Anthem · PayerPolicy · ANTHEM-TRANS.00035
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 |
|---|---|---|
| 00110 | CPT | Not covered |
| 00117 | CPT | Not covered |
| 17999 | CPT | Not covered |
| 20930 | CPT | Not covered |
| 20999 | CPT | Not covered |
| 33999 | CPT | Not covered |
| 38205 | CPT | Not covered |
| 38206 | CPT | Not covered |
| 38230 | CPT | Not covered |
| 38232 | CPT | Not covered |
| 38999 | CPT | Not covered |
| 64999 | CPT | Not covered |
| G0460 | HCPCS | Not covered |
| G0465 | HCPCS | Not covered |
| P9020 | HCPCS | Not covered |
| E08.51 | ICD10CM | Not covered |
| E08.59 | ICD10CM | Not covered |
| E09.51 | ICD10CM | Not covered |
| E09.59 | ICD10CM | Not covered |
| E10.51 | ICD10CM | Not covered |
| E10.59 | ICD10CM | Not covered |
| E11.51 | ICD10CM | Not covered |
| E11.59 | ICD10CM | Not covered |
| E13.51 | ICD10CM | Not covered |
| E13.59 | ICD10CM | Not covered |
| G12.21 | ICD10CM | Not covered |
| G20.A1 | ICD10CM | Not covered |
| G21.9 | ICD10CM | Not covered |
| G30.0 | ICD10CM | Not covered |
| G30.9 | ICD10CM | Not covered |
| G31.01 | ICD10CM | Not covered |
| G31.9 | ICD10CM | Not covered |
| G35.A | ICD10CM | Not covered |
| G35.D | ICD10CM | Not covered |
| I70.201 | ICD10CM | Not covered |
| I70.299 | ICD10CM | Not covered |
| I70.401 | ICD10CM | Not covered |
| I70.499 | ICD10CM | Not covered |
| I73.00 | ICD10CM | Not covered |
| I73.9 | ICD10CM | Not covered |
| K50.00 | ICD10CM | Not covered |
| K51.919 | ICD10CM | Not covered |
| K52.3 | ICD10CM | Not covered |
| K90.0 | ICD10CM | Not covered |
| M04.1 | ICD10CM | Not covered |
| M04.9 | ICD10CM | Not covered |
| M15.0 | ICD10CM | Not covered |
| M19.93 | ICD10CM | Not covered |
| M21.00 | ICD10CM | Not covered |
| M21.079 | ICD10CM | Not covered |
| M21.10 | ICD10CM | Not covered |
| M21.179 | ICD10CM | Not covered |
| M21.70 | ICD10CM | Not covered |
| M21.769 | ICD10CM | Not covered |
| M21.80 | ICD10CM | Not covered |
| M21.869 | ICD10CM | Not covered |
| M21.90 | ICD10CM | Not covered |
| M21.969 | ICD10CM | Not covered |
| M23.000 | ICD10CM | Not covered |
| M23.92 | ICD10CM | Not covered |
| M24.10 | ICD10CM | Not covered |
| M24.19 | ICD10CM | Not covered |
| M24.20 | ICD10CM | Not covered |
| M24.29 | ICD10CM | Not covered |
| M24.60 | ICD10CM | Not covered |
| M24.69 | ICD10CM | Not covered |
| M24.7 | ICD10CM | Not covered |
| M24.80 | ICD10CM | Not covered |
| M24.89 | ICD10CM | Not covered |
| M24.9 | ICD10CM | Not covered |
| M25.50 | ICD10CM | Not covered |
| M25.59 | ICD10CM | Not covered |
| M32.0 | ICD10CM | Not covered |
| M32.9 | ICD10CM | Not covered |
| M75.00 | ICD10CM | Not covered |
| M75.92 | ICD10CM | Not covered |
| M84.30XA | ICD10CM | Not covered |
| M84.9 | ICD10CM | Not covered |
| M87.00 | ICD10CM | Not covered |
| M87.9 | ICD10CM | Not covered |
| M91.0 | ICD10CM | Not covered |
| M94.9 | ICD10CM | Not covered |
| S43.401A | ICD10CM | Not covered |
| S43.499S | ICD10CM | Not covered |