Anthem · PayerPolicy · ANTHEM-SURG.00142
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 |
|---|---|---|
| 00142 | CPT | Not covered |
| 00155 | CPT | Not covered |
| 37242 | CPT | Not covered |
| 64450 | CPT | Not covered |
| 64454 | CPT | Not covered |
| 64624 | CPT | Not covered |
| 64640 | CPT | Not covered |
| 64999 | CPT | Not covered |
| M08.861 | ICD10CM | Not covered |
| M08.869 | ICD10CM | Not covered |
| M08.961 | ICD10CM | Not covered |
| M08.969 | ICD10CM | Not covered |
| M12.561 | ICD10CM | Not covered |
| M12.569 | ICD10CM | Not covered |
| M12.861 | ICD10CM | Not covered |
| M12.869 | ICD10CM | Not covered |
| M13.161 | ICD10CM | Not covered |
| M13.169 | ICD10CM | Not covered |
| M13.861 | ICD10CM | Not covered |
| M13.869 | ICD10CM | Not covered |
| M17.0 | ICD10CM | Not covered |
| M17.9 | ICD10CM | Not covered |
| M21.061 | ICD10CM | Not covered |
| M21.069 | ICD10CM | Not covered |
| M21.161 | ICD10CM | Not covered |
| M21.169 | ICD10CM | Not covered |
| M21.261 | ICD10CM | Not covered |
| M21.269 | ICD10CM | Not covered |
| M22.00 | ICD10CM | Not covered |
| M22.92 | ICD10CM | Not covered |
| M23.000 | ICD10CM | Not covered |
| M23.92 | ICD10CM | Not covered |
| M24.361 | ICD10CM | Not covered |
| M24.369 | ICD10CM | Not covered |
| M24.461 | ICD10CM | Not covered |
| M24.469 | ICD10CM | Not covered |
| M24.561 | ICD10CM | Not covered |
| M24.569 | ICD10CM | Not covered |
| M24.661 | ICD10CM | Not covered |
| M24.669 | ICD10CM | Not covered |
| M25.361 | ICD10CM | Not covered |
| M25.369 | ICD10CM | Not covered |
| M25.561 | ICD10CM | Not covered |
| M25.569 | ICD10CM | Not covered |
| M25.661 | ICD10CM | Not covered |
| M25.669 | ICD10CM | Not covered |
| M25.761 | ICD10CM | Not covered |
| M25.769 | ICD10CM | Not covered |
| M25.861 | ICD10CM | Not covered |
| M25.869 | ICD10CM | Not covered |
| M66.0 | ICD10CM | Not covered |
| M67.361 | ICD10CM | Not covered |
| M67.369 | ICD10CM | Not covered |
| M67.461 | ICD10CM | Not covered |
| M67.469 | ICD10CM | Not covered |
| M67.50 | ICD10CM | Not covered |
| M67.52 | ICD10CM | Not covered |
| M67.861 | ICD10CM | Not covered |
| M67.869 | ICD10CM | Not covered |
| M70.40 | ICD10CM | Not covered |
| M70.42 | ICD10CM | Not covered |
| M70.50 | ICD10CM | Not covered |
| M70.52 | ICD10CM | Not covered |
| M71.20 | ICD10CM | Not covered |
| M71.22 | ICD10CM | Not covered |
| M71.561 | ICD10CM | Not covered |
| M71.569 | ICD10CM | Not covered |
| M92.40 | ICD10CM | Not covered |
| M92.42 | ICD10CM | Not covered |
| M92.50 | ICD10CM | Not covered |
| M92.501 | ICD10CM | Not covered |
| M92.52 | ICD10CM | Not covered |
| M92.529 | ICD10CM | Not covered |
| M94.261 | ICD10CM | Not covered |
| M94.269 | ICD10CM | Not covered |
| S80.00XA | ICD10CM | Not covered |
| S80.02XS | ICD10CM | Not covered |
| S83.101A | ICD10CM | Not covered |
| S83.196S | ICD10CM | Not covered |
| S83.401A | ICD10CM | Not covered |
| S83.92XS | ICD10CM | Not covered |
| S87.00XA | ICD10CM | Not covered |
| S87.02XS | ICD10CM | Not covered |
| T84.84XA | ICD10CM | Not covered |
| T84.84XS | ICD10CM | Not covered |
| Z96.651 | ICD10CM | Not covered |
| Z96.659 | ICD10CM | Not covered |