Anthem · Clinical Guideline · ANTHEM-CG-LAB-25
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 |
|---|---|---|
| 82985 | CPT | Covered |
| 83036 | CPT | Covered |
| C25.4 | ICD10CM | Covered |
| D13.7 | ICD10CM | Covered |
| E08.00 | ICD10CM | Covered |
| E13.9 | ICD10CM | Covered |
| E16.0 | ICD10CM | Covered |
| E16.A3 | ICD10CM | Covered |
| E28.2 | ICD10CM | Covered |
| E31.0 | ICD10CM | Covered |
| E31.9 | ICD10CM | Covered |
| E66.01 | ICD10CM | Covered |
| E66.9 | ICD10CM | Covered |
| E74.00 | ICD10CM | Covered |
| E74.9 | ICD10CM | Covered |
| E78.00 | ICD10CM | Covered |
| E78.9 | ICD10CM | Covered |
| E79.0 | ICD10CM | Covered |
| E83.10 | ICD10CM | Covered |
| E83.19 | ICD10CM | Covered |
| E88.02 | ICD10CM | Covered |
| E88.81 | ICD10CM | Covered |
| E88.810 | ICD10CM | Covered |
| E88.819 | ICD10CM | Covered |
| E88.82 | ICD10CM | Covered |
| E89.1 | ICD10CM | Covered |
| F20.0 | ICD10CM | Covered |
| F25.0 | ICD10CM | Covered |
| F25.9 | ICD10CM | Covered |
| F31.0 | ICD10CM | Covered |
| F31.9 | ICD10CM | Covered |
| I21.01 | ICD10CM | Covered |
| I22.9 | ICD10CM | Covered |
| I24.0 | ICD10CM | Covered |
| I25.9 | ICD10CM | Covered |
| K86.0 | ICD10CM | Covered |
| K86.1 | ICD10CM | Covered |
| K91.2 | ICD10CM | Covered |
| O10.011 | ICD10CM | Covered |
| O11.9 | ICD10CM | Covered |
| O24.011 | ICD10CM | Covered |
| O24.93 | ICD10CM | Covered |
| O26.00 | ICD10CM | Covered |
| O26.03 | ICD10CM | Covered |
| O30.101 | ICD10CM | Covered |
| O30.93 | ICD10CM | Covered |
| O99.210 | ICD10CM | Covered |
| O99.215 | ICD10CM | Covered |
| O99.411 | ICD10CM | Covered |
| O99.43 | ICD10CM | Covered |
| O99.810 | ICD10CM | Covered |
| O99.815 | ICD10CM | Covered |
| P05.00 | ICD10CM | Covered |
| P05.19 | ICD10CM | Covered |
| P07.00 | ICD10CM | Covered |
| P07.18 | ICD10CM | Covered |
| P70.0 | ICD10CM | Covered |
| P70.9 | ICD10CM | Covered |
| R73.01 | ICD10CM | Covered |
| R73.9 | ICD10CM | Covered |
| R79.0 | ICD10CM | Covered |
| R79.9 | ICD10CM | Covered |
| T38.3X1A | ICD10CM | Covered |
| T38.3X4S | ICD10CM | Covered |
| T43.3X5A | ICD10CM | Covered |
| T43.3X5S | ICD10CM | Covered |
| T43.505A | ICD10CM | Covered |
| T43.505S | ICD10CM | Covered |
| T43.595A | ICD10CM | Covered |
| T43.595S | ICD10CM | Covered |
| T46.6X5A | ICD10CM | Covered |
| T46.6X5S | ICD10CM | Covered |
| Z13.1 | ICD10CM | Covered |
| Z68.23 | ICD10CM | Covered |
| Z68.45 | ICD10CM | Covered |
| Z68.53 | ICD10CM | Covered |
| Z68.56 | ICD10CM | Covered |
| Z72.3 | ICD10CM | Covered |
| Z79.4 | ICD10CM | Covered |
| Z79.84 | ICD10CM | Covered |
| Z83.3 | ICD10CM | Covered |
| Z86.2 | ICD10CM | Covered |
| Z86.31 | ICD10CM | Covered |
| Z86.39 | ICD10CM | Covered |
| Z86.74 | ICD10CM | Covered |
| Z86.79 | ICD10CM | Covered |
| Z87.59 | ICD10CM | Covered |