Anthem Blue Cross and Blue Shield Virginia prior authorization, page 49

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
88333	Pathology consultation during surgery; cytologic examination (eg, touch prep, squash prep), initial site	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88342	Immunohistochemistry or immunocytochemistry, each separately identifiable antibody per block, cytologic preparation, or hematologic smear; first separately identifiable antibo	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88344	Immunohistochemistry or immunocytochemistry, per specimen; each multiplex antibody stain procedure	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88346	Immunofluorescent Study, Each Antibody; Direct Method	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 55 Original policy
88348	Electron Microscopy; Dx	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
88355	Morphometric Analysis; Skeletal Muscle	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
88356	Morphometric Analysis; Nerve	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
88358	Morphometric Analysis; Tumor	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
88360	Morphometric Analysis, Tumor Immunohistochemistry, Quantitative Or Semiquantitative, Ea Antibody; Manual	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
88361	Morphometric Analysis; Tumor Immunohistochemistry, Quantitative or Semiquantitative	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
88362	Nerve Teasing Preparations	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
88366	In situ hybridization (eg, FISH), per specimen; each multiplex probe stain procedure	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
88367	Morphometric Analysis, In Situ Hybridization, (Quantitative / Semi-Quant) Ea Probe; By Computer-Assisted Technology	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
88368	Morphometric Analysis, In Situ Hybridization, (Quantitative Or Semi-Quantitative) Each Probe; Manual	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
88371	Protein Analysis, Tissue, Western Blot, W/Interpretation & Report	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
88372	Protein Analysis, Tissue, Western Blot, W/Interpretation & Report; Immunological Probe, Each	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
88374	Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each multiplex probe stain procedure	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
88377	Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each multiplex probe stain procedure	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
88380	Microdissection (ie, sample preparation of microscopically identified target); laser capture	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
88381	Microdissection (ie, sample preparation of microscopically identified target); manual	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
88387	Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies (eg, nucleic acid-based molecular studies), each tissue preparation (eg	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
88720	Bilirubin, total, transcutaneous	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
88738	Hemoglobin (Hgb), quantitative, transcutaneous	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
88740	Hemoglobin, quantitative, transcutaneous, per day; carboxyhemoglobin	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
88741	Hemoglobin, quantitative, transcutaneous, per day; methemoglobin	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
89049	Caffeine halothane contracture test (CHCT) for malignant hyperthermia susceptibility, including interpretation and repor	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
89050	Cell Count, Miscellaneous Body Fluids, Except Blood	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
89051	Cell Count, Miscellaneous Body Fluids, Except Blood; W/Differential Count	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
89055	Leukocyte Count, Fecal	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
89060	Crystal identification by light microscopy with or without polarizing lens analysis, tissue or any body fluid (except ur	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
89125	Fat Stain, Feces, Urine/Respiratory Secretions	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
89160	Meat Fibers, Feces	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
89190	Nasal Smear, Eosinophils	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
89220	Sputum, Obtaining Specimen, Aerosol Induced Technique (Separate Procedure)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
89230	Sweat Collection By Iontophoresis	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
89250	Culture, Oocyte(S)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
89251	Culture & Fertilization, Oocyte(S); W/Co-Culture	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
89253	Assisted Embryo Hatching, Microtechniques (Any Method)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
89254	Oocyte Identification, Follicular Fluid	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
89255	Preparation, Embryo, Transfer (Any Method)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
89257	Sperm Identification, Aspiration (Other Than Seminal Fluid)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
89258	Cryopreservation; Embryo	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
89259	Cryopreservation; Sperm	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
89260	Sperm Isolation; Simple Prep, For Insemination/Diagnosis W/Semen Analysis	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
89261	Sperm Isolation; Complex Prep, For Insemination/Diagnosis W/Semen Analysis	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
89264	Sperm Identification, Testis Tissue, Fresh/Cryopreserved	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
89268	Insemination of Oocytes	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
89272	Extended Culture of Oocyte(s)/Embryo(s), 4-7 Days	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
89280	Assisted Oocyte Fertilization, Microtechnique; Less Than or Equal To 10 Oocytes	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 Original policy
89281	Assisted Oocyte Fertilization, Microtechnique; Greater Than 10 Oocytes	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 56 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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