Anthem · Clinical Guideline · ANTHEM-CG-LAB-20
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 |
|---|---|---|
| 84436 | CPT | Covered |
| 84439 | CPT | Covered |
| 84443 | CPT | Covered |
| 84479 | CPT | Covered |
| A15.0 | ICD10CM | Covered |
| A19.9 | ICD10CM | Covered |
| A50.01 | ICD10CM | Covered |
| A53.9 | ICD10CM | Covered |
| B35.0 | ICD10CM | Covered |
| C00.0 | ICD10CM | Covered |
| C96.9 | ICD10CM | Covered |
| D00.00 | ICD10CM | Covered |
| D09.9 | ICD10CM | Covered |
| D27.0 | ICD10CM | Covered |
| D27.9 | ICD10CM | Covered |
| D35.9 | ICD10CM | Covered |
| D44.0 | ICD10CM | Covered |
| D44.9 | ICD10CM | Covered |
| D49.7 | ICD10CM | Covered |
| D50.0 | ICD10CM | Covered |
| D53.9 | ICD10CM | Covered |
| D59.0 | ICD10CM | Covered |
| D59.19 | ICD10CM | Covered |
| D64.89 | ICD10CM | Covered |
| D64.9 | ICD10CM | Covered |
| D76.1 | ICD10CM | Covered |
| D76.3 | ICD10CM | Covered |
| D80.0 | ICD10CM | Covered |
| D89.9 | ICD10CM | Covered |
| E00.0 | ICD10CM | Covered |
| E07.9 | ICD10CM | Covered |
| E08.00 | ICD10CM | Covered |
| E13.9 | ICD10CM | Covered |
| E20.0 | ICD10CM | Covered |
| E53.0 | ICD10CM | Covered |
| E53.9 | ICD10CM | Covered |
| E64.0 | ICD10CM | Covered |
| E64.9 | ICD10CM | Covered |
| E66.01 | ICD10CM | Covered |
| E66.9 | ICD10CM | Covered |
| E67.1 | ICD10CM | Covered |
| E75.26 | ICD10CM | Covered |
| E78.00 | ICD10CM | Covered |
| E78.9 | ICD10CM | Covered |
| E83.00 | ICD10CM | Covered |
| E83.9 | ICD10CM | Covered |
| E87.0 | ICD10CM | Covered |
| E87.1 | ICD10CM | Covered |
| E88.02 | ICD10CM | Covered |
| E88.82 | ICD10CM | Covered |
| E89.0 | ICD10CM | Covered |
| E89.89 | ICD10CM | Covered |
| F02.80 | ICD10CM | Covered |
| F03.C4 | ICD10CM | Covered |
| F07.9 | ICD10CM | Covered |
| F12.10 | ICD10CM | Covered |
| F12.99 | ICD10CM | Covered |
| F30.10 | ICD10CM | Covered |
| F41.0 | ICD10CM | Covered |
| F41.9 | ICD10CM | Covered |
| F50.00 | ICD10CM | Covered |
| F50.9 | ICD10CM | Covered |
| F53.0 | ICD10CM | Covered |
| F53.1 | ICD10CM | Covered |
| G12.23 | ICD10CM | Covered |
| G25.0 | ICD10CM | Covered |
| G30.0 | ICD10CM | Covered |
| G31.9 | ICD10CM | Covered |
| G35.A | ICD10CM | Covered |
| G35.D | ICD10CM | Covered |
| G47.00 | ICD10CM | Covered |
| G47.9 | ICD10CM | Covered |
| G56.00 | ICD10CM | Covered |
| G60.0 | ICD10CM | Covered |
| G61.9 | ICD10CM | Covered |
| G70.00 | ICD10CM | Covered |
| G73.7 | ICD10CM | Covered |
| G93.31 | ICD10CM | Covered |
| G93.39 | ICD10CM | Covered |
| H02.001 | ICD10CM | Covered |
| H02.9 | ICD10CM | Covered |
| H05.00 | ICD10CM | Covered |
| H05.9 | ICD10CM | Covered |
| H10.821 | ICD10CM | Covered |
| H10.829 | ICD10CM | Covered |
| H11.421 | ICD10CM | Covered |
| H11.439 | ICD10CM | Covered |
| H49.00 | ICD10CM | Covered |
| H49.9 | ICD10CM | Covered |
| H53.2 | ICD10CM | Covered |
| I16.9 | ICD10CM | Covered |
| I31.0 | ICD10CM | Covered |
| I44.0 | ICD10CM | Covered |
| I45.9 | ICD10CM | Covered |
| I47.0 | ICD10CM | Covered |
| I49.9 | ICD10CM | Covered |
| I50.1 | ICD10CM | Covered |
| I50.9 | ICD10CM | Covered |
| I51.7 | ICD10CM | Covered |
| I60.00 | ICD10CM | Covered |
| I60.9 | ICD10CM | Covered |
| I67.1 | ICD10CM | Covered |
| I69.00 | ICD10CM | Covered |
| I69.098 | ICD10CM | Covered |
| I72.0 | ICD10CM | Covered |
| J91.8 | ICD10CM | Covered |
| J96.00 | ICD10CM | Covered |
| J96.92 | ICD10CM | Covered |
| K14.8 | ICD10CM | Covered |
| K52.0 | ICD10CM | Covered |
| K52.9 | ICD10CM | Covered |
| K56.0 | ICD10CM | Covered |
| K56.7 | ICD10CM | Covered |
| K58.0 | ICD10CM | Covered |
| K59.9 | ICD10CM | Covered |
| K90.0 | ICD10CM | Covered |
| K90.9 | ICD10CM | Covered |
| L11.0 | ICD10CM | Covered |
| L29.8 | ICD10CM | Covered |
| L29.81 | ICD10CM | Covered |
| L29.9 | ICD10CM | Covered |
| L60.0 | ICD10CM | Covered |
| L63.0 | ICD10CM | Covered |
| L66.9 | ICD10CM | Covered |
| L85.0 | ICD10CM | Covered |
| L87.9 | ICD10CM | Covered |
| M04.1 | ICD10CM | Covered |
| M04.9 | ICD10CM | Covered |
| M05.00 | ICD10CM | Covered |
| M08.9A | ICD10CM | Covered |
| M30.0 | ICD10CM | Covered |
| M36.8 | ICD10CM | Covered |
| M60.000 | ICD10CM | Covered |
| M60.9 | ICD10CM | Covered |
| M62.50 | ICD10CM | Covered |
| M63.89 | ICD10CM | Covered |
| M79.0 | ICD10CM | Covered |
| M79.9 | ICD10CM | Covered |
| M81.6 | ICD10CM | Covered |
| M81.8 | ICD10CM | Covered |
| M86.00 | ICD10CM | Covered |
| M86.9 | ICD10CM | Covered |
| N91.0 | ICD10CM | Covered |
| N92.6 | ICD10CM | Covered |
| N94.4 | ICD10CM | Covered |
| N94.6 | ICD10CM | Covered |
| N97.0 | ICD10CM | Covered |
| N97.9 | ICD10CM | Covered |
| O09.00 | ICD10CM | Covered |
| O09.93 | ICD10CM | Covered |
| O10.011 | ICD10CM | Covered |
| O16.9 | ICD10CM | Covered |
| O20.0 | ICD10CM | Covered |
| O29.93 | ICD10CM | Covered |
| O30.001 | ICD10CM | Covered |
| O48.1 | ICD10CM | Covered |
| O92.79 | ICD10CM | Covered |
| P04.40 | ICD10CM | Covered |
| P04.5 | ICD10CM | Covered |
| P05.00 | ICD10CM | Covered |
| P07.39 | ICD10CM | Covered |
| P09.1 | ICD10CM | Covered |
| P09.9 | ICD10CM | Covered |
| P28.0 | ICD10CM | Covered |
| P29.9 | ICD10CM | Covered |
| P37.0 | ICD10CM | Covered |
| P52.5 | ICD10CM | Covered |
| P70.0 | ICD10CM | Covered |
| P74.9 | ICD10CM | Covered |
| Q38.2 | ICD10CM | Covered |
| Q89.2 | ICD10CM | Covered |
| Q90.0 | ICD10CM | Covered |
| Q90.9 | ICD10CM | Covered |
| Q96.0 | ICD10CM | Covered |
| Q96.9 | ICD10CM | Covered |
| R00.0 | ICD10CM | Covered |
| R00.9 | ICD10CM | Covered |
| R06.00 | ICD10CM | Covered |
| R06.9 | ICD10CM | Covered |
| R07.0 | ICD10CM | Covered |
| R09.89 | ICD10CM | Covered |
| R13.0 | ICD10CM | Covered |
| R13.19 | ICD10CM | Covered |
| R18.0 | ICD10CM | Covered |
| R19.8 | ICD10CM | Covered |
| R20.0 | ICD10CM | Covered |
| R20.9 | ICD10CM | Covered |
| R23.0 | ICD10CM | Covered |
| R23.9 | ICD10CM | Covered |
| R25.0 | ICD10CM | Covered |
| R27.9 | ICD10CM | Covered |
| R29.0 | ICD10CM | Covered |
| R29.91 | ICD10CM | Covered |
| R40.0 | ICD10CM | Covered |
| R41.9 | ICD10CM | Covered |
| R45.0 | ICD10CM | Covered |
| R45.89 | ICD10CM | Covered |
| R47.01 | ICD10CM | Covered |
| R47.9 | ICD10CM | Covered |
| R49.0 | ICD10CM | Covered |
| R49.9 | ICD10CM | Covered |
| R50.2 | ICD10CM | Covered |
| R50.9 | ICD10CM | Covered |
| R53.83 | ICD10CM | Covered |
| R60.0 | ICD10CM | Covered |
| R60.9 | ICD10CM | Covered |
| R62.0 | ICD10CM | Covered |
| R62.59 | ICD10CM | Covered |
| R63.0 | ICD10CM | Covered |
| R63.8 | ICD10CM | Covered |
| R68.0 | ICD10CM | Covered |
| R68.81 | ICD10CM | Covered |
| R68.89 | ICD10CM | Covered |
| R73.01 | ICD10CM | Covered |
| R73.9 | ICD10CM | Covered |
| R90.0 | ICD10CM | Covered |
| R90.89 | ICD10CM | Covered |
| R93.0 | ICD10CM | Covered |
| R93.9 | ICD10CM | Covered |
| R94.01 | ICD10CM | Covered |
| R94.8 | ICD10CM | Covered |
| S00.00XA | ICD10CM | Covered |
| S09.93XS | ICD10CM | Covered |
| T45.AX1A | ICD10CM | Covered |
| T45.AX5S | ICD10CM | Covered |
| T66.XXXA | ICD10CM | Covered |
| T66.XXXS | ICD10CM | Covered |
| Z05.0 | ICD10CM | Covered |
| Z05.9 | ICD10CM | Covered |
| Z19.1 | ICD10CM | Covered |
| Z19.2 | ICD10CM | Covered |
| Z31.7 | ICD10CM | Covered |
| Z34.00 | ICD10CM | Covered |
| Z34.93 | ICD10CM | Covered |
| Z51.11 | ICD10CM | Covered |
| Z51.12 | ICD10CM | Covered |
| Z79.01 | ICD10CM | Covered |
| Z79.899 | ICD10CM | Covered |
| Z83.2 | ICD10CM | Covered |
| Z83.49 | ICD10CM | Covered |
| Z84.82 | ICD10CM | Covered |
| Z85.00 | ICD10CM | Covered |
| Z85.9 | ICD10CM | Covered |
| Z86.000 | ICD10CM | Covered |
| Z87.898 | ICD10CM | Covered |
| Z92.21 | ICD10CM | Covered |
| Z92.3 | ICD10CM | Covered |