Anthem · Clinical Guideline · ANTHEM-CG-LAB-26
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 |
|---|---|---|
| 82105 | CPT | Covered |
| 82107 | CPT | Covered |
| A52.74 | ICD10CM | Covered |
| B16.0 | ICD10CM | Covered |
| B17.9 | ICD10CM | Covered |
| B18.0 | ICD10CM | Covered |
| B18.9 | ICD10CM | Covered |
| B66.1 | ICD10CM | Covered |
| B66.3 | ICD10CM | Covered |
| C22.0 | ICD10CM | Covered |
| C22.9 | ICD10CM | Covered |
| C38.1 | ICD10CM | Covered |
| C38.3 | ICD10CM | Covered |
| C38.8 | ICD10CM | Covered |
| C48.0 | ICD10CM | Covered |
| C48.8 | ICD10CM | Covered |
| C56.1 | ICD10CM | Covered |
| C56.9 | ICD10CM | Covered |
| C62.00 | ICD10CM | Covered |
| C62.92 | ICD10CM | Covered |
| C75.3 | ICD10CM | Covered |
| C76.3 | ICD10CM | Covered |
| C78.1 | ICD10CM | Covered |
| C78.7 | ICD10CM | Covered |
| C79.60 | ICD10CM | Covered |
| C79.63 | ICD10CM | Covered |
| C79.82 | ICD10CM | Covered |
| C80.0 | ICD10CM | Covered |
| C80.1 | ICD10CM | Covered |
| D01.5 | ICD10CM | Covered |
| D13.4 | ICD10CM | Covered |
| D13.5 | ICD10CM | Covered |
| D15.0 | ICD10CM | Covered |
| D15.2 | ICD10CM | Covered |
| D17.79 | ICD10CM | Covered |
| D20.0 | ICD10CM | Covered |
| D20.1 | ICD10CM | Covered |
| D37.6 | ICD10CM | Covered |
| D39.10 | ICD10CM | Covered |
| D39.12 | ICD10CM | Covered |
| D40.10 | ICD10CM | Covered |
| D40.12 | ICD10CM | Covered |
| D81.82 | ICD10CM | Covered |
| E78.2 | ICD10CM | Covered |
| E83.00 | ICD10CM | Covered |
| E83.09 | ICD10CM | Covered |
| E83.10 | ICD10CM | Covered |
| E83.19 | ICD10CM | Covered |
| E88.01 | ICD10CM | Covered |
| F10.10 | ICD10CM | Covered |
| F10.99 | ICD10CM | Covered |
| J98.59 | ICD10CM | Covered |
| K70.0 | ICD10CM | Covered |
| K70.2 | ICD10CM | Covered |
| K70.31 | ICD10CM | Covered |
| K73.0 | ICD10CM | Covered |
| K73.9 | ICD10CM | Covered |
| K74.00 | ICD10CM | Covered |
| K74.02 | ICD10CM | Covered |
| K74.60 | ICD10CM | Covered |
| K74.69 | ICD10CM | Covered |
| K75.4 | ICD10CM | Covered |
| K75.81 | ICD10CM | Covered |
| K75.9 | ICD10CM | Covered |
| K76.0 | ICD10CM | Covered |
| K76.81 | ICD10CM | Covered |
| K76.89 | ICD10CM | Covered |
| N44.1 | ICD10CM | Covered |
| N44.8 | ICD10CM | Covered |
| N50.3 | ICD10CM | Covered |
| N50.811 | ICD10CM | Covered |
| N50.89 | ICD10CM | Covered |
| N53.12 | ICD10CM | Covered |
| N53.8 | ICD10CM | Covered |
| N53.9 | ICD10CM | Covered |
| O09.00 | ICD10CM | Covered |
| O09.93 | ICD10CM | Covered |
| Q53.10 | ICD10CM | Covered |
| Q53.9 | ICD10CM | Covered |
| Q76.428 | ICD10CM | Covered |
| R39.83 | ICD10CM | Covered |
| R39.84 | ICD10CM | Covered |
| R91.1 | ICD10CM | Covered |
| R91.8 | ICD10CM | Covered |
| R93.2 | ICD10CM | Covered |
| R93.5 | ICD10CM | Covered |
| R93.811 | ICD10CM | Covered |
| R93.89 | ICD10CM | Covered |
| R97.8 | ICD10CM | Covered |
| Z03.71 | ICD10CM | Covered |
| Z03.79 | ICD10CM | Covered |
| Z17.0 | ICD10CM | Covered |
| Z17.1 | ICD10CM | Covered |
| Z34.00 | ICD10CM | Covered |
| Z34.93 | ICD10CM | Covered |
| Z36.0 | ICD10CM | Covered |
| Z36.9 | ICD10CM | Covered |
| Z85.05 | ICD10CM | Covered |
| Z85.238 | ICD10CM | Covered |
| Z85.29 | ICD10CM | Covered |
| Z85.43 | ICD10CM | Covered |
| Z85.47 | ICD10CM | Covered |
| Z86.002 | ICD10CM | Covered |
| Z86.004 | ICD10CM | Covered |