Anthem Blue Cross and Blue Shield Virginia prior authorization, page 65

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
J7179	Injection, von willebrand factor (recombinant), (vonvendi), 1 i.u. vwf:rco	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7180	Injection, factor XIII (antihemophilic factor, human), 1 IU	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7181	Injection, factor xiii a-subunit, (recombinant), per iu	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7182	Injection, factor viii, (antihemophilic factor, recombinant), (novoeight), per iu	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7183	Injection, von Willebrand factor complex (human), Wilate, 1 IU vWF:RCo	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7185	Injection, Factor Viii (Antihemophilic Factor, Recombinant) (Xyntha), Per I.U.	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7186	Injection, antihemophilic factor VIII/von Willebrand factor complex (human), per factor VIII i.u.	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7187	Injection, von Willebrand factor complex (Humate-P), per IU vWF-RC0	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7188	Injection, factor viii (antihemophilic factor, recombinant), (obizur), per i.u.	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7189	Factor VIIa (antihemophilic Factor, recombinant), per 1 mcg	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7190	Factor Viii	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7191	Factor Viii (Porcine)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7192	Factor Viii (Antihemophilic Factor, Recombinant) Per I.U., Not Otherwise Specified	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7193	Factor IX (antihemophilic factor, purified, non-recombinant) per IU	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7194	Factor Ix Complex	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7195	Factor IX (antihemophilic factor, recombinant) per IU	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7198	Anti-Inhibitor	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7200	Injection, factor ix, (antihemophilic factor, recombinant), rixubis, per iu	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7201	Injection, factor IX, Fc fusion protein, (recombinant), Alprolix, 1 IU	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7202	Injection, factor ix, albumin fusion protein, (recombinant), idelvion, 1 i.u.	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7203	Injection Factor IX, (antihemophilic factor, recombinant), glycopegylated, (Rebinyn), 1 IU	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7204	Injection, Factor VIII, antihemophilic factor (recombinant), (Esperoct), glycopegylated-exei, per IU	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7205	Injection, factor viii fc fusion (recombinant), per iu	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7207	Injection, factor viii, (antihemophilic factor, recombinant), pegylated, 1 i.u.	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7208	Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl, (jivi), 1 i.u.	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7209	Injection, factor viii, (antihemophilic factor, recombinant), (nuwiq), 1 i.u.	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7210	Injection, Factor VIII, (antihemophilic factor, recombinant), (Afstyla), 1 IU	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7211	Injection, Factor VIII, (antihemophilic factor, recombinant), (Kovaltry), 1 IU	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7212	Factor viia (antihemophilic factor, recombinant)-jncw (sevenfact), 1 microgram	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7213	Injection, coagulation factor ix (recombinant), ixinity, 1 i.u.	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7214	Injection, Factor VIII/von Willebrand factor complex, recombinant (Altuviiio), per Factor VIII IU	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7311	Injection, fluocinolone acetonide, intravitreal implant (Retisert), 0.01 mg	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7312	Injection, dexamethasone, intravitreal implant, 0.1 mg	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7313	Injection, fluocinolone acetonide, intravitreal implant (Iluvien), 0.01 mg	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7314	Injection, fluocinolone acetonide, intravitreal implant (Yutiq), 0.01 mg	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7330	Cultured Chondrocytes Implnt	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7340	Carbidopa 5 mg/levodopa 20 mg enteral suspension, 100 ml	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7351	Injection, bimatoprost, intracameral implant, 1 microgram	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7352	Afamelanotide implant, 1 mg	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7353	Anacaulase-bcdb, 8.8% gel, 1 gm	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7354	Cantharidin for topical administration, 0.7%, single unit dose applicator (3.2 mg)	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 70 Original policy
J7355	Injection, travoprost, intracameral implant, 1 mcg	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 71 Original policy
J7402	Mometasone furoate sinus implant, (sinuva), 10 micrograms	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 71 Original policy
J7686	Treprostinil, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, 1.74 mg	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 71 Original policy
J9011	Injection, datopotamab deruxtecan-dlnk, 1 mg	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 71 Original policy
J9015	Injection, aldesleukin, per single use vial	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 71 Original policy
J9021	Injection, asparaginase, recombinant, (rylaze), 0.1 mg	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 71 Original policy
J9022	Injection, atezolizumab, 10 mg	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 71 Original policy
J9023	Injection, avelumab, 10 mg	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 71 Original policy
J9024	Injection, atezolizumab, 5 mg and hyaluronidase-tqjs	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 71 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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