Anthem Blue Cross and Blue Shield Virginia prior authorization, page 33

CPT code lookup

Each row is one code from the public prior authorization list. The description is the procedure or service name on that source row. This is not a coverage decision.

Prior authorization codes

Prior authorization codes
Code	Description	Source
82664	Electrophoretic Technique, Not Elsewhere Specified	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 39 Original policy
82668	Erythropoietin	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 39 Original policy
82670	Estradiol; total	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 39 Original policy
82671	Estrogens; Fractionated	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 39 Original policy
82672	Estrogens; Total	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 39 Original policy
82677	Estriol	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 39 Original policy
82679	Estrone	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 39 Original policy
82693	Ethylene Glycol	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 39 Original policy
82696	Etiocholanolone	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 39 Original policy
82705	Fat/Lipids, Feces; Qualitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 39 Original policy
82710	Fat/Lipids, Feces; Quantitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 39 Original policy
82715	Fat Differential, Feces, Quantitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 39 Original policy
82725	Fatty Acids, Nonesterified	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 39 Original policy
82726	Very Long Chain Fatty Acids	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 39 Original policy
82728	Ferritin	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 39 Original policy
82731	Fetal Fibronectin, Cervicovaginal Secretions, Semi-Quantitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 39 Original policy
82735	Fluoride	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 39 Original policy
82746	Folic Acid; Serum	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 39 Original policy
82747	Folic Acid; Rbc	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 40 Original policy
82757	Fructose, Semen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 40 Original policy
82759	Galactokinase, Rbc	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 40 Original policy
82760	Galactose	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 40 Original policy
82775	Galactose-1-Phosphate Uridyl Transferase; Quantitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 40 Original policy
83873	Myelin Basic Protein, Csf	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
83874	Myoglobin	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
83876	Myeloperoxidase (MPO)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
83880	Natriuretic Peptide	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
83883	Nephelometry, Each Analyte Not Elsewhere Specified	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
83884	Neurofilament light chain	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
83885	Nickel	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
83915	Nucleotidase 5	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
83916	Oligoclonal Immunoglobulin (Oligoclonal Bands)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
83918	Organic Acids; Total, Quantitative, Each Specimen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
83919	Organic Acids; Qualitative, Each Specimen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
83921	Organic Acid, Single, Quantitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
83930	Osmolality; Blood	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
83935	Osmolality; Urine	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
83937	Osteocalcin (Bone G1a Protein)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
83945	Oxalate	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
83950	Oncoprotein; HER-2/neu	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
83951	Oncoprotein; des-gamma-carboxy-prothrombin (DCP)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
83970	Parathormone (Parathyroid Hormone)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
83986	pH; body fluid, not otherwise specified	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
83992	Phencyclidine (Pcp)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
83993	Calprotectin, fecal	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84030	Phenylalanine (Pku), Blood	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84035	Phenylketones, Qualitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84060	Phosphatase, Acid; Total	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84066	Phosphatase, Acid; Prostatic	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84075	Phosphatase, Alkaline	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy

Sources

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.