Anthem · Clinical Guideline · ANTHEM-CG-LAB-29
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 |
|---|---|---|
| 82977 | CPT | Covered |
| A02.0 | ICD10CM | Covered |
| A04.9 | ICD10CM | Covered |
| A06.0 | ICD10CM | Covered |
| A15.0 | ICD10CM | Covered |
| A19.9 | ICD10CM | Covered |
| A20.0 | ICD10CM | Covered |
| A20.9 | ICD10CM | Covered |
| A22.7 | ICD10CM | Covered |
| A26.0 | ICD10CM | Covered |
| A27.9 | ICD10CM | Covered |
| A30.0 | ICD10CM | Covered |
| A39.9 | ICD10CM | Covered |
| A40.0 | ICD10CM | Covered |
| A41.9 | ICD10CM | Covered |
| A42.0 | ICD10CM | Covered |
| A42.9 | ICD10CM | Covered |
| A48.0 | ICD10CM | Covered |
| A49.9 | ICD10CM | Covered |
| A51.0 | ICD10CM | Covered |
| A53.9 | ICD10CM | Covered |
| A69.20 | ICD10CM | Covered |
| A69.29 | ICD10CM | Covered |
| A75.0 | ICD10CM | Covered |
| A79.9 | ICD10CM | Covered |
| A95.0 | ICD10CM | Covered |
| A95.9 | ICD10CM | Covered |
| B00.0 | ICD10CM | Covered |
| B00.9 | ICD10CM | Covered |
| B15.0 | ICD10CM | Covered |
| B19.9 | ICD10CM | Covered |
| B25.0 | ICD10CM | Covered |
| B27.99 | ICD10CM | Covered |
| B37.0 | ICD10CM | Covered |
| B37.9 | ICD10CM | Covered |
| B39.4 | ICD10CM | Covered |
| B50.0 | ICD10CM | Covered |
| B57.0 | ICD10CM | Covered |
| B58.9 | ICD10CM | Covered |
| B65.0 | ICD10CM | Covered |
| B67.99 | ICD10CM | Covered |
| B97.0 | ICD10CM | Covered |
| B97.89 | ICD10CM | Covered |
| C00.0 | ICD10CM | Covered |
| C96.Z | ICD10CM | Covered |
| D00.00 | ICD10CM | Covered |
| D09.9 | ICD10CM | Covered |
| D10.0 | ICD10CM | Covered |
| D36.9 | ICD10CM | Covered |
| D37.01 | ICD10CM | Covered |
| D48.9 | ICD10CM | Covered |
| D49.0 | ICD10CM | Covered |
| D49.9 | ICD10CM | Covered |
| D57.00 | ICD10CM | Covered |
| D57.819 | ICD10CM | Covered |
| D68.311 | ICD10CM | Covered |
| D68.4 | ICD10CM | Covered |
| D73.0 | ICD10CM | Covered |
| D73.9 | ICD10CM | Covered |
| D81.0 | ICD10CM | Covered |
| D81.9 | ICD10CM | Covered |
| D84.0 | ICD10CM | Covered |
| D86.9 | ICD10CM | Covered |
| E08.00 | ICD10CM | Covered |
| E13.9 | ICD10CM | Covered |
| E21.0 | ICD10CM | Covered |
| E21.3 | ICD10CM | Covered |
| E55.0 | ICD10CM | Covered |
| E56.9 | ICD10CM | Covered |
| E63.0 | ICD10CM | Covered |
| E64.9 | ICD10CM | Covered |
| E66.01 | ICD10CM | Covered |
| E66.9 | ICD10CM | Covered |
| E70.0 | ICD10CM | Covered |
| E88.9 | ICD10CM | Covered |
| F10.10 | ICD10CM | Covered |
| F19.99 | ICD10CM | Covered |
| F50.00 | ICD10CM | Covered |
| F50.9 | ICD10CM | Covered |
| F55.0 | ICD10CM | Covered |
| F55.8 | ICD10CM | Covered |
| G40.001 | ICD10CM | Covered |
| G40.919 | ICD10CM | Covered |
| G62.0 | ICD10CM | Covered |
| G62.1 | ICD10CM | Covered |
| G71.11 | ICD10CM | Covered |
| G71.19 | ICD10CM | Covered |
| I20.0 | ICD10CM | Covered |
| I25.9 | ICD10CM | Covered |
| I27.0 | ICD10CM | Covered |
| I27.9 | ICD10CM | Covered |
| I50.1 | ICD10CM | Covered |
| I63.00 | ICD10CM | Covered |
| I63.9 | ICD10CM | Covered |
| I80.00 | ICD10CM | Covered |
| I82.91 | ICD10CM | Covered |
| I85.00 | ICD10CM | Covered |
| I85.11 | ICD10CM | Covered |
| J44.0 | ICD10CM | Covered |
| J44.9 | ICD10CM | Covered |
| K50.00 | ICD10CM | Covered |
| K52.9 | ICD10CM | Covered |
| K55.011 | ICD10CM | Covered |
| K59.9 | ICD10CM | Covered |
| K63.1 | ICD10CM | Covered |
| K63.9 | ICD10CM | Covered |
| K65.0 | ICD10CM | Covered |
| K68.9 | ICD10CM | Covered |
| K70.0 | ICD10CM | Covered |
| K80.00 | ICD10CM | Covered |
| M04.1 | ICD10CM | Covered |
| M04.9 | ICD10CM | Covered |
| M32.0 | ICD10CM | Covered |
| M32.9 | ICD10CM | Covered |
| M35.00 | ICD10CM | Covered |
| M35.09 | ICD10CM | Covered |
| M83.0 | ICD10CM | Covered |
| M83.9 | ICD10CM | Covered |
| N00.0 | ICD10CM | Covered |
| N25.0 | ICD10CM | Covered |
| N61.20 | ICD10CM | Covered |
| N61.23 | ICD10CM | Covered |
| O10.011 | ICD10CM | Covered |
| O16.9 | ICD10CM | Covered |
| O24.011 | ICD10CM | Covered |
| O25.3 | ICD10CM | Covered |
| O26.611 | ICD10CM | Covered |
| O26.649 | ICD10CM | Covered |
| O30.001 | ICD10CM | Covered |
| O31.8X99 | ICD10CM | Covered |
| O99.210 | ICD10CM | Covered |
| O99.215 | ICD10CM | Covered |
| P35.0 | ICD10CM | Covered |
| P39.9 | ICD10CM | Covered |
| P76.0 | ICD10CM | Covered |
| P78.9 | ICD10CM | Covered |
| Q85.00 | ICD10CM | Covered |
| Q85.09 | ICD10CM | Covered |
| R10.0 | ICD10CM | Covered |
| R11.2 | ICD10CM | Covered |
| R16.0 | ICD10CM | Covered |
| R29.700 | ICD10CM | Covered |
| R29.742 | ICD10CM | Covered |
| R40.0 | ICD10CM | Covered |
| R40.4 | ICD10CM | Covered |
| R74.01 | ICD10CM | Covered |
| R74.9 | ICD10CM | Covered |
| T36.0X1A | ICD10CM | Covered |
| T65.94XS | ICD10CM | Covered |
| T78.00XA | ICD10CM | Covered |
| T78.1XXS | ICD10CM | Covered |
| Z05.0 | ICD10CM | Covered |
| Z05.9 | ICD10CM | Covered |
| Z19.1 | ICD10CM | Covered |
| Z19.2 | ICD10CM | Covered |
| Z22.7 | ICD10CM | Covered |
| Z48.23 | ICD10CM | Covered |
| Z68.23 | ICD10CM | Covered |
| Z68.45 | ICD10CM | Covered |
| Z68.53 | ICD10CM | Covered |
| Z68.56 | ICD10CM | Covered |
| Z79.01 | ICD10CM | Covered |
| Z79.899 | ICD10CM | Covered |
| Z85.00 | ICD10CM | Covered |
| Z87.19 | ICD10CM | Covered |
| Z94.4 | ICD10CM | Covered |