Anthem · PayerPolicy · ANTHEM-RAD.00038
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 |
|---|---|---|
| 76375 | CPT | Not covered |
| 76376 | CPT | Not covered |
| 76377 | CPT | Not covered |
| 76499 | CPT | Not covered |
| O09.00 | ICD10CM | Not covered |
| O09.93 | ICD10CM | Not covered |
| O10.011 | ICD10CM | Not covered |
| O16.9 | ICD10CM | Not covered |
| O20.0 | ICD10CM | Not covered |
| O29.93 | ICD10CM | Not covered |
| O30.001 | ICD10CM | Not covered |
| O30.93 | ICD10CM | Not covered |
| O31.00X0 | ICD10CM | Not covered |
| O31.8X99 | ICD10CM | Not covered |
| O32.0XX0 | ICD10CM | Not covered |
| O32.9XX9 | ICD10CM | Not covered |
| O33.0 | ICD10CM | Not covered |
| O33.9 | ICD10CM | Not covered |
| O34.00 | ICD10CM | Not covered |
| O34.93 | ICD10CM | Not covered |
| O35.00X0 | ICD10CM | Not covered |
| O35.0XX0 | ICD10CM | Not covered |
| O35.9XX9 | ICD10CM | Not covered |
| O36.0110 | ICD10CM | Not covered |
| O36.93X9 | ICD10CM | Not covered |
| O40.1XX0 | ICD10CM | Not covered |
| O40.9XX9 | ICD10CM | Not covered |
| O41.00X0 | ICD10CM | Not covered |
| O41.93X9 | ICD10CM | Not covered |
| Z03.71 | ICD10CM | Not covered |
| Z03.79 | ICD10CM | Not covered |
| Z34.00 | ICD10CM | Not covered |
| Z34.93 | ICD10CM | Not covered |
| Z36.0 | ICD10CM | Not covered |
| Z36.9 | ICD10CM | Not covered |