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Peach State Health Plan prior authorization, page 103

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
A0435Transportation - patient, provider, equipmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
A0436Transportation - patient, provider, equipmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
T2001Transportation - patient, provider, equipmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
T2002Transportation - patient, provider, equipmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
T2003Transportation - patient, provider, equipmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
T2004Transportation - patient, provider, equipmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
0864TDiagnostic procedures, male genital (includes minor surgery)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
54161Diagnostic procedures, male genital (includes minor surgery)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
54163Diagnostic procedures, male genital (includes minor surgery)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
54164Diagnostic procedures, male genital (includes minor surgery)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
54680Diagnostic procedures, male genital (includes minor surgery)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
54699Diagnostic procedures, male genital (includes minor surgery)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
55400Diagnostic procedures, male genital (includes minor surgery)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
55559Diagnostic procedures, male genital (includes minor surgery)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
50300Kidney transplantCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
50320Kidney transplantCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
50323Kidney transplantCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
50325Kidney transplantCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
50327Kidney transplantCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
50328Kidney transplantCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
50329Kidney transplantCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
50340Kidney transplantCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
50360Kidney transplantCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
50365Kidney transplantCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
50370Kidney transplantCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
50380Kidney transplantCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
0672TNephrectomy and Major Urinary Tract ReconstructionCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
0888TNephrectomy and Major Urinary Tract ReconstructionCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
0935TNephrectomy and Major Urinary Tract ReconstructionCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
50549Nephrectomy and Major Urinary Tract ReconstructionCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
50860Nephrectomy and Major Urinary Tract ReconstructionCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
50949Nephrectomy and Major Urinary Tract ReconstructionCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
51992Nephrectomy and Major Urinary Tract ReconstructionCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
51999Nephrectomy and Major Urinary Tract ReconstructionCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
53451Nephrectomy and Major Urinary Tract ReconstructionCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
53452Nephrectomy and Major Urinary Tract ReconstructionCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
53453Nephrectomy and Major Urinary Tract ReconstructionCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
53454Nephrectomy and Major Urinary Tract ReconstructionCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
54360Nephrectomy and Major Urinary Tract ReconstructionCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
55970Nephrectomy and Major Urinary Tract ReconstructionCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
55980Nephrectomy and Major Urinary Tract ReconstructionCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
55867Open prostatectomyCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
0872TOther diagnostic procedures of urinary tractCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
53899Other diagnostic procedures of urinary tractCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
0738TTransurethral resection of prostate (TURP)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
0739TTransurethral resection of prostate (TURP)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
0867TTransurethral resection of prostate (TURP)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
0941TTransurethral resection of prostate (TURP)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
0942TTransurethral resection of prostate (TURP)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
0943TTransurethral resection of prostate (TURP)CMS 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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