Anthem Blue Cross and Blue Shield Virginia policy
Anthem Blue Cross and Blue Shield Virginia Facility Provider Manual
Anthem Blue Cross and Blue Shield Virginia Facility Provider Manual is a public Anthem Blue Cross and Blue Shield Virginia policy (policy VABCBS-CM-PM-061543-24, effective Oct 1, 2024). It lists 90 CPT or HCPCS codes, 13 of them on the Anthem Blue Cross and Blue Shield Virginia prior authorization list. Not a coverage decision; the payer's own document governs.
View the original policy (PDF) ↗
- Policy number
- VABCBS-CM-PM-061543-24
- Effective
- Oct 1, 2024
- Line of business
- Commercial
- States
- VA
- Source
- www.anthem.com
Codes in this policy
The CPT and HCPCS codes the policy names. A policy can name a code it excludes. Prior authorization status is from the Anthem Blue Cross and Blue Shield Virginia prior authorization list.
| Code | Prior authorization | Description on the prior authorization list | Other Anthem Blue Cross and Blue Shield Virginia policies |
|---|---|---|---|
| 0359T | Not listed | Policies naming 0359T | |
| 0374T | Not listed | Policies naming 0374T | |
| 10157 | Not listed | Policies naming 10157 | |
| 10160 | Not listed | Policies naming 10160 | |
| 10164 | Not listed | Policies naming 10164 | |
| 10183 | Not listed | Policies naming 10183 | |
| 10190 | Not listed | Policies naming 10190 | |
| 11348 | Not listed | Policies naming 11348 | |
| 11369 | Not listed | Policies naming 11369 | |
| 11383 | Not listed | Policies naming 11383 | |
| 11450 | Not listed | Policies naming 11450 | |
| 11493 | Not listed | Policies naming 11493 | |
| 11535 | Not listed | Policies naming 11535 | |
| 12345 | Not listed | Policies naming 12345 | |
| 18776 | Not listed | Policies naming 18776 | |
| 23230 | Not listed | Policies naming 23230 | |
| 23279 | Not listed | Policies naming 23279 | |
| 27401 | Not listed | Policies naming 27401 | |
| 29299 | Not listed | Policies naming 29299 | |
| 29549 | Not listed | Policies naming 29549 | |
| 29762 | Not listed | Policies naming 29762 | |
| 30308 | Not listed | Policies naming 30308 | |
| 30954 | Not listed | Policies naming 30954 | |
| 36415 | Not listed | Policies naming 36415 | |
| 36416 | Not listed | Policies naming 36416 | |
| 42346 | Not listed | Policies naming 42346 | |
| 42348 | Not listed | Policies naming 42348 | |
| 44135 | On the list | Intestinal Allotransplantation; From Cadaver Donor | Policies naming 44135 |
| 44193 | Not listed | Policies naming 44193 | |
| 46239 | Not listed | Policies naming 46239 | |
| 46240 | Not listed | Policies naming 46240 | |
| 46241 | Not listed | Policies naming 46241 | |
| 46264 | Not listed | Policies naming 46264 | |
| 47420 | Not listed | Policies naming 47420 | |
| 47519 | Not listed | Policies naming 47519 | |
| 48765 | Not listed | Policies naming 48765 | |
| 48768 | Not listed | Policies naming 48768 | |
| 51847 | Not listed | Policies naming 51847 | |
| 51848 | Not listed | Policies naming 51848 | |
| 59400 | Not listed | Policies naming 59400 | |
| 59410 | Not listed | Policies naming 59410 | |
| 59510 | Not listed | Policies naming 59510 | |
| 59515 | Not listed | Policies naming 59515 | |
| 59610 | Not listed | Policies naming 59610 | |
| 59612 | Not listed | Policies naming 59612 | |
| 59614 | Not listed | Policies naming 59614 | |
| 59618 | Not listed | Policies naming 59618 | |
| 59620 | Not listed | Policies naming 59620 | |
| 59622 | Not listed | Policies naming 59622 | |
| 61146 | Not listed | Policies naming 61146 | |
| 62387 | Not listed | Policies naming 62387 | |
| 66149 | Not listed | Policies naming 66149 | |
| 73651 | Not listed | Policies naming 73651 | |
| 75310 | Not listed | Policies naming 75310 | |
| 90801 | Not listed | Policies naming 90801 | |
| 90867 | On the list | Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management | Policies naming 90867 |
| 90869 | On the list | Therapeutic Repetitive Transcranial Magnetic Stimulation (Tms) Treatment; Subsequent Motor Threshold Re-Determination With Delivery And Management | Policies naming 90869 |
| 90899 | Not listed | Policies naming 90899 | |
| 94760 | Not listed | Policies naming 94760 | |
| 94761 | Not listed | Policies naming 94761 | |
| 94762 | Not listed | Policies naming 94762 | |
| 96365 | On the list | Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour | Policies naming 96365 |
| 96366 | Not listed | Policies naming 96366 | |
| 96368 | Not listed | Policies naming 96368 | |
| 96374 | Not listed | Policies naming 96374 | |
| 96379 | Not listed | Policies naming 96379 | |
| 97032 | On the list | Application, Modality 1+ Areas; Electrical Stimulation (Manual), Each 15 Min | Policies naming 97032 |
| 97035 | On the list | Application, Modality To 1+ Areas; Ultrasound, Each 15 Min | Policies naming 97035 |
| 97036 | On the list | Application, Modality To 1+ Areas; Hubbard Tank, Each 15 Min | Policies naming 97036 |
| 97110 | On the list | Therapeutic Proc, 1+ Areas, Each 15 Min; Therapeutic Exercises | Policies naming 97110 |
| 97124 | On the list | Therapeutic Proc, 1+ Areas, Each 15 Min; Massage | Policies naming 97124 |
| 97140 | On the list | Manual Therapy Techniques, 1+ Regions, Each 15 Min | Policies naming 97140 |
| 97530 | On the list | Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes | Policies naming 97530 |
| 97542 | On the list | Wheelchair management (eg, assessment, fitting, training), each 15 minutes | Policies naming 97542 |
| 97760 | On the list | 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 | Policies naming 97760 |
| 97762 | Not listed | Policies naming 97762 | |
| 99001 | Not listed | Policies naming 99001 | |
| 99281 | Not listed | Policies naming 99281 | |
| 99282 | Not listed | Policies naming 99282 | |
| 99283 | Not listed | Policies naming 99283 | |
| 99284 | Not listed | Policies naming 99284 | |
| 99285 | Not listed | Policies naming 99285 | |
| G0001 | Not listed | Policies naming G0001 | |
| G0380 | Not listed | Policies naming G0380 | |
| G0381 | Not listed | Policies naming G0381 | |
| G0382 | Not listed | Policies naming G0382 | |
| G0383 | Not listed | Policies naming G0383 | |
| G0384 | Not listed | Policies naming G0384 | |
| J0610 | Not listed | Policies naming J0610 | |
| S2900 | Not listed | Policies naming S2900 |
All Anthem Blue Cross and Blue Shield Virginia policies · Anthem Blue Cross and Blue Shield Virginia prior authorization CPT list