Anthem · Clinical Guideline · ANTHEM-CG-LAB-30
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 |
|---|---|---|
| 82947 | CPT | Covered |
| 82948 | CPT | Covered |
| 82962 | CPT | Covered |
| A15.0 | ICD10CM | Covered |
| A19.9 | ICD10CM | Covered |
| A20.0 | ICD10CM | Covered |
| A49.9 | ICD10CM | Covered |
| B25.0 | ICD10CM | Covered |
| B77.0 | ICD10CM | Covered |
| B78.9 | ICD10CM | Covered |
| C25.4 | ICD10CM | Covered |
| C48.0 | ICD10CM | Covered |
| D13.7 | ICD10CM | Covered |
| E03.0 | ICD10CM | Covered |
| E05.91 | ICD10CM | Covered |
| E08.00 | ICD10CM | Covered |
| E13.9 | ICD10CM | Covered |
| E16.A3 | ICD10CM | Covered |
| E22.0 | ICD10CM | Covered |
| E24.9 | ICD10CM | Covered |
| E28.2 | ICD10CM | Covered |
| E34.0 | ICD10CM | Covered |
| E34.00 | ICD10CM | Covered |
| E34.9 | ICD10CM | Covered |
| E63.0 | ICD10CM | Covered |
| E64.9 | ICD10CM | Covered |
| E66.01 | ICD10CM | Covered |
| E66.9 | ICD10CM | Covered |
| E72.50 | ICD10CM | Covered |
| E72.59 | ICD10CM | Covered |
| E73.0 | ICD10CM | Covered |
| E74.9 | ICD10CM | Covered |
| E75.26 | ICD10CM | Covered |
| E77.0 | ICD10CM | Covered |
| E79.9 | ICD10CM | Covered |
| E83.10 | ICD10CM | Covered |
| E83.19 | ICD10CM | Covered |
| E86.0 | ICD10CM | Covered |
| E88.9 | ICD10CM | Covered |
| E89.1 | ICD10CM | Covered |
| E89.3 | ICD10CM | Covered |
| F10.10 | ICD10CM | Covered |
| F10.99 | ICD10CM | Covered |
| F20.0 | ICD10CM | Covered |
| F25.0 | ICD10CM | Covered |
| F25.9 | ICD10CM | Covered |
| F31.0 | ICD10CM | Covered |
| F31.9 | ICD10CM | Covered |
| G40.001 | ICD10CM | Covered |
| G40.919 | ICD10CM | Covered |
| G56.00 | ICD10CM | Covered |
| G60.0 | ICD10CM | Covered |
| G90.01 | ICD10CM | Covered |
| G90.B | ICD10CM | Covered |
| G93.31 | ICD10CM | Covered |
| G93.49 | ICD10CM | Covered |
| H01.001 | ICD10CM | Covered |
| H02.9 | ICD10CM | Covered |
| H10.821 | ICD10CM | Covered |
| H10.829 | ICD10CM | Covered |
| H25.011 | ICD10CM | Covered |
| H26.9 | ICD10CM | Covered |
| H35.00 | ICD10CM | Covered |
| H36.89 | ICD10CM | Covered |
| H40.001 | ICD10CM | Covered |
| H47.331 | ICD10CM | Covered |
| H47.339 | ICD10CM | Covered |
| H49.00 | ICD10CM | Covered |
| H49.9 | ICD10CM | Covered |
| H52.00 | ICD10CM | Covered |
| H53.9 | ICD10CM | Covered |
| I20.0 | ICD10CM | Covered |
| I25.9 | ICD10CM | Covered |
| I42.0 | ICD10CM | Covered |
| I50.1 | ICD10CM | Covered |
| I70.201 | ICD10CM | Covered |
| I70.92 | ICD10CM | Covered |
| I73.01 | ICD10CM | Covered |
| I95.1 | ICD10CM | Covered |
| J02.0 | ICD10CM | Covered |
| J02.9 | ICD10CM | Covered |
| J12.0 | ICD10CM | Covered |
| J18.9 | ICD10CM | Covered |
| J20.0 | ICD10CM | Covered |
| J20.9 | ICD10CM | Covered |
| J44.9 | ICD10CM | Covered |
| K11.7 | ICD10CM | Covered |
| K12.0 | ICD10CM | Covered |
| K12.39 | ICD10CM | Covered |
| K29.00 | ICD10CM | Covered |
| K52.0 | ICD10CM | Covered |
| K52.9 | ICD10CM | Covered |
| K59.31 | ICD10CM | Covered |
| K59.39 | ICD10CM | Covered |
| K70.0 | ICD10CM | Covered |
| K80.00 | ICD10CM | Covered |
| L08.9 | ICD10CM | Covered |
| L29.0 | ICD10CM | Covered |
| L29.9 | ICD10CM | Covered |
| L68.0 | ICD10CM | Covered |
| L68.9 | ICD10CM | Covered |
| L74.4 | ICD10CM | Covered |
| L89.000 | ICD10CM | Covered |
| L89.96 | ICD10CM | Covered |
| L92.0 | ICD10CM | Covered |
| L92.9 | ICD10CM | Covered |
| L97.101 | ICD10CM | Covered |
| L97.929 | ICD10CM | Covered |
| L98.0 | ICD10CM | Covered |
| M04.1 | ICD10CM | Covered |
| M04.9 | ICD10CM | Covered |
| M60.000 | ICD10CM | Covered |
| M60.9 | ICD10CM | Covered |
| M79.0 | ICD10CM | Covered |
| M79.9 | ICD10CM | Covered |
| M86.00 | ICD10CM | Covered |
| M86.9 | ICD10CM | Covered |
| N28.84 | ICD10CM | Covered |
| N28.86 | ICD10CM | Covered |
| N30.00 | ICD10CM | Covered |
| N30.91 | ICD10CM | Covered |
| N34.0 | ICD10CM | Covered |
| N34.3 | ICD10CM | Covered |
| N35.111 | ICD10CM | Covered |
| N35.119 | ICD10CM | Covered |
| N39.0 | ICD10CM | Covered |
| N45.1 | ICD10CM | Covered |
| N45.4 | ICD10CM | Covered |
| N52.01 | ICD10CM | Covered |
| N53.9 | ICD10CM | Covered |
| N70.01 | ICD10CM | Covered |
| N77.1 | ICD10CM | Covered |
| N91.0 | ICD10CM | Covered |
| N92.6 | 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 |
| O24.011 | ICD10CM | Covered |
| O24.93 | ICD10CM | Covered |
| O30.001 | ICD10CM | Covered |
| O48.1 | ICD10CM | Covered |
| O99.210 | ICD10CM | Covered |
| O99.215 | ICD10CM | Covered |
| O99.810 | ICD10CM | Covered |
| O99.815 | ICD10CM | Covered |
| P05.00 | ICD10CM | Covered |
| P07.39 | ICD10CM | Covered |
| P37.0 | ICD10CM | Covered |
| P78.84 | ICD10CM | Covered |
| R00.0 | ICD10CM | Covered |
| R00.9 | ICD10CM | Covered |
| R06.00 | ICD10CM | Covered |
| R06.9 | ICD10CM | Covered |
| R07.0 | ICD10CM | Covered |
| R07.9 | ICD10CM | Covered |
| R15.0 | ICD10CM | Covered |
| R19.8 | ICD10CM | Covered |
| R20.0 | ICD10CM | Covered |
| R20.9 | ICD10CM | Covered |
| R25.0 | ICD10CM | Covered |
| R27.9 | ICD10CM | Covered |
| R29.0 | ICD10CM | Covered |
| R29.91 | ICD10CM | Covered |
| R35.0 | ICD10CM | Covered |
| R35.89 | ICD10CM | Covered |
| R40.0 | ICD10CM | Covered |
| R45.0 | ICD10CM | Covered |
| R45.89 | ICD10CM | Covered |
| R53.0 | ICD10CM | Covered |
| R56.9 | ICD10CM | Covered |
| R62.0 | ICD10CM | Covered |
| R62.59 | ICD10CM | Covered |
| R63.0 | ICD10CM | Covered |
| R68.2 | ICD10CM | Covered |
| R73.01 | ICD10CM | Covered |
| R73.9 | ICD10CM | Covered |
| R78.71 | ICD10CM | Covered |
| R78.79 | ICD10CM | Covered |
| R79.89 | ICD10CM | Covered |
| R79.9 | ICD10CM | Covered |
| R80.0 | ICD10CM | Covered |
| S02.0XXA | ICD10CM | Covered |
| S02.92XS | ICD10CM | Covered |
| S92.001A | ICD10CM | Covered |
| S92.919S | ICD10CM | Covered |
| S99.001A | ICD10CM | Covered |
| S99.929S | 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 |
| T82.855A | ICD10CM | Covered |
| T82.856S | ICD10CM | Covered |
| Z05.0 | ICD10CM | Covered |
| Z05.9 | ICD10CM | Covered |
| Z13.1 | ICD10CM | Covered |
| Z19.1 | ICD10CM | Covered |
| Z19.2 | 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 |
| Z83.3 | ICD10CM | Covered |
| Z83.430 | ICD10CM | Covered |
| Z83.438 | ICD10CM | Covered |
| Z84.82 | ICD10CM | Covered |
| Z86.31 | ICD10CM | Covered |
| Z86.39 | ICD10CM | Covered |