00402 CPT® code: payer coverage and prior authorization00402 appears in 4 coverage policies from Anthem, Blue Cross & Blue Shield of Mississippi, BlueCross BlueShield of South Carolina.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Anthem | Anesthesia Services and Moderate (“Conscious”) Sedation (CG-MED-21) | covered if criteria are met (range 00400-00474) | Nov 6, 2025 | payer document |
| Blue Cross & Blue Shield of Mississippi | Augmentation Mammoplasty (L.7.01.403) | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Breast Reconstruction Following Mastectomy (L.7.01.424) | covered if criteria are met | payer document | |
| BlueCross BlueShield of South Carolina | Breast Surgical Procedures/Prosthesis (CAM 079) | listed, no stance | Sep 1, 2026 | payer document |
Prior authorization required or conditional in WA.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.