Anthem Blue Cross and Blue Shield Virginia prior authorization, page 43

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
86977	Pretreatment, Serum, Use In Rbc Antibody Identification; Incubation W/Inhibitors, Each	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86978	Pretreatment Serum, Use In Rbc Antibody Identification; Red Cell Absorption, Each Absorption	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
86985	Splitting, Blood/Blood Products, Each Unit	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
87003	Animal Inoculation, Small Animal; W/Observation & Dissection	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
87015	Concentration (Any Type), For Infectious Agents	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
87040	Culture, Bacterial; Blood, W/Isolation & Presumptive Identification Isolates (W/Anaerobic Culture)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
87045	Culture, Bacterial; Feces W/Isolation & Preliminary Exam, Salmonella & Shigella Species	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
87046	Culture, Bacterial; Stool, Addn'l Pathogens, Isolation & Preliminary Exam, Ea Plate	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
87070	Culture, Bacterial; Any Other Source Except Urine/Blood/Stool W/Isolatn & Presumptive Id	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
87071	Culture, Bacterial; Quantit, Aerobic W/ Isolatn & Id Isolates, Any Source Except Urine/Blood/Stool	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
87073	Culture, Bacterial; Quantit, Anaerobic W/Isolatn & Id Isolates, Any Source Except Urine/Blood/Stool	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
87075	Culture, Bacterial; Any Source, Anaerobic W/Isolation & Presumptive Id Of Isolates	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
87076	Culture, Bacterial; Anaerobic Isolate, Add'l Methods Required For Definitive Id, Ea Isolate	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
87077	Culture, Bacterial; Aerobic Isolate, Add'l Methods Required For Definitive Id, Ea Isolate	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
87081	Culture, Presumptive, Pathogenic Organisms, Screening Only	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
87084	Culture, Presumptive, Pathogenic Organisms, Screening Only; W/Colony Estimation From Density Chart	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
87086	Culture, Bacterial; Quantitative Colony Count, Urine	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
87088	Culture, bacterial; with isolation and presumptive identification of each isolate, urine	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
87101	Culture, Fungi (Mold/Yeast) Isolation, W/Presumptive Id Of Isolates; Skin/Hair/Nail	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
87102	Culture, Fungi (Mold/Yeast) Isolation, W/Presumptive Id Of Isolates; Other Source, Except Blood	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
87103	Culture, Fungi (Mold/Yeast) Isolation, W/Presumptive Id Of Isolates; Blood	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
87106	Culture, Fungi, Definitive Id, Each Organism; Yeast	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
87107	Culture, Fungi, Definitive Id, Each Organism; Mold	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
87109	Culture, Mycoplasma, Any Source	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 50 Original policy
87110	Culture, Chlamydia, Any Source	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 Original policy
87116	Culture, Tubercle/Acid-Fast Bacilli Any Source, W/Isolation & Presumptive Id Of Isolates	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 Original policy
87118	Culture, Mycobacterial, Definitive Id, Ea Isolate	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 Original policy
87140	Culture, Typing; Immunofluorescent Method, Ea Antiserum	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 Original policy
87143	Culture, Typing; Gas Liquid Chromatography (Glc)/High Pressure Liquid Chromatography (Hplc) Method	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 Original policy
87147	Culture, typing; immunologic method, other than immunofluorescence (eg, agglutination grouping), per antiserum	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 Original policy
87149	Culture, typing; identification by nucleic acid (DNA or RNA) probe, direct probe technique, per culture or isolate, each	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 Original policy
87150	Culture, typing; identification by nucleic acid (DNA or RNA) probe, amplified probe technique, per culture or isolate, e	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 Original policy
87152	Culture, Typing; Id By Pulse Field Gel Typing	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 Original policy
87153	Culture, typing; identification by nucleic acid sequencing method, each isolate (eg, sequencing of the 16S rRNA gene)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 Original policy
87158	Culture, Typing; Other Methods	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 Original policy
87164	Dark Field Exam, Any Source; W/Specimen Collection	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 Original policy
87166	Dark Field Exam, Any Source; W/O Collection	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 Original policy
87168	Macroscopic Exam; Arthropod	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 Original policy
87169	Macroscopic Exam; Parasite	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 Original policy
87172	Pinworm Exam	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 Original policy
87176	Homogenization, Tissue, For Culture	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 Original policy
87177	Ova & Parasites, Direct Smears, Concentration & Identification	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 Original policy
87181	Susceptibility Studies, Antimicrobial Agent; Agar Dilution Method, Per Agent	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 Original policy
87184	Susceptibility Studies, Antimicrobial Agent; Disk Method, Per Plate (12 Or Fewer Agents)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 Original policy
87185	Susceptibility Studies, Antimicrobial Agent; Enzyme Detection, Per Enzyme	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 Original policy
87186	Susceptibility studies, antimicrobial agent; microdilution or agar dilution (minimum inhibitory concentration [MIC] or b	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 Original policy
87188	Susceptibility Studies, Antimicrob Agent; Macrobroth Dilution Method, Ea Agent	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 Original policy
87190	Susceptibility Studies, Antimicrob Agent; Mycobacteria, Proportion Method, Ea Agent	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 Original policy
87197	Serum bactericidal titer (Schlichter test)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 Original policy
87205	Smear, Primary Source W/Interpretation; Gram Or Giemsa Stain, Bacteria/Fungi/Cell Types	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 51 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.