Anthem Blue Cross and Blue Shield Virginia prior authorization, page 48

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
88165	Cytopathology, Slides, Cervical/Vaginal, Bethesda; W/Manual Screen & Rescreen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88166	Cytopathology, Slides, Cervical/Vaginal, Bethesda; W/Manual Screen & Computer Rescreen	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88167	Cytopathology, Slides, Cervical/Vaginal, Bethesda; Manual Screen, Computer Rescreen, Cell Selection	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88172	Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, first evaluation episode, each site	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88173	Cytopathology, Eval Fine Needle Aspirate; Interpretation & Report	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88174	Cytopathology, Cervical/Vaginal, Auto Thin Layer Prep; Auto Screen, W/Phys Interp	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88175	Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer prepara	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88182	Flow cytometry, cell cycle or DNA analysis	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88184	Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88187	Flow Cytometry, Interpretation; 2 To 8 Markers	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88188	Flow Cytometry, Interpretation; 9 To 15 Markers	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88189	Flow Cytometry, Interpretation; 16 Or More Markers	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88230	Tissue Culture, Non-Neoplastic Disorders; Lymphocyte	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88233	Tissue Culture, Non-Neoplastic Disorders; Skin/Other Solid Tissue Bx	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88235	Tissue Culture, Non-Neoplastic Disorders; Amniotic Fluid/Chorionic Villus Cells	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88237	Tissue Culture, Neoplastic Disorders; Bone Marrow, Blood Cells	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88239	Tissue Culture, Neoplastic Disorders; Solid Tumor	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88240	Cryopreservation, Freezing & Storage, Cells, Each Cell Line	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88241	Thawing & Expansion, Frozen Cells, Each Aliquot	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88245	Chromosome Analysis, Breakage Syndromes; Baseline Sister Chromatid Exchange, 20-25 Cells	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88248	Chromosome Analysis, Breakage Syndromes; Baseline Breakage, 50-100 Cells, Count 20 Cells, 2 Karyotyp	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88249	Chromosome Analysis, Breakage Syndromes; 100 Cells, Clastogen Stress	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88261	Chromosome Analysis; Count 5 Cells, 1 Karyotype, W/Banding	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88262	Chromosome Analysis; Count 15-20 Cells, 2 Karyotypes, W/Banding	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88263	Chromosome Analysis; Count 45 Cells, Mosaicism, 2 Karyotypes, W/Banding	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88264	Chromosome Analysis; Analyze 20-25 Cells	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88267	Chromosome Analysis Amniotic Fluid/Chorionic Villus, 15 Cells, 1 Karyotype W/Banding	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88269	Chromosome Analysis In Situ, Amniotic Fluid Cells, From 6-12 Colonies, 1 Karyotype W/Banding	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88272	Molecular Cytogenetics; Chromosomal In Situ Hybridization, 3-5 Cells	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88273	Molecular Cytogenetics; Chromosomal In Situ Hybridization, 10-30 Cells	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88274	Molecular Cytogenetics; Interphase In Situ Hybridization, 25-99 Cells	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88280	Chromosome Analysis; Add'l Karyotypes, Each Study	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88283	Chromosome Analysis; Add'l Specialized Banding Technique	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88285	Chromosome Analysis; Add'l Cells Counted, Each Study	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88289	Chromosome Analysis; Add'l High Resolution Study	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88291	Cytogenetics & Molecular Cytogenetics, Interpretation & Report	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88300	Level I - Surgical Pathology, Gross Exam Only	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88302	Level Ii - Surgical Pathology, Gross & Microscopic Exam	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88304	Level Iii - Surgical Pathology, Gross & Microscopic Exam	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88305	Level Iv - Surgical Pathology, Gross & Microscopic Exam	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88307	Level V - Surgical Pathology, Gross & Microscopic Exam	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88309	Level Vi - Surgical Pathology, Gross & Microscopic Exam	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88312	Special stain including interpretation and report; Group I for microorganisms (eg, acid fast, methenamine silver)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88313	Special stain including interpretation and report; Group II, all other (eg, iron, trichrome), except stain for microorganisms, stains for enzyme constituents, or immunocytoche	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88319	Special stain including interpretation and report; Group III, for enzyme constituents	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88321	Consultation & Report, Referred Slides Prepared Elsewhere	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88323	Consultation & Report, Referred Matl Requiring Preparation, Slides	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88325	Consultation & Report, Referred Matl, Comprehensive	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88329	Pathology Consultation During Surgery	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88331	Pathology Consultation During Surgery; First Tissue Block, W/Frozen Section(S), Single Specimen	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.