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Retired: CG-OR-PR-05 Myoelectric Upper Extremity Prosthetic Devices | Anthem

Payers/Anthem/ANTHEM-GL-C169421

CG-OR-PR-05 Myoelectric Upper Extremity Prosthetic Devices

Anthem · PayerPolicy · ANTHEM-GL-C169421

Status: Retired
Effective: July 1, 2025
Last reviewed by Anthem: May 8, 2025
Last checked by Backwork: December 30, 2025

Summary of the payer’s published policy. Not a coverage determination — confirm with Anthem before submitting.

This version is retired

Anthem has replaced or withdrawn this version, and Backwork could not match it to a current one. The payer’s current policies are listed on its page.

Anthem policies Payer’s source