Anthem Blue Cross and Blue Shield Virginia prior authorization, page 42

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
86807	Serum Screening, Cytotoxic Percent Reactive Antibody (Pra); Standard Method	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 49 Original policy
86808	Serum Screening, Cytotoxic Percent Reactive Antibody (Pra); Quick Method	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 49 Original policy
86812	Hla Typing; A, B, Or C, Single Antigen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 49 Original policy
86813	Hla Typing; A, B, Or C, Multiple Antigens	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 49 Original policy
86816	Hla Typing; Dr/Dq, Single Antigen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 49 Original policy
86817	Hla Typing; Dr/Dq, Multiple Antigens	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 49 Original policy
86821	Hla Typing; Lymphocyte Culture, Mixed (Mlc)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 49 Original policy
86825	Human leukocyte antigen (HLA) crossmatch, non-cytotoxic (eg, using flow cytometry); first serum sample or dilution	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 49 Original policy
86828	Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, flow cytometry); qualitative assessment of the presence or absence of antibod	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 49 Original policy
86829	Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, Flow cytometry); qualitative assessment of the presence or absence of antibod	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 49 Original policy
86830	Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, Flow cytometry); antibody identification by qualitative panel using complete	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 49 Original policy
86831	Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, Flow cytometry); antibody identification by qualitative panel using complete	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 49 Original policy
86832	Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, Flow cytometry); high definition qualitative panel for identification of anti	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 49 Original policy
86833	Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, Flow cytometry); high definition qualitative panel for identification of anti	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 49 Original policy
86834	Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, Flow cytometry); semi-quantitative panel (eg, titer), HLA Class I	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 49 Original policy
86835	Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, Flow cytometry); semi-quantitative panel (eg, titer), HLA Class II	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 49 Original policy
86850	Antibody Screen, Rbc, Each Serum Technique	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 49 Original policy
86860	Antibody Elution (Rbc), Each Elution	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 49 Original policy
86870	Antibody Identification, Rbc Antibodies, Each Panel, Each Serum Technique	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86880	Antihuman Globulin Test (Coombs Test); Direct, Each Antiserum	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86885	Antihuman globulin test (Coombs test); indirect, qualitative, each reagent red cell	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86886	Antihuman globulin test (Coombs test); indirect, each antibody titer	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86890	Autologous Blood/Component, Collect/Process/Storage; Predeposited	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86891	Autologous Blood/Component, Collect/Process/Storage; Intra-/Postoperative Salvage	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86900	Blood Typing; Abo	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86901	Blood Typing; Rh (D)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86902	Blood typing; antigen testing of donor blood using reagent serum, each antigen test	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86904	Blood Typing; Antigen Screening, Compatible Unit Using Patient Serum, Per Unit Screened	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86905	Blood Typing; Rbc Antigens, Other Than Abo/Rh (D), Each	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86906	Blood Typing; Rh Phenotyping, Complete	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86910	Blood Typing, Paternity Testing, Per Individual; Abo, Rh & Mn	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86920	Compatibility Test Each Unit; Immediate Spin Technique	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86921	Compatibility Test Each Unit; Incubation Technique	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86922	Compatibility Test Each Unit; Antiglobulin Technique	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86923	Compatibility test each unit; electronic	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86927	Fresh Frozen Plasma, Thawing, Each Unit	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86930	Frozen Blood, Each Unit; Freezing (W/Preparation)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86931	Frozen Blood, Each Unit; Thawing	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86932	Frozen Blood, Each Unit; Freezing (W/Preparation)& Thawing	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86940	Hemolysins & Agglutinins; Auto, Screen, Each	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86941	Hemolysins & Agglutinins; Incubated	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86945	Irradiation, Blood Product, Each Unit	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86950	Leukocyte Transfusion	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86960	Volume reduction of blood or blood product (eg, red blood cells or platelets), each unit	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86965	Pooling, Platelets/Other Blood Products	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86970	Pretreatment Rbc's, Antibody Detection/Id/Compatibility; Incubation W/Chemicals/Drugs, Each	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86971	Pretreatment Rbc's, Antibody Detection/Id/Compatibility; Incubation W/Enzymes, Each	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86972	Pretreatment Rbc's, Antibody Detection/Id/Compatibility; Density Gradient Separation	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86975	Pretreatment, Serum, Use In Rbc Antibody Identification; Incubation W/Drugs, Each	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86976	Pretreatment, Serum, Use In Rbc Antibody Identification; Dilution	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 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.

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