Anthem Blue Cross and Blue Shield Virginia prior authorization, page 68

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
J9381	Injection, teplizumab-mzwv, 5 mcg	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 72 Original policy
J9382	Injection, zenocutuzumab-zbco, 1 mg	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
J9400	Injection, ziv-aflibercept, 1 mg	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
J9601	Injection, linvoseltamab-gcpt, 1 mg	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0010	Stnd Wt Frame Power Whlchr	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0011	Stnd Wt Pwr Whlchr W Control	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0012	Ltwt Portbl Power Whlchr	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0013	Custom motorized/power wheelchair base	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0014	Other Power Whlchr Base	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0800	POWER OPERATED VEHICLE, GROUP 1 STANDARD, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0801	POWER OPERATED VEHICLE, GROUP 1 HEAVY DUTY, PATIENT WEIGHT CAPACITY, 301 TO 450 POUNDS	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0802	POWER OPERATED VEHICLE, GROUP 1 VERY HEAVY DUTY, PATIENT WEIGHT CAPACITY 451 TO 600 POUNDS	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0806	POWER OPERATED VEHICLE, GROUP 2 STANDARD, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0807	POWER OPERATED VEHICLE, GROUP 2 HEAVY DUTY, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0808	POWER OPERATED VEHICLE, GROUP 2 VERY HEAVY DUTY, PATIENT WEIGHT CAPACITY 451 TO 600 POUNDS	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0812	POWER OPERATED VEHICLE, NOT OTHERWISE CLASSIFIED	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0813	POWER WHEELCHAIR, GROUP 1 STANDARD, PORTABLE, SLING/SOLID SEAT AND BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0814	POWER WHEELCHAIR, GROUP 1 STANDARD, PORTABLE, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0815	POWER WHEELCHAIR, GROUP 1 STANDARD, SLING/SOLID SEAT AND BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0816	POWER WHEELCHAIR, GROUP 1 STANDARD, CAPTAINS CHAIR, PATIENT WEIGHT CAPACTIY UP TO AND INCLUDING 300 POUNDS	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0820	POWER WHEELCHAIR, GROUP 2 STANDARD, PORTABLE, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POU	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0821	POWER WHEELCHAIR, GROUP 2 STANDARD, PORTABLE, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0822	POWER WHEELCHAIR, GROUP 2 STANDARD, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0823	POWER WHEELCHAIR, GROUP 2 STANDARD, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0824	POWER WHEELCHAIR, GROUP 2 HEAVY DUTY, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0825	POWER WHEELCHAIR, GROUP 2 HEAVY DUTY, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0826	POWER WHEELCHAIR, GROUP 2 VERY HEAVY DUTY, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 451 TO 600 POUNDS	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0827	POWER WHEELCHAIR, GROUP 2 VERY HEAVY DUTY, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY 451 TO 600 POUNDS	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0828	POWER WHEELCHAIR, GROUP 2 EXTRA HEAVY DUTY, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 601 POUNDS OR MORE	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0829	POWER WHEELCHAIR, GROUP 2 EXTRA HEAVY DUTY, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY 601 POUNDS OR MORE	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0830	POWER WHEELCHAIR, GROUP 2 STANDARD, SEAT ELEVATOR, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 30	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0831	POWER WHEELCHAIR, GROUP 2 STANDARD, SEAT ELEVATOR, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUND	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0835	POWER WHEELCHAIR, GROUP 2 STANDARD, SINGLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUD	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0836	POWER WHEELCHAIR, GROUP 2 STANDARD, SINGLE POWER OPTION, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0837	POWER WHEELCHAIR, GROUP 2 HEAVY DUTY, SINGLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 301 TO 450 POU	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0838	POWER WHEELCHAIR, GROUP 2 HEAVY DUTY, SINGLE POWER OPTION, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0839	POWER WHEELCHAIR, GROUP 2 VERY HEAVY DUTY, SINGLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 451 TO 60	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0840	POWER WHEELCHAIR, GROUP 2 EXTRA HEAVY DUTY, SINGLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 601 POUN	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0841	POWER WHEELCHAIR, GROUP 2 STANDARD, MULTIPLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCL	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0842	POWER WHEELCHAIR, GROUP 2 STANDARD, MULTIPLE POWER OPTION, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 3	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0843	POWER WHEELCHAIR, GROUP 2 HEAVY DUTY, MULTIPLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 301 TO 450 P	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0848	POWER WHEELCHAIR, GROUP 3 STANDARD, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0849	POWER WHEELCHAIR, GROUP 3 STANDARD, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0850	POWER WHEELCHAIR, GROUP 3 HEAVY DUTY, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0851	POWER WHEELCHAIR, GROUP 3 HEAVY DUTY, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0852	POWER WHEELCHAIR, GROUP 3 VERY HEAVY DUTY, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 451 TO 600 POUNDS	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0853	POWER WHEELCHAIR, GROUP 3 VERY HEAVY DUTY, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY, 451 TO 600 POUNDS	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0854	POWER WHEELCHAIR, GROUP 3 EXTRA HEAVY DUTY, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 601 POUNDS OR MORE	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0855	POWER WHEELCHAIR, GROUP 3 EXTRA HEAVY DUTY, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY 601 POUNDS OR MORE	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy
K0856	POWER WHEELCHAIR, GROUP 3 STANDARD, SINGLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUD	Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 73 Original policy

Sources

Disclaimer

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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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