Anthem Blue Cross and Blue Shield Virginia prior authorization, page 37

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
85245	Clotting; Factor Viii, Vw Factor, Ristocetin Cofactor	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85246	Clotting; Factor Viii, Vw Factor Antigen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85247	Clotting; Factor Viii, Vw Factor, Multimetric Analysis	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85250	Clotting; Factor Ix (Ptc/Christmas)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85260	Clotting; Factor X (Stuart-Prower)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85270	Clotting; Factor Xi (Pta)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85280	Clotting; Factor Xii (Hageman)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85290	Clotting; Factor Xiii (Fibrin Stabilizing)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85291	Clotting; Factor Xiii (Fibrin Stabilizing), Screen Solubility	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85292	Clotting; Prekallikrein Assay (Fletcher Factor Assay)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85293	Clotting; High Molecular Wt Kininogen Assay (Fitzgerald Factor Assay)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85300	Clotting Inhibitors/Anticoagulants; Antithrombin Iii, Activity	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85301	Clotting Inhibitors/Anticoagulants; Antithrombin Iii, Antigen Assay	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85302	Clotting Inhibitors/Anticoagulants; Protein C, Antigen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85303	Clotting Inhibitors/Anticoagulants; Protein C, Activity	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85305	Clotting Inhibitors/Anticoagulants; Protein S, Total	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85306	Clotting Inhibitors/Anticoagulants; Protein S, Free	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85307	Activated Protein C (Apc) Resistance Assay	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85335	Factor Inhibitor Test	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85337	Thrombomodulin	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85345	Coagulation Time; Lee & White	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85347	Coagulation Time; Activated	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85348	Coagulation Time; Other Methods	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85360	Euglobulin Lysis	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85362	Fibrin(Ogen) Degradation (Split) Products (Fdp)(Fsp); Agglutination Slide, Semiquantitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85366	Fibrin(Ogen) Degradation (Split) Products (Fdp)(Fsp); Paracoagulation	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85370	Fibrin(Ogen) Degradation (Split) Products (Fdp)(Fsp); Quantitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85378	Fibrin Degradation Products, D-Dimer; Qualitative Or Semiquantitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85379	Fibrin Degradation Products, D-Dimer; Quantitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85380	Fibrin Degradation Products, D-Dimer; Ultrasensitive, Qualitative Or Semiquantitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85384	Fibrinogen; Activity	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85385	Fibrinogen; Antigen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85390	Fibrinolysins/Coagulopathy Screen, Interpretation & Report	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85396	Coagulation/Fibrinolysis Assay, Whole Blood, Inc Use of Pharmacologic Additive(s), w Interpretation and Report, Per Day	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85397	Coagulation and fibrinolysis, functional activity, not otherwise specified (eg, ADAMTS-13), each analyte	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85400	Fibrinolytic Factors & Inhibitors; Plasmin	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85410	Fibrinolytic Factors & Inhibitors; Alpha-2 Antiplasmin	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85415	Fibrinolytic Factors & Inhibitors; Plasminogen Activator	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85420	Fibrinolytic Factors & Inhibitors; Plasminogen, Except Antigenic Assay	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85421	Fibrinolytic Factors & Inhibitors; Plasminogen, Antigenic Assay	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85441	Heinz Bodies; Direct	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85445	Heinz Bodies; Induced, Acetyl Phenylhydrazine	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85460	Hemoglobin/Rbcs, Fetal, Fetomaternal Hemorrhage; Differential Lysis (Kleihauer-Betke)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85461	Hemoglobin/Rbcs, Fetal, Fetomaternal Hemorrhage; Rosette	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 45 Original policy
85475	Hemolysin, Acid	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 46 Original policy
85520	Heparin Assay	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 46 Original policy
85525	Heparin Neutralization	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 46 Original policy
85530	Heparin-Protamine Tolerance Test	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 46 Original policy
85536	Iron Stain Peripheral Blood	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 46 Original policy
85540	Leukocyte Alkaline Phosphatase W/Count	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 46 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.