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Peach State Health Plan prior authorization, page 102

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

Prior authorization codes
CodeDescriptionSource
V5260Hearing devices and audiology suppliesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
V5261Hearing devices and audiology suppliesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
V5262Hearing devices and audiology suppliesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
V5265Hearing devices and audiology suppliesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
V5267Hearing devices and audiology suppliesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
V5275Hearing devices and audiology suppliesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
V5298Hearing devices and audiology suppliesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
V5299Hearing devices and audiology suppliesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
0175TTelehealth (calls, online communication, remote monitoring)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
0650TTelehealth (calls, online communication, remote monitoring)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
11920Injections: muscles, tendons, bursa, joints, soft tissueCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
11921Injections: muscles, tendons, bursa, joints, soft tissueCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
11922Injections: muscles, tendons, bursa, joints, soft tissueCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
11950Injections: muscles, tendons, bursa, joints, soft tissueCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
11951Injections: muscles, tendons, bursa, joints, soft tissueCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
11952Injections: muscles, tendons, bursa, joints, soft tissueCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
11954Injections: muscles, tendons, bursa, joints, soft tissueCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
11960Injections: muscles, tendons, bursa, joints, soft tissueCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
11970Injections: muscles, tendons, bursa, joints, soft tissueCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
11971Injections: muscles, tendons, bursa, joints, soft tissueCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
20550Injections: muscles, tendons, bursa, joints, soft tissueCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
20551Injections: muscles, tendons, bursa, joints, soft tissueCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
20552Injections: muscles, tendons, bursa, joints, soft tissueCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
20553Injections: muscles, tendons, bursa, joints, soft tissueCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
20606Injections: muscles, tendons, bursa, joints, soft tissueCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
96420Therapeutic infusion Services (Chemotherapy)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
96549Therapeutic infusion Services (Chemotherapy)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
90281Vaccine and Immune Globulin ProductsCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
90283Vaccine and Immune Globulin ProductsCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
90284Vaccine and Immune Globulin ProductsCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
90291Vaccine and Immune Globulin ProductsCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
90378Vaccine and Immune Globulin ProductsCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
90380Vaccine and Immune Globulin ProductsCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
90381Vaccine and Immune Globulin ProductsCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
90758Vaccine and Immune Globulin ProductsCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
90759Vaccine and Immune Globulin ProductsCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
91308Vaccine and Immune Globulin ProductsCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
91309Vaccine and Immune Globulin ProductsCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
91310Vaccine and Immune Globulin ProductsCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
A0100Transportation - patient, provider, equipmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
A0110Transportation - patient, provider, equipmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
A0140Transportation - patient, provider, equipmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
A0170Transportation - patient, provider, equipmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
A0180Transportation - patient, provider, equipmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
A0190Transportation - patient, provider, equipmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
A0200Transportation - patient, provider, equipmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
A0210Transportation - patient, provider, equipmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
A0428Transportation - patient, provider, equipmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
A0430Transportation - patient, provider, equipmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
A0431Transportation - patient, provider, equipmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy

Sources

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.

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