Anthem Blue Cross and Blue Shield Virginia prior authorization, page 35

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
84260	Serotonin	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84270	Sex Hormone Binding Globulin (Shbg)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84275	Sialic Acid	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84285	Silica	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84295	Sodium; serum, plasma or whole blood	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84300	Sodium; Urine	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84302	Sodium; Other Source	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84305	Somatomedin	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84307	Somatostatin	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84311	Spectrophotometry, Analyte Not Elsewhere Specified	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84315	Specific Gravity (Except Urine)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84375	Sugars, Chromatographic, Tlc/Paper Chromatography	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84376	Sugars (Mono, Di, & Oligosaccharides); Single Qualitative, Each Specimen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84377	Sugars (Mono, Di, & Oligosaccharides); Multiple Qualitative, Each Specimen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84378	Sugars (Mono, Di, & Oligosaccharides); Single Quantitative, Each Specimen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84379	Sugars (Mono, Di, & Oligosaccharides); Multiple Quantitative, Each Specimen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84392	Sulfate, Urine	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84393	Tau, phosphorylated	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84394	Tau, total	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84402	Testosterone; Free	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84403	Testosterone; Total	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84410	Testosterone; bioavailable, direct meansurement (eg, differential precipitation)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84425	Thiamine (Vitamin B-1)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84430	Thiocyanate	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84431	Thromboxane metabolite(s), including thromboxane if performed, urine	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84432	Thyroglobulin	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84436	Thyroxine; Total	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84437	Thyroxine; Requiring Elution	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84439	Thyroxine; Free	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84442	Thyroxine Binding Globulin (Tbg)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84443	Thyroid Stimulating Hormone (Tsh)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84445	Thyroid Stimulating Immunoglobulins (Tsi)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 43 Original policy
84446	Tocopherol Alpha (Vitamin E)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84449	Transcortin (Cortisol Binding Globulin)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84450	Transferase; Aspartate Amino (Ast) (Sgot)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84460	Transferase; Alanine Amino (Alt) (Sgpt)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84466	Transferrin	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84478	Triglycerides	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84479	Thyroid Hormone (T3/T4) Uptake/Thyroid Hormone Binding Ratio (Thbr)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84480	Triiodothyronine T3; total (TT-3)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84481	Triiodothyronine T3; Free	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84482	Triiodothyronine T3; Reverse	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84484	Troponin, Quantitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84485	Trypsin; Duodenal Fluid	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84488	Trypsin; Feces, Qualitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84490	Trypsin; Feces, Quantitative, 24-Hour Collection	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84510	Tyrosine	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84512	Troponin, Qualitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84520	Urea Nitrogen; Quantitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84525	Urea Nitrogen; Semiquantitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 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.