Anthem · PayerPolicy · ANTHEM-SURG.00158
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 |
|---|---|---|
| 00158 | CPT | Covered |
| 64555 | CPT | Covered |
| 64575 | CPT | Covered |
| 64590 | CPT | Covered |
| 64596 | CPT | Covered |
| 64597 | CPT | Covered |
| A4438 | HCPCS | Covered |
| C1767 | HCPCS | Covered |
| C1778 | HCPCS | Covered |
| C1787 | HCPCS | Covered |
| C9807 | HCPCS | Covered |
| L8678 | HCPCS | Covered |
| L8679 | HCPCS | Covered |
| L8680 | HCPCS | Covered |
| L8681 | HCPCS | Covered |
| L8683 | HCPCS | Covered |
| L8688 | HCPCS | Covered |
| M62.85 | ICD10CM | Covered |