Blue Shield of California Promise Health Plan prior authorization, page 11
CPT code lookup
Each row is one code from the public prior authorization list. The description is the procedure or service name on that source row. This is not a coverage decision.
Prior authorization codes
| Code | Description | Source |
|---|---|---|
| E2291 | BACK PLANAR PED SZ WC INCL FIX ATTCHING HARDWARE | Medi-Cal Prior Authorization List, Pg 23 Original policy |
| E2292 | SEAT PLANAR PED SZ WC INCL FIX ATTCHING HARDWARE | Medi-Cal Prior Authorization List, Pg 23 Original policy |
| E2298 | Complex rehabilitative power wheelchair accessory, power seat elevation system, any type | Medi-Cal Prior Authorization List, Pg 23 Original policy |
| E2301 | PWR STANDING | Medi-Cal Prior Authorization List, Pg 23 Original policy |
| E2310 | PWR WC ACSS ELEC CNCT BETWN WC CNTRLLER&ONE PWR | Medi-Cal Prior Authorization List, Pg 23 Original policy |
| E2311 | PWR WC ACSS ELEC CNCT BETWN WC CNTRLLER&TWO/MORE | Medi-Cal Prior Authorization List, Pg 23 Original policy |
| E2312 | POWER WC ACCESS HAND OR CHIN CONTROL INTERFACE | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2313 | POWER WC ACCESS HARNESS UPGRADE EXP CONTROLLR EA | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2321 | PWR WC ACSS HND CNTRL REMOT JOYSTCK NO PRPRTNL | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2322 | PWR WC ACSS HND CNTRL MX MECH SWTCH NO PRPRTNL | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2323 | PWR WC ACSS SPCLTY JOYSTCK HNDLE HND CNTRL PRFAB | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2324 | POWER WHLCHAIR ACSS CHIN CUP CHIN CNTRL INTERFCE | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2325 | PWR WC ACSS SIP&PUFF INTERFCE NONPROPRTNAL | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2326 | PWR WC ACSS BREATH TUBE KIT SIP&PUFF INTERFCE | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2327 | PWR WC ACSS HEAD CNTRL INTERFCE MECH PROPRTNAL | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2328 | PWR WC ACSS HEAD CNTRL/EXT CNTRL ELEC PRPRTNL | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2329 | PWR WC ACSS HEAD CNTRL CNTC SWTCH MECH NOPRPRTNL | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2330 | PWR WC ACCSS HEAD PROX SWITCH MECH NONPRPRTNL | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2331 | PWR WC ACSS ATTENDANT CONTROL PROPROTIONAL | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2340 | POWER WC ACCESS NONSTAND SEAT FRAME WD 20-23 IN | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2341 | PWR WC ACSS NONSTD SEAT FRME WIDTH 24-27 IN | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2342 | PWR WC ACSS NONSTD SEAT FRME DEPTH 20/21 IN | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2343 | PWR WC ACSS NONSTD SEAT FRME DEPTH 22-25 IN | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2351 | PWR WC ACSS ELEC INTERFCE OPERATE SPCH GEN DEVC | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2358 | GR 34 NONSEALED LEADACID | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2359 | GR34 SEALED LEADACID BATTERY | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2360 | PWR WC ACSS 22 NF NON-SEALED LEAD ACID BATTRY EA | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2361 | PWR WC ACSS 22NF SEALED LEAD ACID BATTRY EA | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2362 | PWR WC ACSS GRP 24 NON-SEALED LEAD ACID BATT EA | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2363 | PWR WC ACSS GRP 24 SEALED LEAD ACID BATTRY EA | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2364 | PWR WC ACSS U-1 NON-SEALED LEAD ACID BATTRY EA | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2365 | PWR WHLCHAIR ACSS U-1 SEALED LEAD ACID BATTRY EA | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2366 | PWR WC ACSS BATTRY CHRGR 1 MODE W/ONLY 1 BATTRY | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2367 | PWR WC ACSS BATT CHRGR DUL MODE W/EITHER BATT EA | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2368 | Pwr wc drivewheel motor repl | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2369 | Pwr wc drivewheel gear repl | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2370 | Pwr wc dr wh motor/gear comb | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2371 | POWER WC ACSS GRP 27 SEALED LEAD ACID BATTERY EA | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2372 | PWR WC ACSS GRP 27 NONSEALED LEAD ACID BATTRY EA | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2373 | PWR WC MINI-PROPORTIONAL COMPACT REMOTE JOYSTICK | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2374 | PWR WC STANDARD REMOTE JOYSTICK REPLACEMENT ONLY | Medi-Cal Prior Authorization List, Pg 24 Original policy |
| E2375 | PWR WC NONEXPNDABLE CONTROLLER REPLACEMENT ONLY | Medi-Cal Prior Authorization List, Pg 25 Original policy |
| E2376 | PWR WC EXPANDABLE CONTROLLER REPLACEMENT ONLY | Medi-Cal Prior Authorization List, Pg 25 Original policy |
| E2377 | PWR WC EXPANDABLE CONTROLLER UPGRADE INIT ISSUE | Medi-Cal Prior Authorization List, Pg 25 Original policy |
| E2378 | Pw actuator replacement | Medi-Cal Prior Authorization List, Pg 25 Original policy |
| E2381 | PWR WC PNEUMATIC DRIVE WHEEL TIRE REPL ONLY EACH | Medi-Cal Prior Authorization List, Pg 25 Original policy |
| E2382 | PWR WC TUBE PNEUMATIC DRIVE WHEEL TIRE REPL EACH | Medi-Cal Prior Authorization List, Pg 25 Original policy |
| E2383 | PWR WC INSERT PNEUMATIC WHEEL TIRE REPL ONLY EA | Medi-Cal Prior Authorization List, Pg 25 Original policy |
| E2384 | PWR WC PNEUMATIC CASTER TIRE REPL ONLY EACH | Medi-Cal Prior Authorization List, Pg 25 Original policy |
| E2385 | PWR WC TUBE PNEUMATIC CASTER TIRE REPL ONLY EACH | Medi-Cal Prior Authorization List, Pg 25 Original policy |