Policies naming 01634 | |
| 01636 | Not listed | Policies naming 01636 | |
| 01638 | Not listed | Policies naming 01638 | |
| 01650 | Not listed | Policies naming 01650 | |
| 01652 | Not listed | Policies naming 01652 | |
| 01654 | Not listed | Policies naming 01654 | |
| 01656 | Not listed | Policies naming 01656 | |
| 01670 | Not listed | Policies naming 01670 | |
| 01680 | Not listed | Policies naming 01680 | |
| 01710 | Not listed | Policies naming 01710 | |
| 01712 | Not listed | Policies naming 01712 | |
| 01714 | Not listed | Policies naming 01714 | |
| 01716 | Not listed | Policies naming 01716 | |
| 01730 | Not listed | Policies naming 01730 | |
| 01732 | Not listed | Policies naming 01732 | |
| 01740 | Not listed | Policies naming 01740 | |
| 01742 | Not listed | Policies naming 01742 | |
| 01744 | Not listed | Policies naming 01744 | |
| 01756 | Not listed | Policies naming 01756 | |
| 01758 | Not listed | Policies naming 01758 | |
| 01760 | Not listed | Policies naming 01760 | |
| 01770 | Not listed | Policies naming 01770 | |
| 01772 | Not listed | Policies naming 01772 | |
| 01780 | Not listed | Policies naming 01780 | |
| 01782 | Not listed | Policies naming 01782 | |
| 01810 | Not listed | Policies naming 01810 | |
| 01820 | Not listed | Policies naming 01820 | |
| 01829 | Not listed | Policies naming 01829 | |
| 01830 | Not listed | Policies naming 01830 | |
| 01832 | Not listed | Policies naming 01832 | |
| 01840 | Not listed | Policies naming 01840 | |
| 01842 | Not listed | Policies naming 01842 | |
| 01844 | Not listed | Policies naming 01844 | |
| 01850 | Not listed | Policies naming 01850 | |
| 01852 | Not listed | Policies naming 01852 | |
| 01860 | Not listed | Policies naming 01860 | |
| 01916 | Not listed | Policies naming 01916 | |
| 01920 | Not listed | Policies naming 01920 | |
| 01922 | Not listed | Policies naming 01922 | |
| 01924 | Not listed | Policies naming 01924 | |
| 01925 | Not listed | Policies naming 01925 | |
| 01926 | Not listed | Policies naming 01926 | |
| 01930 | Not listed | Policies naming 01930 | |
| 01931 | Not listed | Policies naming 01931 | |
| 01932 | Not listed | Policies naming 01932 | |
| 01933 | Not listed | Policies naming 01933 | |
| 01937 | Not listed | Policies naming 01937 | |
| 01938 | Not listed | Policies naming 01938 | |
| 01951 | Not listed | Policies naming 01951 | |
| 01952 | Not listed | Policies naming 01952 | |
| 01953 | Not listed | Policies naming 01953 | |
| 01958 | Not listed | Policies naming 01958 | |
| 01960 | Not listed | Policies naming 01960 | |
| 01961 | Not listed | Policies naming 01961 | |
| 01962 | Not listed | Policies naming 01962 | |
| 01963 | Not listed | Policies naming 01963 | |
| 01965 | Not listed | Policies naming 01965 | |
| 01966 | Not listed | Policies naming 01966 | |
| 01967 | Not listed | Policies naming 01967 | |
| 01968 | Not listed | Policies naming 01968 | |
| 01969 | Not listed | Policies naming 01969 | |
| 01990 | Not listed | Policies naming 01990 | |
| 01996 | Not listed | Policies naming 01996 | |
| 01999 | Not listed | Policies naming 01999 | |
| 99100 | Not listed | Policies naming 99100 | |
| 99116 | Not listed | Policies naming 99116 | |
| 99135 | Not listed | Policies naming 99135 | |
| 99140 | Not listed | Policies naming 99140 | |
| 99151 | On the list | Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intraservice time, patient younger than 5 years of age | Policies naming 99151 |
| 99152 | On the list | Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intraservice time, patient age 5 years or older | Policies naming 99152 |
| 99153 | Not listed | Policies naming 99153 | |
| 99155 | On the list | Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient younger than 5 years of age | Policies naming 99155 |
| 99156 | On the list | Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient age 5 years or older | Policies naming 99156 |
| 99157 | Not listed | Policies naming 99157 | |
| G0500 | Not listed | Policies naming G0500 |
All Anthem Blue Cross Blue Shield of Georgia policies · Anthem Blue Cross Blue Shield of Georgia prior authorization CPT list