Anthem Blue Cross and Blue Shield Virginia prior authorization, page 53

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
97034	Application, Modality To 1+ Areas; Contrast Baths, Each 15 Min	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97035	Application, Modality To 1+ Areas; Ultrasound, Each 15 Min	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97036	Application, Modality To 1+ Areas; Hubbard Tank, Each 15 Min	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97110	Therapeutic Proc, 1+ Areas, Each 15 Min; Therapeutic Exercises	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97112	Therapeutic Proc, 1+ Areas, Each 15 Min; Neuromuscular Reeducation	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97113	Therapeutic Proc, 1+ Areas, Each 15 Min; Aquatic Therapy W/Exercises	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97116	Therapeutic Proc, 1+ Areas, Each 15 Min; Gait Training (W/Stair Climbing)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97124	Therapeutic Proc, 1+ Areas, Each 15 Min; Massage	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97129	Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensato	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97130	Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensato	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97140	Manual Therapy Techniques, 1+ Regions, Each 15 Min	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97150	Therapeutic Proc(S), Group, (2+ Individuals)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97151	Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97152	Behavior identification-supporting assessment, administered by one technician under the direction of a physician or other qualified health care professional, face-to-face with	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97153	Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patie	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97154	Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with two	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97155	Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous direction of tech	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97156	Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with gua	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97157	Multiple-family group adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present), face-to-face w	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97158	Group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, face-to-face with multiple patients, each	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97161	Physical therapy evaluation; low complexity, requiring components	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97162	Physical therapy evaluation; moderate complexity requiring components	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97163	Physical therapy evaluation; high complexity requiring components	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97164	Reevaluation of physical therapy established plan of care requiring components	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97165	Occupational therapy evaluation; low complexity requiring components	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97166	Occupational therapy evaluation; moderate complexity requiring components	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97167	Occupational therapy evaluation; high complexity requiring components	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97168	Reevaluation of occupational therapy care/established plan of care requiring components	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 59 Original policy
97530	Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 60 Original policy
97533	Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 60 Original policy
97535	Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive t	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 60 Original policy
97537	Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 60 Original policy
97542	Wheelchair management (eg, assessment, fitting, training), each 15 minutes	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 60 Original policy
97545	Work Hardening/Conditioning; Initial 2 Hours	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 60 Original policy
97546	Work Hardening/Conditioning; Add'l Hr	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 60 Original policy
97610	Low frequency, non-contact, non-thermal ultrasound, including topical application(s), when performed, wound assessment, and instruction(s) for ongoing care, per day	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 60 Original policy
97750	Physical Performance Test, W/Written Report, Each 15 Min	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 60 Original policy
97755	Assistive technology assessment (eg, to restore, augment or compensate for existing function, optimize functional tasks and/or maximize environmental accessibility), direct on	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 60 Original policy
97760	Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ies) and/or trunk, initial orthotic(s	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 60 Original policy
97761	Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 60 Original policy
97763	Orthotic(s)/prosthetic(s) management and/or training, upper extremity(ies), lower extremity(ies), and/or trunk, subsequent orthotic(s)/prosthetic(s) encounter, each 15 minutes	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 60 Original policy
98943	Chiropractic manipulative treatment (CMT); extraspinal, 1 or more regions	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 60 Original policy
99151	Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation suppor	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 60 Original policy
99152	Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation suppor	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 60 Original policy
99155	Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 60 Original policy
99156	Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 60 Original policy
99183	Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 60 Original policy
99601	Home infusion/specialty drug administration, per visit (up to 2 hours)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 60 Original policy
99602	Home infusion/specialty drug administration, per visit (up to 2 hours); each additional hour (List separately in additio	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 60 Original policy
A0430	Fixed Wing Air Transport	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 60 Original policy

Sources

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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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