Anthem Blue Cross and Blue Shield Virginia prior authorization, page 39

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
86200	Cyclic citrullinated peptide (CCP), antibody	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86215	Deoxyribonuclease, Antibody	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86225	Deoxyribonucleic Acid (Dna) Antibody; Native/Double Stranded	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86226	Deoxyribonucleic Acid (Dna) Antibody; Single Stranded	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86235	Extractable Nuclear Antigen, Antibody To, Any Method, Each Antibody	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86277	Growth Hormone, Human (Hgh), Antibody	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86280	Hemagglutination Inhibition Test (Hai)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86294	Immunoassay For Tumor Antigen, Qualitative/Semiquantitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86300	Immunoassay, Tumor Antigen, Quantitative; Ca 15-3 (27.29)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86301	Immunoassay, Tumor Antigen, Quantitative; Ca 19-9	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86304	Immunoassay, Tumor Antigen, Quantitative; Ca 125	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86305	Human epididymis protein 4 (HE4)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86308	Heterophile Antibodies; Screening	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86309	Heterophile Antibodies; Titer	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86310	Heterophile Antibodies; Titers After Absorption W/Beef Cells & Guinea Pig Kidney	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86316	Immunoassay, Tumor Antigen; Other Antigen, Quantitative, Each	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86317	Immunoassay, Infectious Agent Antibody, Quantitative, Not Otherwise Specified	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86318	Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86320	Immunoelectrophoresis; Serum	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86325	Immunoelectrophoresis; Other Fluids W/Concentration	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86328	Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86329	Immunodiffusion; Not Elsewhere Specified	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86331	Immunodiffusion; Gel Diffusion, Qualitative (Ouchterlony), Each Antigen/Antibody	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86332	Immune Complex Assay	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86334	Immunofixation Electrophoresis	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86335	Immunoglob Typing (Gc Gm Inv),Ea	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86336	Inhibin A	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86337	Insulin Antibodies	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86340	Intrinsic Factor Antibodies	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86341	Islet Cell Antibody	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86343	Leukocyte Histamine Release Test (Lhr)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86344	Leukocyte Phagocytosis	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86352	Cellular function assay involving stimulation (eg, mitogen or antigen) and detection of biomarker (eg, ATP)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86353	Lymphocyte Transformation, Mitogen (Phytomitogen)/Antigen Induced Blastogenesis	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86355	B cells, total count	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86356	Mononuclear cell antigen, quantitative (eg, flow cytometery), not otherwise specified, each antigen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86357	Natural killer (NK) cells, total count	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86359	T Cells; Total Count	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86360	T Cells; Absolute Cd4 & Cd8 Count, W/Ratio	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86361	T Cells; Absolute Cd4 Count	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86367	Stem cells (ie, CD34), total count	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86376	Microsomal Antibodies, Each	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86382	Neutralization Test, Viral	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86384	Nitroblue Tetrazolium Dye Test (Ntd)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86386	Nuclear Matrix Protein 22 (Nmp22), Qualitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86403	Particle Agglutination; Screen, Each Antibody	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86406	Particle Agglutination; Titer, Each Antibody	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86430	Rheumatoid Factor; Qualitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86431	Rheumatoid Factor; Quantitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 Original policy
86480	Tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 47 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.