BCBS Montana · PayerPolicy · BCBSMT-SUR717.001
Summary of the payer’s published policy. Not a coverage determination — confirm with BCBS Montana before submitting.
Free account. Policy pages stay open to everyone.
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 |
|---|---|---|
| 11950 | CPT | Covered |
| 11951 | CPT | Covered |
| 11952 | CPT | Covered |
| 11954 | CPT | Covered |
| 11980 | CPT | Covered |
| 11981 | CPT | Covered |
| 11982 | CPT | Covered |
| 11983 | CPT | Covered |
| 15780 | CPT | Covered |
| 15781 | CPT | Covered |
| 15782 | CPT | Covered |
| 15783 | CPT | Covered |
| 15786 | CPT | Covered |
| 15787 | CPT | Covered |
| 15788 | CPT | Covered |
| 15789 | CPT | Covered |
| 15792 | CPT | Covered |
|---|
| 15793 | CPT | Covered |
|---|
| 15820 | CPT | Covered |
|---|
| 15821 | CPT | Covered |
|---|
| 15822 | CPT | Covered |
|---|
| 15823 | CPT | Covered |
|---|
| 15824 | CPT | Covered |
|---|
| 15825 | CPT | Covered |
|---|
| 15826 | CPT | Covered |
|---|
| 15828 | CPT | Covered |
|---|
| 15830 | CPT | Covered |
|---|
| 15832 | CPT | Covered |
|---|
| 15833 | CPT | Covered |
|---|
| 15834 | CPT | Covered |
|---|
| 15835 | CPT | Covered |
|---|
| 15836 | CPT | Covered |
|---|
| 15837 | CPT | Covered |
|---|
| 15838 | CPT | Covered |
|---|
| 15839 | CPT | Covered |
|---|
| 15876 | CPT | Covered |
|---|
| 15877 | CPT | Covered |
|---|
| 15878 | CPT | Covered |
|---|
| 15879 | CPT | Covered |
|---|
| 17380 | CPT | Covered |
|---|
| 19316 | CPT | Covered |
|---|
| 19318 | CPT | Covered |
|---|
| 19325 | CPT | Covered |
|---|
| 19340 | CPT | Covered |
|---|
| 19342 | CPT | Covered |
|---|
| 21120 | CPT | Covered |
|---|
| 21121 | CPT | Covered |
|---|
| 21122 | CPT | Covered |
|---|
| 21123 | CPT | Covered |
|---|
| 21125 | CPT | Covered |
|---|
| 21127 | CPT | Covered |
|---|
| 30400 | CPT | Covered |
|---|
| 30410 | CPT | Covered |
|---|
| 30420 | CPT | Covered |
|---|
| 30430 | CPT | Covered |
|---|
| 30435 | CPT | Covered |
|---|
| 30450 | CPT | Covered |
|---|
| 53430 | CPT | Covered |
|---|
| 54125 | CPT | Covered |
|---|
| 54400 | CPT | Covered |
|---|
| 54401 | CPT | Covered |
|---|
| 54405 | CPT | Covered |
|---|
| 54406 | CPT | Covered |
|---|
| 54408 | CPT | Covered |
|---|
| 54410 | CPT | Covered |
|---|
| 54411 | CPT | Covered |
|---|
| 54415 | CPT | Covered |
|---|
| 54416 | CPT | Covered |
|---|
| 54417 | CPT | Covered |
|---|
| 54520 | CPT | Covered |
|---|
| 54660 | CPT | Covered |
|---|
| 54690 | CPT | Covered |
|---|
| 55175 | CPT | Covered |
|---|
| 55180 | CPT | Covered |
|---|
| 55970 | CPT | Covered |
|---|
| 55980 | CPT | Covered |
|---|
| 56625 | CPT | Covered |
|---|
| 56800 | CPT | Covered |
|---|
| 56805 | CPT | Covered |
|---|
| 56810 | CPT | Covered |
|---|
| 57106 | CPT | Covered |
|---|
| 57107 | CPT | Covered |
|---|
| 57110 | CPT | Covered |
|---|
| 57111 | CPT | Covered |
|---|
| 57291 | CPT | Covered |
|---|
| 57292 | CPT | Covered |
|---|
| 57295 | CPT | Covered |
|---|
| 57296 | CPT | Covered |
|---|
| 57335 | CPT | Covered |
|---|
| 57426 | CPT | Covered |
|---|
| 58150 | CPT | Covered |
|---|
| 58180 | CPT | Covered |
|---|
| 58260 | CPT | Covered |
|---|
| 58262 | CPT | Covered |
|---|
| 58275 | CPT | Covered |
|---|
| 58280 | CPT | Covered |
|---|
| 58285 | CPT | Covered |
|---|
| 58290 | CPT | Covered |
|---|
| 58291 | CPT | Covered |
|---|
| 58541 | CPT | Covered |
|---|
| 58542 | CPT | Covered |
|---|
| 58543 | CPT | Covered |
|---|
| 58544 | CPT | Covered |
|---|
| 58550 | CPT | Covered |
|---|
| 58552 | CPT | Covered |
|---|
| 58553 | CPT | Covered |
|---|
| 58554 | CPT | Covered |
|---|
| 58570 | CPT | Covered |
|---|
| 58571 | CPT | Covered |
|---|
| 58572 | CPT | Covered |
|---|
| 58573 | CPT | Covered |
|---|
| 58661 | CPT | Covered |
|---|
| 58720 | CPT | Covered |
|---|
| 90845 | CPT | Covered |
|---|
| 90846 | CPT | Covered |
|---|
| 90847 | CPT | Covered |
|---|
| 90849 | CPT | Covered |
|---|
| 90853 | CPT | Covered |
|---|
| 90863 | CPT | Covered |
|---|
| J1071 | HCPCS | Covered |
|---|
| J2320 | HCPCS | Covered |
|---|
| J3121 | HCPCS | Covered |
|---|
| J3145 | HCPCS | Covered |
|---|
| S0189 | HCPCS | Covered |
|---|