Peach State Health Plan prior authorization, page 19

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
Code	Description	Source
D7510	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7511	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7520	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7521	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7530	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7540	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7550	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7560	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7610	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7620	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7630	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7640	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7650	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7660	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7670	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7671	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7680	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7710	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7720	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7730	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7740	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7750	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7760	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7770	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7771	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7780	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7810	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7820	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7830	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 5 Original policy
D7840	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7850	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7852	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7854	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7856	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7858	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7860	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7865	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7870	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7871	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7872	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7873	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7874	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7875	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7876	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7877	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7880	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7899	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7910	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7911	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7912	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy

Sources

CMS Final Rule 0057-F Prior Authorization Requirements