Ambetter · PayerPolicy · AMBETTER-CP-BH-124
Summary of the payer’s published policy. Not a coverage determination — confirm with Ambetter before submitting.
Free account. Policy pages stay open to everyone.
Each code’s status is what the policy records for it. This page does not show the policy’s criteria. Read them in the payer’s source.
| Code | Code system | Status in this policy |
|---|---|---|
| 70450 | CPT | Covered |
| 70460 | CPT | Covered |
| 70470 | CPT | Covered |
| 70496 | CPT | Covered |
| 70551 | CPT | Covered |
| 70552 | CPT | Covered |
| 70553 | CPT | Covered |
| 70554 | CPT | Covered |
| 70555 | CPT | Covered |
| 76390 | CPT | Covered |
| 78600 | CPT | Covered |
| 78601 | CPT | Covered |
| 78605 | CPT | Covered |
| 78606 | CPT | Covered |
| 78607 | CPT | Covered |
| 78608 | CPT | Covered |
| 78609 | CPT | Covered |
| 78610 | CPT | Covered |
| 78803 | CPT | Covered |
| 80061 | CPT | Covered |
| 81171 | CPT | Covered |
| 81172 | CPT | Covered |
| 81229 | CPT | Covered |
| 82365 | CPT | Covered |
| 82465 | CPT | Covered |
| 82721 | CPT | Covered |
| 82728 | CPT | Covered |
| 82784 | CPT | Covered |
| 82787 | CPT | Covered |
| 83540 | CPT | Covered |
| 83550 | CPT | Covered |
| 83718 | CPT | Covered |
| 83719 | CPT | Covered |
| 83721 | CPT | Covered |
| 83722 | CPT | Covered |
| 84436 | CPT | Covered |
| 84437 | CPT | Covered |
| 84439 | CPT | Covered |
| 84442 | CPT | Covered |
| 84443 | CPT | Covered |
| 84445 | CPT | Covered |
| 84475 | CPT | Covered |
| 84478 | CPT | Covered |
| 84479 | CPT | Covered |
| 84481 | CPT | Covered |
| 84630 | CPT | Covered |
| 86001 | CPT | Covered |
| 90867 | CPT | Covered |
| 90868 | CPT | Covered |
| 90869 | CPT | Covered |
| 90901 | CPT | Covered |
| 92065 | CPT | Covered |
| 92540 | CPT | Covered |
| 92541 | CPT | Covered |
| 92542 | CPT | Covered |
| 92544 | CPT | Covered |
| 92547 | CPT | Covered |
| 92550 | CPT | Covered |
| 92558 | CPT | Covered |
| 92567 | CPT | Covered |
| 92568 | CPT | Covered |
| 92569 | CPT | Covered |
| 92570 | CPT | Covered |
| 92585 | CPT | Covered |
| 92586 | CPT | Covered |
| 92587 | CPT | Covered |
| 92588 | CPT | Covered |
| 92650 | CPT | Covered |
| 92651 | CPT | Covered |
| 92652 | CPT | Covered |
| 92653 | CPT | Covered |
| 93000 | CPT | Covered |
| 93005 | CPT | Covered |
| 93010 | CPT | Covered |
| 95705 | CPT | Covered |
| 95706 | CPT | Covered |
| 95707 | CPT | Covered |
| 95708 | CPT | Covered |
| 95709 | CPT | Covered |
| 95710 | CPT | Covered |
| 95711 | CPT | Covered |
| 95712 | CPT | Covered |
| 95713 | CPT | Covered |
| 95714 | CPT | Covered |
| 95715 | CPT | Covered |
| 95716 | CPT | Covered |
| 95717 | CPT | Covered |
| 95718 | CPT | Covered |
| 95719 | CPT | Covered |
| 95720 | CPT | Covered |
| 95721 | CPT | Covered |
| 95722 | CPT | Covered |
| 95723 | CPT | Covered |
| 95724 | CPT | Covered |
| 95725 | CPT | Covered |
| 95726 | CPT | Covered |
| 95803 | CPT | Covered |
| 95812 | CPT | Covered |
| 95813 | CPT | Covered |
| 95816 | CPT | Covered |
| 95819 | CPT | Covered |
| 95827 | CPT | Covered |
| 95925 | CPT | Covered |
| 95926 | CPT | Covered |
| 95927 | CPT | Covered |
| 95928 | CPT | Covered |
| 95929 | CPT | Covered |
| 95930 | CPT | Covered |
| 95933 | CPT | Covered |
| 95937 | CPT | Covered |
| 95938 | CPT | Covered |
| 95939 | CPT | Covered |
| 95954 | CPT | Covered |
| 96020 | CPT | Covered |
| 96101 | CPT | Covered |
| 96102 | CPT | Covered |
| 96103 | CPT | Covered |
| 96116 | CPT | Covered |
| 96118 | CPT | Covered |
| 96119 | CPT | Covered |
| 96120 | CPT | Covered |
| 96121 | CPT | Covered |
| 96130 | CPT | Covered |
| 96131 | CPT | Covered |
| 96132 | CPT | Covered |
| 96133 | CPT | Covered |
| 96136 | CPT | Covered |
| 96137 | CPT | Covered |
| 96138 | CPT | Covered |
| 96139 | CPT | Covered |
| 96146 | CPT | Covered |
| 96365 | CPT | Covered |
| 96366 | CPT | Covered |
| 96367 | CPT | Covered |
| 96902 | CPT | Covered |
| 97010 | CPT | Covered |
| 97012 | CPT | Covered |
| 97014 | CPT | Covered |
| 97016 | CPT | Covered |
| 97018 | CPT | Covered |
| 97022 | CPT | Covered |
| 97024 | CPT | Covered |
| 97026 | CPT | Covered |
| 97028 | CPT | Covered |
| 97032 | CPT | Covered |
| 97033 | CPT | Covered |
| 97034 | CPT | Covered |
| 97035 | CPT | Covered |
| 97036 | CPT | Covered |
| 97127 | CPT | Covered |
| 97129 | CPT | Covered |
| 97130 | CPT | Covered |
| 97530 | CPT | Covered |
| 97532 | CPT | Covered |
| 97533 | CPT | Covered |
| 97810 | CPT | Covered |
| 97811 | CPT | Covered |
| 97813 | CPT | Covered |
| 97814 | CPT | Covered |
| 98940 | CPT | Covered |
| 98941 | CPT | Covered |
| 98942 | CPT | Covered |
| 98943 | CPT | Covered |
| G0176 | HCPCS | Covered |
| P2031 | HCPCS | Covered |
| S8040 | HCPCS | Covered |
| F90.0-F90.9 | ICD10CM | Covered |