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Anthem Blue Cross and Blue Shield Virginia prior authorization code reference, page 90

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Source code lookup

Each row links an imported source code to its service or category label. Check the original document for the complete plan scope, review type and qualifications.

Source code index

Imported source codes and labels; verify the complete review requirements in the original document
CodeDescriptionSource
S5522Home infusion therapy, insertion of peripherally inserted central venous catheter (PICC), nursing services only (no suppVirginia PPO standard precertification/prior authorization requirements, Pg 74 Original policy
S5523Home infusion therapy, insertion of midline central venous catheter, nursing services only (no supplies or catheter inclVirginia PPO standard precertification/prior authorization requirements, Pg 74 Original policy
S9061Medical Supplies And EquipmeVirginia PPO standard precertification/prior authorization requirements, Pg 74 Original policy
S9097Home Visit For Wound CareVirginia PPO standard precertification/prior authorization requirements, Pg 74 Original policy
S9122Home health aide or certified nurse assistant, providing care in the home; per hourVirginia PPO standard precertification/prior authorization requirements, Pg 74 Original policy
S9127Social Work Visit, In The HoVirginia PPO standard precertification/prior authorization requirements, Pg 74 Original policy
S9128Speech Therapy, In The HomeVirginia PPO standard precertification/prior authorization requirements, Pg 74 Original policy
S9129Occupational Therapy, In TheVirginia PPO standard precertification/prior authorization requirements, Pg 74 Original policy
S9131Physical therapy, in the home, per diemVirginia PPO standard precertification/prior authorization requirements, Pg 74 Original policy
S9209Home management of preterm premature rupture of membranes (pprom)Virginia PPO standard precertification/prior authorization requirements, Pg 74 Original policy
S9211Home management of gestational hypertensionVirginia PPO standard precertification/prior authorization requirements, Pg 74 Original policy
S9212Home management of postpartum hypertensionVirginia PPO standard precertification/prior authorization requirements, Pg 75 Original policy
S9213Home management of preeclampsiaVirginia PPO standard precertification/prior authorization requirements, Pg 75 Original policy
S9214Home management of gestational diabetesVirginia PPO standard precertification/prior authorization requirements, Pg 75 Original policy
S9325Home infusion therapy, pain management infusion (do not use this code with S9326, S9327 or S9328)Virginia PPO standard precertification/prior authorization requirements, Pg 75 Original policy
S9326Home infusion therapy, continuous pain management infusionVirginia PPO standard precertification/prior authorization requirements, Pg 75 Original policy
S9327Home infusion therapy, intermittent pain management infusionVirginia PPO standard precertification/prior authorization requirements, Pg 75 Original policy
S9328Home infusion therapy, implanted pump pain management infusionVirginia PPO standard precertification/prior authorization requirements, Pg 75 Original policy
S9329Home infusion therapy, chemotherapy infusion (do not use this code with S9330 or S9331)Virginia PPO standard precertification/prior authorization requirements, Pg 75 Original policy
S9330Home infusion therapy, continuous chemotherapy infusionVirginia PPO standard precertification/prior authorization requirements, Pg 75 Original policy
S9331Home infusion therapy, intermittent chemotherapy infusionVirginia PPO standard precertification/prior authorization requirements, Pg 75 Original policy
S9338Home infusion therapy, immunotherapy therapyVirginia PPO standard precertification/prior authorization requirements, Pg 75 Original policy
S9345Home infusion therapy, anti-hemophilic agent infusion therapy (e.g., factor VIII)Virginia PPO standard precertification/prior authorization requirements, Pg 75 Original policy
S9346Home infusion therapy, alpha-1-proteinase inhibitor (e.g., Prolastin)Virginia PPO standard precertification/prior authorization requirements, Pg 75 Original policy
S9348Home infusion therapy, sympathomimetic/inotropic agent infusion therapy (e,g. Dobutamine)Virginia PPO standard precertification/prior authorization requirements, Pg 75 Original policy
S9353Home infusion therapy, continuous insulin infusion therapyVirginia PPO standard precertification/prior authorization requirements, Pg 75 Original policy
S9357Home infusion therapy, enzyme replacement intravenous therapy; (e.g., Imiglucerase)Virginia PPO standard precertification/prior authorization requirements, Pg 75 Original policy
S9361Home infusion therapy, diuretic intravenous therapyVirginia PPO standard precertification/prior authorization requirements, Pg 75 Original policy
S9363Home infusion therapy, anti-spasmotic intravenous therapyVirginia PPO standard precertification/prior authorization requirements, Pg 75 Original policy
S9370Home therapy, intermittent anti-emetic injection therapyVirginia PPO standard precertification/prior authorization requirements, Pg 75 Original policy
S9372Home infusion therapy, intermittent anticoagulant injection therapy; (e.g., Heparin); (do not use this code for flushingVirginia PPO standard precertification/prior authorization requirements, Pg 75 Original policy
S9379Home infusion therapy, infusion therapy, not otherwise classified; administrative services, professional pharmacy servicVirginia PPO standard precertification/prior authorization requirements, Pg 75 Original policy
S9538Home transfusion of blood product(s) (blood products, drugs and nursing visits coded separately), per diemVirginia PPO standard precertification/prior authorization requirements, Pg 76 Original policy
S9560Home injectable therapy; hormonal therapy (e.g., leuprolide, goserelin) (drugs and nursing visits coded separately), perVirginia PPO standard precertification/prior authorization requirements, Pg 76 Original policy
S9590Home Therpay, Irrigation Therpay (E.G. Sterile Irrigation Of An OrganVirginia PPO standard precertification/prior authorization requirements, Pg 76 Original policy
T1030Nursing Care, In The Home, By Registered Nurse, Per DiemVirginia PPO standard precertification/prior authorization requirements, Pg 76 Original policy
T1031Nursing Care, In The Home, By Licensed Practical Nurse, Per DiemVirginia PPO standard precertification/prior authorization requirements, Pg 76 Original policy

Sources

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.

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