Anthem Blue Cross and Blue Shield Virginia policy

Download the Dental Provider Reference Manual

Download the Dental Provider Reference Manual is a public Anthem Blue Cross and Blue Shield Virginia policy. It lists 111 CPT or HCPCS codes, 4 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) ↗

Payer
Anthem Blue Cross and Blue Shield Virginia
Line of business
Commercial
States
CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, VA, WI
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.

CodePrior authorizationDescription on the prior authorization listOther Anthem Blue Cross and Blue Shield Virginia policies
30348Not listedPolicies naming 30348
55440Not listedPolicies naming 55440
78265Not listedPolicies naming 78265
D2390Not listedPolicies naming D2390
D2510Not listedPolicies naming D2510
D2664Not listedPolicies naming D2664
D2710Not listedPolicies naming D2710
D2799Not listedPolicies naming D2799
D2930Not listedPolicies naming D2930
D2934Not listedPolicies naming D2934
D2940Not listedPolicies naming D2940
D2950Not listedPolicies naming D2950
D2952Not listedPolicies naming D2952
D2957Not listedPolicies naming D2957
D2960Not listedPolicies naming D2960
D2962Not listedPolicies naming D2962
D2980Not listedPolicies naming D2980
D2983Not listedPolicies naming D2983
D3220Not listedPolicies naming D3220
D3240Not listedPolicies naming D3240
D3310Not listedPolicies naming D3310
D3348Not listedPolicies naming D3348
D3351Not listedPolicies naming D3351
D3353Not listedPolicies naming D3353
D3355Not listedPolicies naming D3355
D3357Not listedPolicies naming D3357
D3410Not listedPolicies naming D3410
D3450Not listedPolicies naming D3450
D3460Not listedPolicies naming D3460
D3470Not listedPolicies naming D3470
D3920Not listedPolicies naming D3920
D4210Not listedPolicies naming D4210
D4211Not listedPolicies naming D4211
D4212Not listedPolicies naming D4212
D4240Not listedPolicies naming D4240
D4245Not listedPolicies naming D4245
D4249Not listedPolicies naming D4249
D4260Not listedPolicies naming D4260
D4261Not listedPolicies naming D4261
D4263Not listedPolicies naming D4263
D4264Not listedPolicies naming D4264
D4265Not listedPolicies naming D4265
D4267Not listedPolicies naming D4267
D4268Not listedPolicies naming D4268
D4270Not listedPolicies naming D4270
D4274Not listedPolicies naming D4274
D4285Not listedPolicies naming D4285
D4341Not listedPolicies naming D4341
D4342Not listedPolicies naming D4342
D4355Not listedPolicies naming D4355
D4381Not listedPolicies naming D4381
D4910Not listedPolicies naming D4910
D5110Not listedPolicies naming D5110
D5140Not listedPolicies naming D5140
D5211Not listedPolicies naming D5211
D5226Not listedPolicies naming D5226
D5281Not listedPolicies naming D5281
D5410Not listedPolicies naming D5410
D5761Not listedPolicies naming D5761
D5982Not listedPolicies naming D5982
D6010Not listedPolicies naming D6010
D6190Not listedPolicies naming D6190
D6199Not listedPolicies naming D6199
D6205Not listedPolicies naming D6205
D6290Not listedPolicies naming D6290
D6794Not listedPolicies naming D6794
D6999Not listedPolicies naming D6999
D7210Not listedPolicies naming D7210
D7251Not listedPolicies naming D7251
D7260Not listedPolicies naming D7260
D7270Not listedPolicies naming D7270
D7272Not listedPolicies naming D7272
D7283Not listedPolicies naming D7283
D7285Not listedPolicies naming D7285
D7286Not listedPolicies naming D7286
D7287Not listedPolicies naming D7287
D7291Not listedPolicies naming D7291
D7310Not listedPolicies naming D7310
D7321Not listedPolicies naming D7321
D7410Not listedPolicies naming D7410
D7461Not listedPolicies naming D7461
D7471Not listedPolicies naming D7471
D7490Not listedPolicies naming D7490
D7510Not listedPolicies naming D7510
D7521Not listedPolicies naming D7521
D7530Not listedPolicies naming D7530
D7560Not listedPolicies naming D7560
D7810Not listedPolicies naming D7810
D7877Not listedPolicies naming D7877
D7880Not listedPolicies naming D7880
D7881Not listedPolicies naming D7881
D7899Not listedPolicies naming D7899
D7920Not listedPolicies naming D7920
D7951Not listedPolicies naming D7951
D7953Not listedPolicies naming D7953
D7960Not listedPolicies naming D7960
D7963Not listedPolicies naming D7963
D7970Not listedPolicies naming D7970
D7996On the listimplant-mandible for augmentation purposes (excluding alveolar ridge), by reportPolicies naming D7996
D8030Not listedPolicies naming D8030
D8090Not listedPolicies naming D8090
D9120Not listedPolicies naming D9120
D9223On the listdeep sedation/general anesthesia - each subsequent 15 minute incrementPolicies naming D9223
D9243Not listedPolicies naming D9243
D9610Not listedPolicies naming D9610
D9630Not listedPolicies naming D9630
D9920Not listedPolicies naming D9920
D9930Not listedPolicies naming D9930
D9940Not listedPolicies naming D9940
D9951On the listocclusal adjustment - limitedPolicies naming D9951
D9952On the listocclusal adjustment - completePolicies naming D9952

All Anthem Blue Cross and Blue Shield Virginia policies · Anthem Blue Cross and Blue Shield Virginia prior authorization CPT list

Disclaimer

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.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.