Anthem Blue Cross Blue Shield of Georgia policy
Percutaneous Spinal Surgery
Percutaneous Spinal Surgery is a public Anthem Blue Cross Blue Shield of Georgia policy (policy SURG.00071). It lists 8 CPT or HCPCS codes, 6 of them on the Anthem Blue Cross Blue Shield of Georgia prior authorization list. Not a coverage decision; the payer's own document governs.
- Policy number
- SURG.00071
- 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 |
|---|---|---|---|
| 0274T | On the list | Percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy), any method, under indirect image guidance (eg, fluoroscopic, CT), single or multiple levels, unilateral or bilateral; cervical or thoracic | Policies naming 0274T |
| 22899 | Not listed | Policies naming 22899 | |
| 62287 | On the list | Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle based technique to remove disc material under fluoroscopic imaging or other form of indirect visualization, with discography and/or epidural injection(s) at the treated level(s), when performed, single or multiple levels, lumbar | Policies naming 62287 |
| 62330 | On the list | Decompression, percutaneous, with partial removal of the ligamentum flavum, including laminotomy for access, epidurography, and imaging guidance (ie, CT or fluoroscopy), bilateral; one interspace, lumbar | Policies naming 62330 |
| 62331 | Not listed | Policies naming 62331 | |
| 64999 | On the list | Unlisted procedure, nervous system | Policies naming 64999 |
| C2614 | On the list | Probe, percutaneous lumbar discectomy | Policies naming C2614 |
| S2348 | On the list | Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, using radiofrequency energy, single or multiple levels, lumbar | Policies naming S2348 |
All Anthem Blue Cross Blue Shield of Georgia policies · Anthem Blue Cross Blue Shield of Georgia prior authorization CPT list