Anthem Blue Cross and Blue Shield Virginia policy
Selected Protein Biomarker Algorithmic Assays
Selected Protein Biomarker Algorithmic Assays is a public Anthem Blue Cross and Blue Shield Virginia policy (policy LAB.00011). It lists 9 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.
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- Policy number
- LAB.00011
- 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 |
|---|---|---|---|
| 0080U | On the list | Oncology (lung), mass spectrometric analysis of galectin-3-binding protein and scavenger receptor cysteine-rich type 1 protein M130, with five clinical risk factors (age, smok | Policies naming 0080U |
| 0092U | Not listed | Policies naming 0092U | |
| 0174U | Not listed | Policies naming 0174U | |
| 0247U | On the list | Obstetrics (preterm birth), insulin-like growth factor-binding protein 4 (IBP4), sex hormone- binding globulin (SHBG), quantitative measurement by LC-MS/MS, utilizing maternal | Policies naming 0247U |
| 0249U | Not listed | Policies naming 0249U | |
| 0342U | Not listed | Policies naming 0342U | |
| 0360U | On the list | Oncology (lung), enzyme-linked immunosorbent assay (ELISA) of 7 autoantibodies (p53, NY- ESO-1, CAGE, GBU4-5, SOX2, MAGE A4, and HuD), plasma, algorithm reported as a categoric | Policies naming 0360U |
| 81538 | On the list | Oncology (lung), mass spectrometric 8-protein signature, including amyloid A, utilizing serum, prognostic and predictive algorithm reported as good versus poor overall surviva | Policies naming 81538 |
| 81599 | Not listed | Policies naming 81599 |
All Anthem Blue Cross and Blue Shield Virginia policies · Anthem Blue Cross and Blue Shield Virginia prior authorization CPT list