Anthem Blue Cross and Blue Shield Virginia prior authorization, page 47

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
87808	Infectious agent antigen detection by immunoassay with direct optical	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
87809	Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; adenovirus	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
87810	Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Chlamydia trachomatis	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
87850	Infectious agent antigen detection by immunoassay with direct optical	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
87880	Infectious agent antigen detection by immunoassay with direct optical	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
87899	Infectious agent antigen detection by immunoassay with direct optical	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
87900	Infectious agent drug susceptibility phenotype prediction using regularly updated genotypic bioinformatics	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
87901	Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV-1, reverse transcriptase and protease regions	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
87902	Infectious Agent Genotype Analysis, Nucleic Acid (Dna/Rna); Hepatitis C Virus	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
87903	Infect Agnt Phenotyp Analys (Dna/Rna) W/Drug Resist Tissu Cult Analys, Hiv 1; 1-10 Drugs	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
87905	Infectious agent enzymatic activity other than virus (eg, sialidase activity in vaginal fluid)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
87906	Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV-1, other region (eg, integrase, fusion)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
87910	Infectious agent genotype analysis by nucleic acid (DNA or RNA); cytomegalovirus	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
87912	Infectious agent genotype analysis by nucleic acid (DNA or RNA); Hepatitis B virus	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88000	Necropsy (Autopsy), Gross Exam Only; W/O Cns	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88005	Necropsy (Autopsy), Gross Exam Only; W/Brain	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88007	Necropsy (Autopsy), Gross Exam Only; W/Brain & Spinal Cord	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88012	Necropsy (Autopsy), Gross Exam Only; Infant W/Brain	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88014	Necropsy (Autopsy), Gross Exam Only; Stillborn/Newborn W/Brain	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88016	Necropsy (Autopsy), Gross Exam Only; Macerated Stillborn	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88020	Necropsy (Autopsy), Gross & Microscopic; W/O Cns	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88025	Necropsy (Autopsy), Gross & Microscopic; W/Brain	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88027	Necropsy (Autopsy), Gross & Microscopic; W/Brain & Spinal Cord	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88028	Necropsy (Autopsy), Gross & Microscopic; Infant W/ Brain	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88029	Necropsy (Autopsy), Gross & Microscopic; Stillborn/Newborn W/Brain	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88036	Necropsy (Autopsy), Limited, Gross &/Or Microscopic; Regional	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88037	Necropsy (Autopsy), Limited, Gross &/Or Microscopic; Single Organ	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88040	Necropsy (Autopsy); Forensic Exam	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88045	Necropsy (Autopsy); Coroner's Call	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88104	Cytopathology Except Cervical/Vaginal; Smears W/Interpretation	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88106	Cytopathology, fluids, washings or brushings, except cervical or vaginal; simple filter method with interpretation	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88108	Cytopathology, Concentration Technique, Smears & Interpretation	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88112	Cytopathology, Selective Cellular Enhancement Technique with Interpretation, Except Cervical or Vaginal	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88120	Cytopathology, in situ hybridization (eg, FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; manual	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88121	Cytopathology, in situ hybridization (eg, FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; using computer-assisted technology	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88125	Cytopathology, Forensic	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88130	Sex Chromatin Identification; Barr Bodies	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88140	Sex Chromatin Identification; Peripheral Blood Smear, Polymorphonuclear Drumsticks	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88141	Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88142	Cytopathology, Cervical/Vaginal, Preservative Fluid, Auto Thin Layer Prep; Manual Screen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88143	Cytopathology, Cervical/Vaginal, Preservative Fluid, Auto Thin Layer Prep; Manual Screen/Rescreen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88147	Cytopathology, Cervical/Vaginal; Automated Screen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88148	Cytopathology, Cervical/Vaginal; Automated Screen, Manual Rescreen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88150	Cytopathology, Slides, Cervical/Vaginal; Manual Screen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88152	Cytopathology, Slides, Cervical/Vaginal; Manual Screen, Computer Rescreen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88153	Cytopathology, Slides, Cervical/Vaginal; Manual Screen/Rescreen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88160	Cytopathology, Smears, Other Source; Screening & Interpretation	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88161	Cytopathology, Smears, Other Source; Preparation, Screening & Interpretation	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 54 Original policy
88162	Cytopathology, Smears, Other Source; Extended Study, > 5 Slides &/Or Multiple Stains	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88164	Cytopathology, Slides, Cervical/Vaginal, Bethesda; Manual Screen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 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.