Anthem Blue Cross and Blue Shield Virginia prior authorization, page 34

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
84078	Phosphatase, Alkaline; Heat Stable (Total Not Included)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84080	Phosphatase, Alkaline; Isoenzymes	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84081	Phosphatidylglycerol	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84085	Phosphogluconate, 6-, Dehydrogenase, Rbc	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84087	Phosphohexose Isomerase	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84100	Phosphorus Inorganic (Phosphate)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84105	Phosphorus Inorganic (Phosphate); Urine	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84106	Porphobilinogen, Urine; Qualitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84110	Porphobilinogen, Urine; Quantitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84112	Evaluation of cervicovaginal fluid for specific amniotic fluid protein(s) (eg, placental alpha microglobulin-1 [PAMG-1], placental protein 12 [PP12], alpha-fetoprotein), quali	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84119	Porphyrins, Urine; Qualitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84120	Porphyrins, Urine; Quantitation & Fractionation	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84126	Porphyrins, Feces; Quantitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84132	Potassium; serum, plasma or whole blood	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84133	Potassium; Urine	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84134	Prealbumin	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84135	Pregnanediol	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84138	Pregnanetriol	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84140	Pregnenolone	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84143	17-Hydroxypregnenolone	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84144	Progesterone	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84145	Procalcitonin (PCT)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84146	Prolactin	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84150	Prostaglandin, Each	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84152	Prostate Specific Antigen (Psa); Complexed (Direct Measurement)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84153	Prostate Specific Antigen (Psa); Total	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 42 Original policy
84154	Prostate Specific Antigen (Psa); Free	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84155	Protein, total, except by refractometry; serum, plasma or whole blood	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84156	Protein, Total, Except By Refractometry; Urine	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84157	Protein, Total, Except By Refractometry; Other Source (Eg, Synovial Fluid, Cerebrospinal Fluid)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84160	Protein; Refractometric	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84163	Pregnancy-Associated Plasma Protein-A (Papp-A)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84165	Protein; Electrophoretic Fractionation & Quantitation	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84166	Protein; Electrophoretic Fractionation And Quantitation, Other Fluids With Concentration (Eg, Urine, Csf)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84181	Protein; Western Blot, W/Interpretation & Report, Blood/Other Body Fluid	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84182	Protein; Western Blot, W/Interpretation & Report, W/Immunological Probe, Each	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84202	Protoporphyrin, Rbc; Quantitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84203	Protoporphyrin, Rbc; Screen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84206	Proinsulin	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84207	Pyridoxal Phosphate (Vitamin B-6)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84210	Pyruvate	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84220	Pyruvate Kinase	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84228	Quinine	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84233	Receptor Assay; Estrogen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84234	Receptor Assay; Progesterone	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84235	Receptor Assay; Endocrine, Other Than Estrogen/Progesterone (Specify Hormone)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84238	Receptor assay; non-endocrine (specify receptor)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84244	Renin	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84252	Riboflavin (Vitamin B-2)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84255	Selenium	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 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.