Regence BCBS · PayerPolicy · REGENCE-MED153
Summary of the payer’s published policy. Not a coverage determination — confirm with Regence BCBS 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 |
|---|---|---|
| 11920 | CPT | Covered |
| 11921 | CPT | Covered |
| 11950 | CPT | Covered |
| 11951 | CPT | Covered |
| 11952 | CPT | Covered |
| 11954 | CPT | Covered |
| 11970 | CPT | Covered |
| 11971 | CPT | Covered |
| 14020 | CPT | Covered |
| 14021 | CPT | Covered |
| 14061 | CPT | Covered |
| 14301 | CPT | Covered |
| 14302 | CPT | Covered |
| 15730 | CPT | Covered |
| 15769 | CPT | Covered |
| 15770 | CPT | Covered |
| 15771 | CPT | Covered |
|---|
| 15772 | CPT | Covered |
|---|
| 15773 | CPT | Covered |
|---|
| 15774 | CPT | Covered |
|---|
| 15775 | CPT | Covered |
|---|
| 15776 | 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 |
|---|
| 15829 | 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 |
|---|
| 15847 | CPT | Covered |
|---|
| 15876 | CPT | Covered |
|---|
| 15877 | CPT | Covered |
|---|
| 15878 | CPT | Covered |
|---|
| 15879 | CPT | Covered |
|---|
| 17380 | CPT | Covered |
|---|
| 17999 | CPT | Covered |
|---|
| 19303 | CPT | Covered |
|---|
| 19316 | CPT | Covered |
|---|
| 19318 | CPT | Covered |
|---|
| 19325 | CPT | Covered |
|---|
| 19350 | CPT | Covered |
|---|
| 19499 | CPT | Covered |
|---|
| 21025 | CPT | Covered |
|---|
| 21120 | CPT | Covered |
|---|
| 21121 | CPT | Covered |
|---|
| 21122 | CPT | Covered |
|---|
| 21123 | CPT | Covered |
|---|
| 21125 | CPT | Covered |
|---|
| 21127 | CPT | Covered |
|---|
| 21137 | CPT | Covered |
|---|
| 21139 | CPT | Covered |
|---|
| 21141 | CPT | Covered |
|---|
| 21142 | CPT | Covered |
|---|
| 21143 | CPT | Covered |
|---|
| 21145 | CPT | Covered |
|---|
| 21146 | CPT | Covered |
|---|
| 21147 | CPT | Covered |
|---|
| 21188 | CPT | Covered |
|---|
| 21193 | CPT | Covered |
|---|
| 21194 | CPT | Covered |
|---|
| 21195 | CPT | Covered |
|---|
| 21196 | CPT | Covered |
|---|
| 21208 | CPT | Covered |
|---|
| 21209 | CPT | Covered |
|---|
| 21235 | CPT | Covered |
|---|
| 21270 | CPT | Covered |
|---|
| 21299 | CPT | Covered |
|---|
| 30400 | CPT | Covered |
|---|
| 30410 | CPT | Covered |
|---|
| 30420 | CPT | Covered |
|---|
| 30430 | CPT | Covered |
|---|
| 30435 | CPT | Covered |
|---|
| 30450 | CPT | Covered |
|---|
| 30465 | CPT | Covered |
|---|
| 31599 | CPT | Covered |
|---|
| 31750 | CPT | Covered |
|---|
| 31899 | CPT | Covered |
|---|
| 40799 | CPT | Covered |
|---|
| 53400 | CPT | Covered |
|---|
| 53405 | CPT | Covered |
|---|
| 53410 | CPT | Covered |
|---|
| 53415 | CPT | Covered |
|---|
| 53420 | CPT | Covered |
|---|
| 53425 | CPT | Covered |
|---|
| 53430 | CPT | Covered |
|---|
| 54125 | CPT | Covered |
|---|
| 54400 | CPT | Covered |
|---|
| 54401 | CPT | Covered |
|---|
| 54405 | CPT | Covered |
|---|
| 54520 | CPT | Covered |
|---|
| 54660 | CPT | Covered |
|---|
| 54690 | CPT | Covered |
|---|
| 55175 | CPT | Covered |
|---|
| 55180 | CPT | Covered |
|---|
| 55899 | CPT | Covered |
|---|
| 55970 | CPT | Covered |
|---|
| 55980 | CPT | Covered |
|---|
| 56625 | CPT | Covered |
|---|
| 56800 | CPT | Covered |
|---|
| 56805 | CPT | Covered |
|---|
| 57106 | CPT | Covered |
|---|
| 57110 | 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 |
|---|
| 58270 | CPT | Covered |
|---|
| 58275 | CPT | Covered |
|---|
| 58290 | CPT | Covered |
|---|
| 58291 | CPT | Covered |
|---|
| 58353 | CPT | Covered |
|---|
| 58356 | 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 |
|---|
| 58563 | CPT | Covered |
|---|
| 58570 | CPT | Covered |
|---|
| 58571 | CPT | Covered |
|---|
| 58572 | CPT | Covered |
|---|
| 58573 | CPT | Covered |
|---|
| 58720 | CPT | Covered |
|---|
| 58780 | CPT | Covered |
|---|
| 67900 | CPT | Covered |
|---|
| 67901 | CPT | Covered |
|---|
| 67902 | CPT | Covered |
|---|
| 67903 | CPT | Covered |
|---|
| 67904 | CPT | Covered |
|---|
| 67906 | CPT | Covered |
|---|
| 67908 | CPT | Covered |
|---|
| 67909 | CPT | Covered |
|---|
| 67950 | CPT | Covered |
|---|
| C1789 | HCPCS | Covered |
|---|
| C1813 | HCPCS | Covered |
|---|
| C2622 | HCPCS | Covered |
|---|
| L8039 | HCPCS | Covered |
|---|
| L8600 | HCPCS | Covered |
|---|
| E25.0 | ICD10CM | Covered |
|---|
| E34.50 | ICD10CM | Covered |
|---|