Anthem Blue Cross and Blue Shield Virginia policy
CG-MED-53 Cervical Cancer Screening Using Cytology and Human Papillomavirus Testing
CG-MED-53 Cervical Cancer Screening Using Cytology and Human Papillomavirus Testing is a public Anthem Blue Cross and Blue Shield Virginia policy (policy CG-MED-53). It lists 31 CPT or HCPCS codes, 27 of them on the Anthem Blue Cross and Blue Shield Virginia prior authorization list. Not a coverage decision; the payer's own document governs.
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- Policy number
- CG-MED-53
- Line of business
- Commercial
- 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 |
|---|---|---|---|
| 0502U | Not listed | Policies naming 0502U | |
| 87623 | On the list | Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), low- risk types (eg, 6, 11, 42, 43, 44) | Policies naming 87623 |
| 87624 | On the list | Human Papillomavirus (HPV), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68), pooled result | Policies naming 87624 |
| 87625 | On the list | Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), types 16 and 18 only, includes type 45, if performed | Policies naming 87625 |
| 87626 | Not listed | Policies naming 87626 | |
| 88141 | On the list | Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician | Policies naming 88141 |
| 88142 | On the list | Cytopathology, Cervical/Vaginal, Preservative Fluid, Auto Thin Layer Prep; Manual Screen | Policies naming 88142 |
| 88143 | On the list | Cytopathology, Cervical/Vaginal, Preservative Fluid, Auto Thin Layer Prep; Manual Screen/Rescreen | Policies naming 88143 |
| 88147 | On the list | Cytopathology, Cervical/Vaginal; Automated Screen | Policies naming 88147 |
| 88148 | On the list | Cytopathology, Cervical/Vaginal; Automated Screen, Manual Rescreen | Policies naming 88148 |
| 88150 | On the list | Cytopathology, Slides, Cervical/Vaginal; Manual Screen | Policies naming 88150 |
| 88152 | On the list | Cytopathology, Slides, Cervical/Vaginal; Manual Screen, Computer Rescreen | Policies naming 88152 |
| 88153 | On the list | Cytopathology, Slides, Cervical/Vaginal; Manual Screen/Rescreen | Policies naming 88153 |
| 88164 | On the list | Cytopathology, Slides, Cervical/Vaginal, Bethesda; Manual Screen | Policies naming 88164 |
| 88165 | On the list | Cytopathology, Slides, Cervical/Vaginal, Bethesda; W/Manual Screen & Rescreen | Policies naming 88165 |
| 88166 | On the list | Cytopathology, Slides, Cervical/Vaginal, Bethesda; W/Manual Screen & Computer Rescreen | Policies naming 88166 |
| 88167 | On the list | Cytopathology, Slides, Cervical/Vaginal, Bethesda; Manual Screen, Computer Rescreen, Cell Selection | Policies naming 88167 |
| 88174 | On the list | Cytopathology, Cervical/Vaginal, Auto Thin Layer Prep; Auto Screen, W/Phys Interp | Policies naming 88174 |
| 88175 | On the list | Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer prepara | Policies naming 88175 |
| G0123 | On the list | Screen Cerv/Vag Thin Layer | Policies naming G0123 |
| G0124 | On the list | Screen C/V Thin Layer By Md | Policies naming G0124 |
| G0141 | On the list | Scr C/V Cyto,Autosys And Md | Policies naming G0141 |
| G0143 | On the list | Scr C/V Cyto,Thinlayer,Rescr | Policies naming G0143 |
| G0144 | On the list | Scr C/V Cyto,Thinlayer,Rescr | Policies naming G0144 |
| G0145 | On the list | Scr C/V Cyto,Thinlayer,Rescr | Policies naming G0145 |
| G0147 | On the list | Scr C/V Cyto, Automated Sys | Policies naming G0147 |
| G0148 | On the list | Scr C/V Cyto, Autosys, Rescr | Policies naming G0148 |
| G0476 | Not listed | Policies naming G0476 | |
| P3000 | On the list | Screen Pap By Tech W Md Supv | Policies naming P3000 |
| P3001 | On the list | Screening Pap Smear By Phys | Policies naming P3001 |
| Q0091 | Not listed | Policies naming Q0091 |
All Anthem Blue Cross and Blue Shield Virginia policies · Anthem Blue Cross and Blue Shield Virginia prior authorization CPT list