Anthem · PayerPolicy · ANTHEM-MED.00103
Summary of the payer’s published policy. Not a coverage determination — confirm with Anthem before submitting.
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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 |
|---|---|---|
| 00103 | CPT | Not covered |