Anthem Blue Cross and Blue Shield Virginia prior authorization, page 45

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
87390	Infectious agent antigen detection by immunoassay technique, (eg, enzy	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87391	Infectious agent antigen detection by immunoassay technique, (eg, enzy	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87400	Infectious agent antigen detection by immunoassay technique, (eg, enzy	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87420	Infectious agent antigen detection by immunoassay technique, (eg, enzy	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87425	Infectious agent antigen detection by immunoassay technique, (eg, enzy	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87427	Infectious agent antigen detection by immunoassay technique, (eg, enzy	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87430	Infectious agent antigen detection by immunoassay technique, (eg, enzy	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87449	Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunoch	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87451	Infectious agent antigen detection by immunoassay technique, (eg, enzy	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87471	Infectious Agent, Nucleic Acid (Dna/Rna); Bartonella, Amplified Probe	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87472	Infectious Agent, Nucleic Acid (Dna/Rna); Bartonella, Quantification	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87475	Infectious Agent, Nucleic Acid (Dna/Rna); Borrelia, Direct Probe	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87476	Infectious Agent, Nucleic Acid (Dna/Rna); Borrelia, Amplified Probe	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87480	Infectious Agent, Nucleic Acid (Dna/Rna); Candida, Direct Probe	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87481	Infectious Agent, Nucleic Acid (Dna/Rna); Candida, Amplified Probe	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87482	Infectious Agent, Nucleic Acid (Dna/Rna); Candida, Quantification	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87483	Infectious agent detection by nucleic acid (DNA or RNA); central nervous system pathogen (eg, Neisseria meningitidis, Streptococcus pneumoniae, Listeria, Haemophilus influenza	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87485	Infectious Agent, Nucleic Acid (Dna/Rna); Chlamydia Pneumoniae, Direct Probe	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87486	Infectious Agent, Nucleic Acid (Dna/Rna); Chlamydia Pneumoniae, Amplified Probe	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87487	Infectious Agent, Nucleic Acid (Dna/Rna); Chlamydia Pneumoniae, Quantification	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87490	Infectious Agent, Nucleic Acid (Dna/Rna); Chlamydia Trachomatis, Direct Probe	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87491	Infectious Agent, Nucleic Acid (Dna/Rna); Chlamydia Trachomatis, Amplified Probe	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87492	Infectious Agent, Nucleic Acid (Dna/Rna); Chlamydia Trachomatis, Quantification	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87493	Infectious agent detection by nucleic acid (DNA or RNA); Clostridium difficile, toxin gene(s), amplified probe technique	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87495	Infectious Agent, Nucleic Acid (Dna/Rna); Cytomegalovirus, Direct Probe	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87496	Infectious Agent, Nucleic Acid (Dna/Rna); Cytomegalovirus, Amplified Probe	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87497	Infectious Agent, Nucleic Acid (Dna/Rna); Cytomegalovirus, Quantification	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87498	Infectious agent detection by nucleic acid (DNA or RNA); enterovirus, amplified probe technique, includes reverse transcription when performed	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87500	Infectious agent detection by nucleic acid(DNA or RNA); vancomycin resistance (eg, enterococcus species van A, van B), a	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87501	Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, reverse transcription and amplified probe technique, each type or subtype	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87502	Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for multiple types or sub-types, includes multiplex reverse transcription, when performed, and multip	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87510	Infectious Agent, Nucleic Acid (Dna/Rna); Gardnerella Vaginalis, Direct Probe	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87511	Infectious Agent, Nucleic Acid (Dna/Rna); Gardnerella Vaginalis, Amplified Probe	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87512	Infectious Agent, Nucleic Acid (Dna/Rna); Gardnerella Vaginalis, Quantification	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87516	Infectious Agent, Nucleic Acid (Dna/Rna); Hepatitis B Virus, Amplified Probe	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87517	Infectious Agent, Nucleic Acid (Dna/Rna); Hepatitis B Virus, Quantification	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 52 Original policy
87520	Infectious Agent, Nucleic Acid (Dna/Rna); Hepatitis C Virus, Direct Probe	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 53 Original policy
87521	Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, amplified probe technique, includes reverse transcription when performed	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 53 Original policy
87522	Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification, includes reverse transcription when performed	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 53 Original policy
87525	Infectious Agent, Nucleic Acid (Dna/Rna); Hepatitis G Virus, Direct Probe	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 53 Original policy
87526	Infectious Agent, Nucleic Acid (Dna/Rna); Hepatitis G Virus, Amplified Probe	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 53 Original policy
87527	Infectious Agent, Nucleic Acid (Dna/Rna); Hepatitis G Virus, Quantification	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 53 Original policy
87528	Infectious Agent, Nucleic Acid (Dna/Rna); Herpes Simplex Virus, Direct Probe	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 53 Original policy
87529	Infectious Agent, Nucleic Acid (Dna/Rna); Herpes Simplex Virus, Amplified Probe	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 53 Original policy
87530	Infectious Agent, Nucleic Acid (Dna/Rna); Herpes Simplex Virus, Quantification	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 53 Original policy
87531	Infectious Agent, Nucleic Acid (Dna/Rna); Herpes Virus-6, Direct Probe	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 53 Original policy
87532	Infectious Agent, Nucleic Acid (Dna/Rna); Herpes Virus-6, Amplified Probe	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 53 Original policy
87533	Infectious Agent, Nucleic Acid (Dna/Rna); Herpes Virus-6, Quantification	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 53 Original policy
87534	Infectious Agent, Nucleic Acid (Dna/Rna); Hiv-1, Direct Probe	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 53 Original policy
87535	Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, amplified probe technique, includes reverse transcription when performed	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 53 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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