Anthem Blue Cross Blue Shield of Georgia policy
SURG.00096 Surgical and Ablative Treatments for Chronic Headaches
SURG.00096 Surgical and Ablative Treatments for Chronic Headaches is a public Anthem Blue Cross Blue Shield of Georgia policy (policy SURG.00096). It lists 18 CPT or HCPCS codes, 17 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
- SURG.00096
- 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 |
|---|---|---|---|
| 14040 | On the list | Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less | Policies naming 14040 |
| 14041 | On the list | Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10.1 sq cm to 30.0 sq cm | Policies naming 14041 |
| 14060 | On the list | Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less | Policies naming 14060 |
| 14061 | On the list | Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10.1 sq cm to 30.0 sq cm | Policies naming 14061 |
| 15824 | On the list | Rhytidectomy; forehead | Policies naming 15824 |
| 15826 | On the list | Rhytidectomy; glabellar frown lines | Policies naming 15826 |
| 64640 | On the list | Destruction by neurolytic agent; other peripheral nerve or branch | Policies naming 64640 |
| 64716 | On the list | Neuroplasty and/or transposition; cranial nerve (specify) | Policies naming 64716 |
| 64722 | On the list | Decompression; unspecified nerve(s) (specify) | Policies naming 64722 |
| 64732 | On the list | Transection or avulsion of; supraorbital nerve | Policies naming 64732 |
| 64734 | On the list | Transection or avulsion of; infraorbital nerve | Policies naming 64734 |
| 64744 | On the list | Transection or avulsion of; greater occipital nerve | Policies naming 64744 |
| 64771 | On the list | Transection or avulsion of other cranial nerve, extradural | Policies naming 64771 |
| 64772 | On the list | Transection or avulsion of other spinal nerve, extradural | Policies naming 64772 |
| 64787 | Not listed | Policies naming 64787 | |
| 64999 | On the list | Unlisted procedure, nervous system | Policies naming 64999 |
| 67900 | On the list | Repair of brow ptosis (supraciliary, mid-forehead or coronal approach) | Policies naming 67900 |
| 93580 | On the list | Percutaneous transcatheter closure of congenital interatrial communication (ie, Fontan fenestration, atrial septal defect) with implant | Policies naming 93580 |
All Anthem Blue Cross Blue Shield of Georgia policies · Anthem Blue Cross Blue Shield of Georgia prior authorization CPT list