Anthem Blue Cross and Blue Shield Virginia prior authorization, page 36

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
84540	Urea Nitrogen, Urine	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84545	Urea Nitrogen, Clearance	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84550	Uric Acid; Blood	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84560	Uric Acid; Other Source	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84577	Urobilinogen, Feces, Quantitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84578	Urobilinogen, Urine; Qualitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84580	Urobilinogen, Urine; Quantitative, Timed Specimen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84583	Urobilinogen, Urine; Semiquantitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84585	Vanillylmandelic Acid (Vma), Urine	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84586	Vasoactive Intestinal Peptide (Vip)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84588	Vasopressin (Antidiuretic Hormone, Adh)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84590	Vitamin A	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84591	Vitamin, Not Otherwise Specified	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84597	Vitamin K	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84600	Volatiles	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84620	Xylose Absorption Test, Blood &/Or Urine	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84630	Zinc	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84681	C-Peptide	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84702	Gonadotropin, Chorionic (Hcg); Quantitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84703	Gonadotropin, Chorionic (Hcg); Qualitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84704	Gonadotropin, chorionic (hCG); free beta chain	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
84830	Ovulation Tests, Visual Color Comparison Methods, Human Luteinizing Hormone	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
85002	Bleeding Time	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
85004	Blood Count; Automated Differential Wbc Count	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
85007	Blood Count; Blood Smear, Microscop Exam W/Manual Differential Wbc Count	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
85008	Blood Count; Blood Smear Microscop Exam W/O Manual Differential Wbc Count	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
85009	Blood Count; Manual Differential Wbc Count, Buffy Coat	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
85013	Blood Count; Spun Microhematocrit	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
85014	Blood Count; Hematocrit	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
85018	Blood Count; Hemoglobin	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
85025	Blood Count; Complete Cbc, Automated (Hgb, Hct, Rbc, Wbc, & Platelet) & Automated Differential Wbc	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
85027	Blood Count; Complete Cbc, Automated (Hgb, Hct, Rbc, Wbc, & Platelet)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
85032	Blood Count; Manual Cell (Erythrocyte, Leukocyte, Or Platelet) Each	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
85041	Blood Count; Red Blood Cell (Rbc), Automated	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
85044	Blood Count; Reticulocyte, Manual	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
85045	Blood Count; Reticulocyte, Automated	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
85046	Blood count; reticulocytes, automated, including one or more cellular parameters (eg, reticulocyte hemoglobin content [C	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
85048	Blood Count; Leukocyte (Wbc), Automated	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 44 Original policy
85049	Blood Count; Platelet, Automated	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85055	Reticulated Platelet Assay	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85060	Blood Smear, Peripheral, Interpretation, Physician W/Written Report	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85097	Bone Marrow, Smear Interpretation	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85130	Chromogenic Substrate Assay	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85170	Clot Retraction	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85175	Clot Lysis Time, Whole Blood Dilution	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85210	Clotting; Factor Ii, Prothrombin, Specific	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85220	Clotting; Factor V (Acg/Proaccelerin), Labile Factor	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85230	Clotting; Factor Vii (Proconvertin, Stable Factor)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85240	Clotting; Factor Viii (Ahg), One Stage	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85244	Clotting; Factor Viii Related Antigen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 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.