Anthem Blue Cross Blue Shield of Georgia policy
SURG.00124 Carotid Sinus Baroreceptor Stimulation Devices
SURG.00124 Carotid Sinus Baroreceptor Stimulation Devices is a public Anthem Blue Cross Blue Shield of Georgia policy (policy SURG.00124). It lists 9 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
- SURG.00124
- 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 |
|---|---|---|---|
| 64654 | On the list | Initial open implantation of baroreflex activation therapy (BAT) modulation system, including lead placement onto the carotid sinus, lead tunnelling, connection to a pulse generator placed in a distant subcutaneous pocket (ie, total system), and intraoperative interrogation and programming | Policies naming 64654 |
| 64655 | On the list | Revision or replacement of baroreflex activation therapy (BAT) modulation system, with intraoperative interrogation and programming; lead only | Policies naming 64655 |
| 64656 | On the list | Revision or replacement of baroreflex activation therapy (BAT) modulation system, with intraoperative interrogation and programming; pulse generator only | Policies naming 64656 |
| 64657 | On the list | Removal of baroreflex activation therapy (BAT) modulation system; total system, including lead and pulse generator | Policies naming 64657 |
| 64658 | On the list | Removal of baroreflex activation therapy (BAT) modulation system; lead only | Policies naming 64658 |
| 64659 | On the list | Removal of baroreflex activation therapy (BAT) modulation system; pulse generator only | Policies naming 64659 |
| 93145 | On the list | Interrogation device evaluation (in person), carotid sinus baroreflex activation therapy (BAT) modulation system including telemetric iterative communication with the implantable device to monitor device diagnostics and programmed therapy values, with interpretation and report (eg, battery status, lead impedance, pulse amplitude, pulse width, therapy frequency, pathway mode, burst mode, therapy start/stop times each day); without programming | Policies naming 93145 |
| 93146 | Not listed | Policies naming 93146 | |
| C1825 | On the list | Generator, neurostimulator (implantable), non- rechargeable with carotid sinus baroreceptor stimulation lead(s) | Policies naming C1825 |
All Anthem Blue Cross Blue Shield of Georgia policies · Anthem Blue Cross Blue Shield of Georgia prior authorization CPT list