Anthem · Clinical Guideline · ANTHEM-CG-LAB-11
Summary of the payer’s published policy. Not a coverage determination — confirm with Anthem before submitting.
Free account. Policy pages stay open to everyone.
Each code’s status is what the policy records for it. This page does not show the policy’s criteria. Read them in the payer’s source.
| Code | Code system | Status in this policy |
|---|---|---|
| 82306 | CPT | Covered |
| 82652 | CPT | Covered |
| L3735 | HCPCS | Covered |
| A15.0 | ICD10CM | Covered |
| A19.9 | ICD10CM | Covered |
| B38.0 | ICD10CM | Covered |
| B38.9 | ICD10CM | Covered |
| B39.0 | ICD10CM | Covered |
| B39.9 | ICD10CM | Covered |
| C22.0 | ICD10CM | Covered |
| C26.9 | ICD10CM | Covered |
| C82.00 | ICD10CM | Covered |
| C83.9A | ICD10CM | Covered |
| C84.00 | ICD10CM | Covered |
| C84.1A | ICD10CM | Covered |
| D13.0 | ICD10CM | Covered |
| D13.99 | ICD10CM | Covered |
| D86.0 | ICD10CM | Covered |
| D86.9 | ICD10CM | Covered |
| E08.21 | ICD10CM | Covered |
| E08.29 | ICD10CM | Covered |
| E09.21 | ICD10CM | Covered |
| E09.29 | ICD10CM | Covered |
| E10.21 | ICD10CM | Covered |
| E10.29 | ICD10CM | Covered |
| E11.21 | ICD10CM | Covered |
| E11.29 | ICD10CM | Covered |
| E13.21 | ICD10CM | Covered |
| E13.29 | ICD10CM | Covered |
| E20.0 | ICD10CM | Covered |
| E21.5 | ICD10CM | Covered |
| E55.0 | ICD10CM | Covered |
| E55.9 | ICD10CM | Covered |
| E64.0 | ICD10CM | Covered |
| E64.9 | ICD10CM | Covered |
| E66.01 | ICD10CM | Covered |
| E66.9 | ICD10CM | Covered |
| E67.2 | ICD10CM | Covered |
| E67.3 | ICD10CM | Covered |
| E83.30 | ICD10CM | Covered |
| E83.39 | ICD10CM | Covered |
| E83.50 | ICD10CM | Covered |
| E83.59 | ICD10CM | Covered |
| E84.0 | ICD10CM | Covered |
| E84.9 | ICD10CM | Covered |
| E89.2 | ICD10CM | Covered |
| G12.0 | ICD10CM | Covered |
| G12.9 | ICD10CM | Covered |
| G35.A | ICD10CM | Covered |
| G37.9 | ICD10CM | Covered |
| G40.001 | ICD10CM | Covered |
| G40.919 | ICD10CM | Covered |
| G40.A01 | ICD10CM | Covered |
| G40.C19 | ICD10CM | Covered |
| G60.0 | ICD10CM | Covered |
| G65.2 | ICD10CM | Covered |
| G70.00 | ICD10CM | Covered |
| G73.7 | ICD10CM | Covered |
| G80.0 | ICD10CM | Covered |
| G80.9 | ICD10CM | Covered |
| G82.20 | ICD10CM | Covered |
| G82.54 | ICD10CM | Covered |
| I12.0 | ICD10CM | Covered |
| I13.2 | ICD10CM | Covered |
| J63.2 | ICD10CM | Covered |
| K50.00 | ICD10CM | Covered |
| K51.919 | ICD10CM | Covered |
| K70.0 | ICD10CM | Covered |
| K80.00 | ICD10CM | Covered |
| K90.0 | ICD10CM | Covered |
| K90.9 | ICD10CM | Covered |
| K91.2 | ICD10CM | Covered |
| K91.82 | ICD10CM | Covered |
| K95.01 | ICD10CM | Covered |
| K95.89 | ICD10CM | Covered |
| M33.00 | ICD10CM | Covered |
| M33.99 | ICD10CM | Covered |
| M80.00XA | ICD10CM | Covered |
| M81.8 | ICD10CM | Covered |
| M83.0 | ICD10CM | Covered |
| M83.9 | ICD10CM | Covered |
| M84.30XA | ICD10CM | Covered |
| M84.9 | ICD10CM | Covered |
| M85.00 | ICD10CM | Covered |
| M85.9 | ICD10CM | Covered |
| M88.0 | ICD10CM | Covered |
| M88.9 | ICD10CM | Covered |
| N18.1 | ICD10CM | Covered |
| N18.9 | ICD10CM | Covered |
| N91.0 | ICD10CM | Covered |
| N91.3 | ICD10CM | Covered |
| O99.840 | ICD10CM | Covered |
| O99.845 | ICD10CM | Covered |
| Q78.0 | ICD10CM | Covered |
| Q78.2 | ICD10CM | Covered |
| R25.2 | ICD10CM | Covered |
| R26.0 | ICD10CM | Covered |
| R27.9 | ICD10CM | Covered |
| R29.6 | ICD10CM | Covered |
| R41.0 | ICD10CM | Covered |
| R47.1 | ICD10CM | Covered |
| R53.0 | ICD10CM | Covered |
| Z68.30 | ICD10CM | Covered |
| Z68.45 | ICD10CM | Covered |
| Z68.54 | ICD10CM | Covered |
| Z68.56 | ICD10CM | Covered |
| Z79.3 | ICD10CM | Covered |
| Z79.52 | ICD10CM | Covered |
| Z87.310 | ICD10CM | Covered |
| Z87.312 | ICD10CM | Covered |
| Z98.84 | ICD10CM | Covered |