Anthem Blue Cross and Blue Shield Virginia policy
HEDIS ECDS Coding Booklet 2024 - Medicare
HEDIS ECDS Coding Booklet 2024 - Medicare is a public Anthem Blue Cross and Blue Shield Virginia policy (policy MULTI-BCBS-CR-048500-23-CPN48308). It lists 466 CPT or HCPCS codes, 49 of them on the Anthem Blue Cross and Blue Shield Virginia prior authorization list. Not a coverage decision; the payer's own document governs.
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- Policy number
- MULTI-BCBS-CR-048500-23-CPN48308
- States
- CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, VA, WI
- Source
- www.anthem.com
Codes in this policy
The CPT and HCPCS codes the policy names. A policy can name a code it excludes. Prior authorization status is from the Anthem Blue Cross and Blue Shield Virginia prior authorization list.
| Code | Prior authorization | Description on the prior authorization list | Other Anthem Blue Cross and Blue Shield Virginia policies |
|---|---|---|---|
| 10450 | Not listed | Policies naming 10450 | |
| 10524 | Not listed | Policies naming 10524 | |
| 12503 | Not listed | Policies naming 12503 | |
| 12504 | Not listed | Policies naming 12504 | |
| 12773 | Not listed | Policies naming 12773 | |
| 13457 | Not listed | Policies naming 13457 | |
| 14563 | Not listed | Policies naming 14563 | |
| 14564 | Not listed | Policies naming 14564 | |
| 14565 | Not listed | Policies naming 14565 | |
| 17037 | Not listed | Policies naming 17037 | |
| 17855 | Not listed | Policies naming 17855 | |
| 17856 | Not listed | Policies naming 17856 | |
| 17865 | Not listed | Policies naming 17865 | |
| 18261 | Not listed | Policies naming 18261 | |
| 18262 | Not listed | Policies naming 18262 | |
| 18500 | Not listed | Policies naming 18500 | |
| 19762 | Not listed | Policies naming 19762 | |
| 19764 | Not listed | Policies naming 19764 | |
| 19765 | Not listed | Policies naming 19765 | |
| 19766 | Not listed | Policies naming 19766 | |
| 19774 | Not listed | Policies naming 19774 | |
| 20436 | Not listed | Policies naming 20436 | |
| 20437 | Not listed | Policies naming 20437 | |
| 20438 | Not listed | Policies naming 20438 | |
| 20440 | Not listed | Policies naming 20440 | |
| 21440 | Not listed | Policies naming 21440 | |
| 24604 | Not listed | Policies naming 24604 | |
| 24605 | Not listed | Policies naming 24605 | |
| 24606 | Not listed | Policies naming 24606 | |
| 24610 | Not listed | Policies naming 24610 | |
| 26175 | Not listed | Policies naming 26175 | |
| 26176 | Not listed | Policies naming 26176 | |
| 26177 | Not listed | Policies naming 26177 | |
| 26287 | Not listed | Policies naming 26287 | |
| 26289 | Not listed | Policies naming 26289 | |
| 26291 | Not listed | Policies naming 26291 | |
| 26346 | Not listed | Policies naming 26346 | |
| 26347 | Not listed | Policies naming 26347 | |
| 26348 | Not listed | Policies naming 26348 | |
| 26349 | Not listed | Policies naming 26349 | |
| 26350 | Not listed | Policies naming 26350 | |
| 26351 | Not listed | Policies naming 26351 | |
| 26554 | Not listed | Policies naming 26554 | |
| 27396 | Not listed | Policies naming 27396 | |
| 27401 | Not listed | Policies naming 27401 | |
| 27925 | Not listed | Policies naming 27925 | |
| 27926 | Not listed | Policies naming 27926 | |
| 29771 | Not listed | Policies naming 29771 | |
| 30167 | Not listed | Policies naming 30167 | |
| 3044F | Not listed | Policies naming 3044F | |
| 3046F | Not listed | Policies naming 3046F | |
| 3048F | Not listed | Policies naming 3048F | |
| 3049F | Not listed | Policies naming 3049F | |
| 3050F | Not listed | Policies naming 3050F | |
| 3051F | Not listed | Policies naming 3051F | |
| 3052F | Not listed | Policies naming 3052F | |
| 33717 | Not listed | Policies naming 33717 | |
| 36319 | Not listed | Policies naming 36319 | |
| 36625 | Not listed | Policies naming 36625 | |
| 36626 | Not listed | Policies naming 36626 | |
| 36627 | Not listed | Policies naming 36627 | |
| 36642 | Not listed | Policies naming 36642 | |
| 36962 | Not listed | Policies naming 36962 | |
| 37005 | Not listed | Policies naming 37005 | |
| 37006 | Not listed | Policies naming 37006 | |
| 37016 | Not listed | Policies naming 37016 | |
| 37017 | Not listed | Policies naming 37017 | |
| 37028 | Not listed | Policies naming 37028 | |
| 37029 | Not listed | Policies naming 37029 | |
| 37030 | Not listed | Policies naming 37030 | |
| 37037 | Not listed | Policies naming 37037 | |
| 37038 | Not listed | Policies naming 37038 | |
| 37052 | Not listed | Policies naming 37052 | |
| 37053 | Not listed | Policies naming 37053 | |
| 37539 | Not listed | Policies naming 37539 | |
| 37542 | Not listed | Policies naming 37542 | |
| 37543 | Not listed | Policies naming 37543 | |
| 37551 | Not listed | Policies naming 37551 | |
| 37552 | Not listed | Policies naming 37552 | |
| 37553 | Not listed | Policies naming 37553 | |
| 37554 | Not listed | Policies naming 37554 | |
| 37768 | Not listed | Policies naming 37768 | |
| 37769 | Not listed | Policies naming 37769 | |
| 37770 | Not listed | Policies naming 37770 | |
| 37771 | Not listed | Policies naming 37771 | |
| 37772 | Not listed | Policies naming 37772 | |
| 37773 | Not listed | Policies naming 37773 | |
| 37774 | Not listed | Policies naming 37774 | |
| 37775 | Not listed | Policies naming 37775 | |
| 38070 | Not listed | Policies naming 38070 | |
| 38071 | Not listed | Policies naming 38071 | |
| 38072 | Not listed | Policies naming 38072 | |
| 38090 | Not listed | Policies naming 38090 | |
| 38091 | Not listed | Policies naming 38091 | |
| 38372 | Not listed | Policies naming 38372 | |
| 38807 | Not listed | Policies naming 38807 | |
| 38820 | Not listed | Policies naming 38820 | |
| 38854 | Not listed | Policies naming 38854 | |
| 38855 | Not listed | Policies naming 38855 | |
| 39150 | Not listed | Policies naming 39150 | |
| 39152 | Not listed | Policies naming 39152 | |
| 39153 | Not listed | Policies naming 39153 | |
| 39154 | Not listed | Policies naming 39154 | |
| 41024 | Not listed | Policies naming 41024 | |
| 42168 | Not listed | Policies naming 42168 | |
| 42169 | Not listed | Policies naming 42169 | |
| 42174 | Not listed | Policies naming 42174 | |
| 42415 | Not listed | Policies naming 42415 | |
| 42416 | Not listed | Policies naming 42416 | |
| 44261 | Not listed | Policies naming 44261 | |
| 44388 | Not listed | Policies naming 44388 | |
| 44389 | Not listed | Policies naming 44389 | |
| 44390 | Not listed | Policies naming 44390 | |
| 44391 | Not listed | Policies naming 44391 | |
| 44392 | Not listed | Policies naming 44392 | |
| 44394 | Not listed | Policies naming 44394 | |
| 44401 | Not listed | Policies naming 44401 | |
| 44402 | Not listed | Policies naming 44402 | |
| 44403 | Not listed | Policies naming 44403 | |
| 44404 | Not listed | Policies naming 44404 | |
| 44405 | Not listed | Policies naming 44405 | |
| 44406 | Not listed | Policies naming 44406 | |
| 44407 | Not listed | Policies naming 44407 | |
| 44408 | Not listed | Policies naming 44408 | |
| 45330 | Not listed | Policies naming 45330 | |
| 45331 | Not listed | Policies naming 45331 | |
| 45332 | Not listed | Policies naming 45332 | |
| 45333 | Not listed | Policies naming 45333 | |
| 45334 | Not listed | Policies naming 45334 | |
| 45335 | Not listed | Policies naming 45335 | |
| 45337 | Not listed | Policies naming 45337 | |
| 45338 | Not listed | Policies naming 45338 | |
| 45340 | Not listed | Policies naming 45340 | |
| 45341 | Not listed | Policies naming 45341 | |
| 45342 | Not listed | Policies naming 45342 | |
| 45346 | Not listed | Policies naming 45346 | |
| 45347 | Not listed | Policies naming 45347 | |
| 45349 | Not listed | Policies naming 45349 | |
| 45350 | Not listed | Policies naming 45350 | |
| 45378 | Not listed | Policies naming 45378 | |
| 45379 | Not listed | Policies naming 45379 | |
| 45380 | Not listed | Policies naming 45380 | |
| 45381 | Not listed | Policies naming 45381 | |
| 45382 | Not listed | Policies naming 45382 | |
| 45384 | Not listed | Policies naming 45384 | |
| 45385 | Not listed | Policies naming 45385 | |
| 45386 | Not listed | Policies naming 45386 | |
| 45388 | Not listed | Policies naming 45388 | |
| 45389 | Not listed | Policies naming 45389 | |
| 45390 | Not listed | Policies naming 45390 | |
| 45391 | Not listed | Policies naming 45391 | |
| 45392 | Not listed | Policies naming 45392 | |
| 45393 | Not listed | Policies naming 45393 | |
| 45398 | Not listed | Policies naming 45398 | |
| 46335 | Not listed | Policies naming 46335 | |
| 46336 | Not listed | Policies naming 46336 | |
| 46337 | Not listed | Policies naming 46337 | |
| 46338 | Not listed | Policies naming 46338 | |
| 46339 | Not listed | Policies naming 46339 | |
| 46342 | Not listed | Policies naming 46342 | |
| 46350 | Not listed | Policies naming 46350 | |
| 46351 | Not listed | Policies naming 46351 | |
| 46354 | Not listed | Policies naming 46354 | |
| 46355 | Not listed | Policies naming 46355 | |
| 46356 | Not listed | Policies naming 46356 | |
| 46380 | Not listed | Policies naming 46380 | |
| 47527 | Not listed | Policies naming 47527 | |
| 47528 | Not listed | Policies naming 47528 | |
| 48475 | Not listed | Policies naming 48475 | |
| 48492 | Not listed | Policies naming 48492 | |
| 48544 | Not listed | Policies naming 48544 | |
| 48545 | Not listed | Policies naming 48545 | |
| 49132 | Not listed | Policies naming 49132 | |
| 49134 | Not listed | Policies naming 49134 | |
| 55440 | Not listed | Policies naming 55440 | |
| 55758 | Not listed | Policies naming 55758 | |
| 56490 | Not listed | Policies naming 56490 | |
| 56491 | Not listed | Policies naming 56491 | |
| 57905 | Not listed | Policies naming 57905 | |
| 58453 | Not listed | Policies naming 58453 | |
| 59263 | Not listed | Policies naming 59263 | |
| 59264 | Not listed | Policies naming 59264 | |
| 59420 | Not listed | Policies naming 59420 | |
| 60515 | Not listed | Policies naming 60515 | |
| 69002 | Not listed | Policies naming 69002 | |
| 69150 | Not listed | Policies naming 69150 | |
| 69251 | Not listed | Policies naming 69251 | |
| 69259 | Not listed | Policies naming 69259 | |
| 71354 | Not listed | Policies naming 71354 | |
| 71431 | Not listed | Policies naming 71431 | |
| 71777 | Not listed | Policies naming 71777 | |
| 71802 | Not listed | Policies naming 71802 | |
| 71965 | Not listed | Policies naming 71965 | |
| 72137 | Not listed | Policies naming 72137 | |
| 72138 | Not listed | Policies naming 72138 | |
| 72139 | Not listed | Policies naming 72139 | |
| 72140 | Not listed | Policies naming 72140 | |
| 72141 | On the list | Mri, Cervical Spine; W/O Contrast | Policies naming 72141 |
| 72142 | On the list | Mri, Cervical Spine; W/Contrast | Policies naming 72142 |
| 72531 | Not listed | Policies naming 72531 | |
| 74261 | On the list | Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material | Policies naming 74261 |
| 74262 | On the list | Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including | Policies naming 74262 |
| 74263 | On the list | Computed tomographic (CT) colonography, screening, including image postprocessing | Policies naming 74263 |
| 75624 | Not listed | Policies naming 75624 | |
| 75626 | Not listed | Policies naming 75626 | |
| 75694 | Not listed | Policies naming 75694 | |
| 75889 | Not listed | Policies naming 75889 | |
| 77061 | Not listed | Policies naming 77061 | |
| 77062 | Not listed | Policies naming 77062 | |
| 77063 | Not listed | Policies naming 77063 | |
| 77065 | Not listed | Policies naming 77065 | |
| 77066 | Not listed | Policies naming 77066 | |
| 77067 | Not listed | Policies naming 77067 | |
| 77353 | Not listed | Policies naming 77353 | |
| 77354 | Not listed | Policies naming 77354 | |
| 77379 | Not listed | Policies naming 77379 | |
| 77399 | Not listed | Policies naming 77399 | |
| 77400 | Not listed | Policies naming 77400 | |
| 79069 | Not listed | Policies naming 79069 | |
| 79071 | Not listed | Policies naming 79071 | |
| 79101 | On the list | Radiopharmaceutical Therapy, By Intravenous Administration | Policies naming 79101 |
| 80047 | On the list | Basic metabolic panel (Calcium, ionized) This panel must include the following: Calcium, ionized (82330) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (8256 | Policies naming 80047 |
| 80048 | On the list | Basic metabolic panel (Calcium, total) This panel must include the following: Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) G | Policies naming 80048 |
| 80050 | On the list | General Health Panel | Policies naming 80050 |
| 80053 | On the list | Comprehensive metabolic panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Calcium, t | Policies naming 80053 |
| 80061 | On the list | Lipid Panel | Policies naming 80061 |
| 80069 | On the list | Renal function panel This panel must include the following: Albumin (82040) Calcium, total (82310) Carbon dioxide (bicar | Policies naming 80069 |
| 80372 | Not listed | Policies naming 80372 | |
| 81528 | Not listed | Policies naming 81528 | |
| 82270 | On the list | Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (ie, patie | Policies naming 82270 |
| 82274 | On the list | Blood, Occult, Fecal Hemoglobin Determin, Immunoassay, Qualitative, Feces, 1-3 Simultan Determin | Policies naming 82274 |
| 82354 | Not listed | Policies naming 82354 | |
| 82456 | Not listed | Policies naming 82456 | |
| 82465 | On the list | Cholesterol, Serum/Whole Blood, Total | Policies naming 82465 |
| 82675 | Not listed | Policies naming 82675 | |
| 82688 | Not listed | Policies naming 82688 | |
| 82947 | Not listed | Policies naming 82947 | |
| 82950 | Not listed | Policies naming 82950 | |
| 82951 | Not listed | Policies naming 82951 | |
| 83036 | Not listed | Policies naming 83036 | |
| 83037 | Not listed | Policies naming 83037 | |
| 83700 | On the list | Lipoprotein, blood; electrophoretic separation and | Policies naming 83700 |
| 83701 | On the list | Lipoprotein, blood; high resolution fractionation and quantitation of lipoproteins including lipoprotein subclasses when | Policies naming 83701 |
| 83704 | On the list | Lipoprotein, blood; quantitation of lipoprotein particle number(s) (eg, by nuclear magnetic resonance spectroscopy), includes lipoprotein particle subclass(es), when performed | Policies naming 83704 |
| 83718 | Not listed | Policies naming 83718 | |
| 83721 | Not listed | Policies naming 83721 | |
| 83722 | Not listed | Policies naming 83722 | |
| 84478 | On the list | Triglycerides | Policies naming 84478 |
| 86462 | Not listed | Policies naming 86462 | |
| 86463 | Not listed | Policies naming 86463 | |
| 87624 | On the list | Human Papillomavirus (HPV), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68), pooled result | Policies naming 87624 |
| 87625 | On the list | Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), types 16 and 18 only, includes type 45, if performed | Policies naming 87625 |
| 88037 | On the list | Necropsy (Autopsy), Limited, Gross &/Or Microscopic; Single Organ | Policies naming 88037 |
| 88122 | Not listed | Policies naming 88122 | |
| 88123 | Not listed | Policies naming 88123 | |
| 88124 | Not listed | Policies naming 88124 | |
| 88141 | On the list | Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician | Policies naming 88141 |
| 88142 | On the list | Cytopathology, Cervical/Vaginal, Preservative Fluid, Auto Thin Layer Prep; Manual Screen | Policies naming 88142 |
| 88143 | On the list | Cytopathology, Cervical/Vaginal, Preservative Fluid, Auto Thin Layer Prep; Manual Screen/Rescreen | Policies naming 88143 |
| 88147 | On the list | Cytopathology, Cervical/Vaginal; Automated Screen | Policies naming 88147 |
| 88148 | On the list | Cytopathology, Cervical/Vaginal; Automated Screen, Manual Rescreen | Policies naming 88148 |
| 88150 | On the list | Cytopathology, Slides, Cervical/Vaginal; Manual Screen | Policies naming 88150 |
| 88152 | On the list | Cytopathology, Slides, Cervical/Vaginal; Manual Screen, Computer Rescreen | Policies naming 88152 |
| 88153 | On the list | Cytopathology, Slides, Cervical/Vaginal; Manual Screen/Rescreen | Policies naming 88153 |
| 88164 | On the list | Cytopathology, Slides, Cervical/Vaginal, Bethesda; Manual Screen | Policies naming 88164 |
| 88165 | On the list | Cytopathology, Slides, Cervical/Vaginal, Bethesda; W/Manual Screen & Rescreen | Policies naming 88165 |
| 88166 | On the list | Cytopathology, Slides, Cervical/Vaginal, Bethesda; W/Manual Screen & Computer Rescreen | Policies naming 88166 |
| 88167 | On the list | Cytopathology, Slides, Cervical/Vaginal, Bethesda; Manual Screen, Computer Rescreen, Cell Selection | Policies naming 88167 |
| 88174 | On the list | Cytopathology, Cervical/Vaginal, Auto Thin Layer Prep; Auto Screen, W/Phys Interp | Policies naming 88174 |
| 88175 | On the list | Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer prepara | Policies naming 88175 |
| 89204 | Not listed | Policies naming 89204 | |
| 89205 | Not listed | Policies naming 89205 | |
| 89208 | Not listed | Policies naming 89208 | |
| 89209 | Not listed | Policies naming 89209 | |
| 89569 | Not listed | Policies naming 89569 | |
| 90221 | Not listed | Policies naming 90221 | |
| 90619 | Not listed | Policies naming 90619 | |
| 90630 | Not listed | Policies naming 90630 | |
| 90633 | Not listed | Policies naming 90633 | |
| 90644 | Not listed | Policies naming 90644 | |
| 90647 | Not listed | Policies naming 90647 | |
| 90648 | Not listed | Policies naming 90648 | |
| 90649 | Not listed | Policies naming 90649 | |
| 90650 | Not listed | Policies naming 90650 | |
| 90651 | Not listed | Policies naming 90651 | |
| 90653 | Not listed | Policies naming 90653 | |
| 90654 | Not listed | Policies naming 90654 | |
| 90655 | Not listed | Policies naming 90655 | |
| 90656 | Not listed | Policies naming 90656 | |
| 90657 | Not listed | Policies naming 90657 | |
| 90658 | Not listed | Policies naming 90658 | |
| 90660 | Not listed | Policies naming 90660 | |
| 90661 | Not listed | Policies naming 90661 | |
| 90662 | Not listed | Policies naming 90662 | |
| 90670 | Not listed | Policies naming 90670 | |
| 90671 | Not listed | Policies naming 90671 | |
| 90672 | Not listed | Policies naming 90672 | |
| 90673 | Not listed | Policies naming 90673 | |
| 90674 | Not listed | Policies naming 90674 | |
| 90677 | Not listed | Policies naming 90677 |
And 166 more in the original policy.
All Anthem Blue Cross and Blue Shield Virginia policies · Anthem Blue Cross and Blue Shield Virginia prior authorization CPT list