Does Anthem require prior authorization for CPT 93750?

Status not confirmed in our dataset. Confirm against the current Anthem clinical policy before submitting.

What documentation does Anthem require for CPT 93750?

Documentation requirements vary by case. Standard items include clinical notes, imaging or test results, history of conservative treatment, and a clear statement of medical necessity.

How much does Medicare pay for CPT 93750 in 2026?

In 2026, the national Medicare allowable for CPT 93750 is $53.11 in an office setting and $34.07 in a facility. Commercial allowables for Anthem are typically negotiated against this benchmark.

What if Anthem denies the PA for CPT 93750?

Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.

Prior Authorization

Anthem Prior Authorization for CPT 93750

In-person interrogation of ventricular assist device (heart pump) · Standard commercial plans

Status not confirmed

Source

Data pending source-document linkage. Verify against Anthem's current clinical policy before submission.

Not medical advice. PA policies change frequently. Always confirm against the payer's current policy before submitting. d3rx pulls directly from publicly published policy PDFs and refreshes daily.

We don't have a source-backed prior-authorization verdict for CPT 93750 with Anthem under Standard commercial plans yet — confirm directly with the payer. The 2026 Medicare reference rate for this code is below, and you can draft the request free in Ask D3.

2026 Medicare rate for CPT 93750

Office (non-facility)

$53.11

Facility

$34.07

Total RVUs (office)

1.59

Conversion factor

$33.4009

National Medicare Physician Fee Schedule amounts (GPCI 1.0). Anthem's commercial allowable is negotiated against this benchmark — see the full RVU and locality breakdown on the CPT 93750 code page.

How to submit the PA

1Verify the requirement against the current clinical policy linked above.
2Gather patient history, prior conservative treatment, and clinical justification.
3Submit via the payer's provider portal or designated PA channel.
4Document the reference number and follow up within 5 business days if no determination is received.

FAQ

Does Anthem require prior authorization for CPT 93750?: Status not confirmed in our dataset. Confirm against the current Anthem clinical policy before submitting.
What documentation does Anthem require for CPT 93750?: Documentation requirements vary by case. Standard items include clinical notes, imaging or test results, history of conservative treatment, and a clear statement of medical necessity.
How much does Medicare pay for CPT 93750 in 2026?: In 2026, the national Medicare allowable for CPT 93750 is $53.11 in an office setting and $34.07 in a facility. Commercial allowables for Anthem are typically negotiated against this benchmark.
What if Anthem denies the PA for CPT 93750?: Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.

Other Anthem PA lookups

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CPT 93750 prior authorization by payer

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