Regence BCBS · PayerPolicy · REGENCE-SUR218
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 |
|---|---|---|
| 58150 | CPT | Covered |
| 58152 | CPT | Covered |
| 58180 | CPT | Covered |
| 58260 | CPT | Covered |
| 58262 | CPT | Covered |
| 58267 | CPT | Covered |
| 58270 | CPT | Covered |
| 58275 | CPT | Covered |
| 58280 | CPT | Covered |
| 58290 | CPT | Covered |
| 58291 | CPT | Covered |
| 58292 | CPT | Covered |
| 58294 | 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 |
| A18.17 | ICD10CM | Covered |
| A54.24 | ICD10CM | Covered |
| A54.85 | ICD10CM | Covered |
| A56.11 | ICD10CM | Covered |
| A74.81 | ICD10CM | Covered |
| D06.0 | ICD10CM | Covered |
| D06.1 | ICD10CM | Covered |
| D06.7 | ICD10CM | Covered |
| D06.9 | ICD10CM | Covered |
| D21.9 | ICD10CM | Covered |
| D25.0 | ICD10CM | Covered |
| D25.1 | ICD10CM | Covered |
| D25.2 | ICD10CM | Covered |
| D25.9 | ICD10CM | Covered |
| G89.29 | ICD10CM | Covered |
| K66.0 | ICD10CM | Covered |
| N70.01 | ICD10CM | Covered |
| N70.02 | ICD10CM | Covered |
| N70.03 | ICD10CM | Covered |
| N70.11 | ICD10CM | Covered |
| N70.12 | ICD10CM | Covered |
| N70.13 | ICD10CM | Covered |
| N70.91 | ICD10CM | Covered |
| N70.92 | ICD10CM | Covered |
| N70.93 | ICD10CM | Covered |
| N71.0 | ICD10CM | Covered |
| N71.1 | ICD10CM | Covered |
| N71.9 | ICD10CM | Covered |
| N72 | ICD10CM | Covered |
| N73.0 | ICD10CM | Covered |
| N73.1 | ICD10CM | Covered |
| N73.2 | ICD10CM | Covered |
| N73.3 | ICD10CM | Covered |
| N73.4 | ICD10CM | Covered |
| N73.5 | ICD10CM | Covered |
| N73.6 | ICD10CM | Covered |
| N73.8 | ICD10CM | Covered |
| N73.9 | ICD10CM | Covered |
| N74 | ICD10CM | Covered |
| N80.00 | ICD10CM | Covered |
| N80.01 | ICD10CM | Covered |
| N80.02 | ICD10CM | Covered |
| N80.03 | ICD10CM | Covered |
| N80.101 | ICD10CM | Covered |
| N80.102 | ICD10CM | Covered |
| N80.103 | ICD10CM | Covered |
| N80.109 | ICD10CM | Covered |
| N80.111 | ICD10CM | Covered |
| N80.112 | ICD10CM | Covered |
| N80.113 | ICD10CM | Covered |
| N80.119 | ICD10CM | Covered |
| N80.121 | ICD10CM | Covered |
| N80.122 | ICD10CM | Covered |
| N80.123 | ICD10CM | Covered |
| N80.129 | ICD10CM | Covered |
| N80.201 | ICD10CM | Covered |
| N80.202 | ICD10CM | Covered |
| N80.203 | ICD10CM | Covered |
| N80.209 | ICD10CM | Covered |
| N80.211 | ICD10CM | Covered |
| N80.212 | ICD10CM | Covered |
| N80.213 | ICD10CM | Covered |
| N80.219 | ICD10CM | Covered |
| N80.221 | ICD10CM | Covered |
| N80.222 | ICD10CM | Covered |
| N80.223 | ICD10CM | Covered |
| N80.229 | ICD10CM | Covered |
| N80.30 | ICD10CM | Covered |
| N80.311 | ICD10CM | Covered |
| N80.312 | ICD10CM | Covered |
| N80.319 | ICD10CM | Covered |
| N80.321 | ICD10CM | Covered |
| N80.322 | ICD10CM | Covered |
| N80.329 | ICD10CM | Covered |
| N80.331 | ICD10CM | Covered |
| N80.332 | ICD10CM | Covered |
| N80.333 | ICD10CM | Covered |
| N80.339 | ICD10CM | Covered |
| N80.341 | ICD10CM | Covered |
| N80.342 | ICD10CM | Covered |
| N80.343 | ICD10CM | Covered |
| N80.349 | ICD10CM | Covered |
| N80.351 | ICD10CM | Covered |
| N80.352 | ICD10CM | Covered |
| N80.353 | ICD10CM | Covered |
| N80.359 | ICD10CM | Covered |
| N80.361 | ICD10CM | Covered |
| N80.362 | ICD10CM | Covered |
| N80.363 | ICD10CM | Covered |
| N80.369 | ICD10CM | Covered |
| N80.371 | ICD10CM | Covered |
| N80.372 | ICD10CM | Covered |
| N80.373 | ICD10CM | Covered |
| N80.379 | ICD10CM | Covered |
| N80.381 | ICD10CM | Covered |
| N80.382 | ICD10CM | Covered |
| N80.383 | ICD10CM | Covered |
| N80.389 | ICD10CM | Covered |
| N80.391 | ICD10CM | Covered |
| N80.392 | ICD10CM | Covered |
| N80.399 | ICD10CM | Covered |
| N80.3A1 | ICD10CM | Covered |
| N80.3A2 | ICD10CM | Covered |
| N80.3A3 | ICD10CM | Covered |
| N80.3A9 | ICD10CM | Covered |
| N80.3B1 | ICD10CM | Covered |
| N80.3B2 | ICD10CM | Covered |
| N80.3B3 | ICD10CM | Covered |
| N80.3B9 | ICD10CM | Covered |
| N80.3C1 | ICD10CM | Covered |
| N80.3C2 | ICD10CM | Covered |
| N80.3C3 | ICD10CM | Covered |
| N80.3C9 | ICD10CM | Covered |
| N80.40 | ICD10CM | Covered |
| N80.41 | ICD10CM | Covered |
| N80.42 | ICD10CM | Covered |
| N80.50 | ICD10CM | Covered |
| N80.511 | ICD10CM | Covered |
| N80.512 | ICD10CM | Covered |
| N80.519 | ICD10CM | Covered |
| N80.521 | ICD10CM | Covered |
| N80.522 | ICD10CM | Covered |
| N80.529 | ICD10CM | Covered |
| N80.531 | ICD10CM | Covered |
| N80.532 | ICD10CM | Covered |
| N80.539 | ICD10CM | Covered |
| N80.541 | ICD10CM | Covered |
| N80.542 | ICD10CM | Covered |
| N80.549 | ICD10CM | Covered |
| N80.551 | ICD10CM | Covered |
| N80.552 | ICD10CM | Covered |
| N80.559 | ICD10CM | Covered |
| N80.562 | ICD10CM | Covered |
| N80.569 | ICD10CM | Covered |
| N80.6 | ICD10CM | Covered |
| N80.8 | ICD10CM | Covered |
| N80.9 | ICD10CM | Covered |
| N80.A0 | ICD10CM | Covered |
| N80.A1 | ICD10CM | Covered |
| N80.A2 | ICD10CM | Covered |
| N80.A41 | ICD10CM | Covered |
| N80.A42 | ICD10CM | Covered |
| N80.A43 | ICD10CM | Covered |
| N80.A49 | ICD10CM | Covered |
| N80.A51 | ICD10CM | Covered |
| N80.A52 | ICD10CM | Covered |
| N80.A53 | ICD10CM | Covered |
| N80.A59 | ICD10CM | Covered |
| N80.A61 | ICD10CM | Covered |
| N80.A62 | ICD10CM | Covered |
| N80.A63 | ICD10CM | Covered |
| N80.A69 | ICD10CM | Covered |
| N80.B1 | ICD10CM | Covered |
| N80.B2 | ICD10CM | Covered |
| N80.B31 | ICD10CM | Covered |
| N80.B32 | ICD10CM | Covered |
| N80.B39 | ICD10CM | Covered |
| N80.B4 | ICD10CM | Covered |
| N80.B5 | ICD10CM | Covered |
| N80.B6 | ICD10CM | Covered |
| N80.C0 | ICD10CM | Covered |
| N80.C10 | ICD10CM | Covered |
| N80.C11 | ICD10CM | Covered |
| N80.C19 | ICD10CM | Covered |
| N80.C2 | ICD10CM | Covered |
| N80.C3 | ICD10CM | Covered |
| N80.C4 | ICD10CM | Covered |
| N80.C9 | ICD10CM | Covered |
| N80.D0 | ICD10CM | Covered |
| N80.D1 | ICD10CM | Covered |
| N80.D2 | ICD10CM | Covered |
| N80.D3 | ICD10CM | Covered |
| N80.D4 | ICD10CM | Covered |
| N80.D5 | ICD10CM | Covered |
| N80.D6 | ICD10CM | Covered |
| N80.D9 | ICD10CM | Covered |
| N83.6 | ICD10CM | Covered |
| N83.7 | ICD10CM | Covered |
| N87.0 | ICD10CM | Covered |
| N87.1 | ICD10CM | Covered |
| N87.9 | ICD10CM | Covered |
| N92.0 | ICD10CM | Covered |
| N92.1 | ICD10CM | Covered |
| N92.3 | ICD10CM | Covered |
| N92.4 | ICD10CM | Covered |
| N92.5 | ICD10CM | Covered |
| N92.6 | ICD10CM | Covered |
| N93.0 | ICD10CM | Covered |
| N93.8 | ICD10CM | Covered |
| N93.9 | ICD10CM | Covered |
| N94.0 | ICD10CM | Covered |
| N94.10 | ICD10CM | Covered |
| N94.11 | ICD10CM | Covered |
| N94.12 | ICD10CM | Covered |
| N94.19 | ICD10CM | Covered |
| N94.4 | ICD10CM | Covered |
| N94.5 | ICD10CM | Covered |
| N94.6 | ICD10CM | Covered |
| N94.89 | ICD10CM | Covered |
| N94.9 | ICD10CM | Covered |
| N95.0 | ICD10CM | Covered |
| N99.4 | ICD10CM | Covered |
| R10.2 | ICD10CM | Covered |
| R87.610 | ICD10CM | Covered |
| R87.611 | ICD10CM | Covered |
| R87.612 | ICD10CM | Covered |
| R87.613 | ICD10CM | Covered |
| R87.619 | ICD10CM | Covered |
| R87.810 | ICD10CM | Covered |