Peach State Health Plan prior authorization, page 20

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
D7920	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7940	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7941	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7943	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7944	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7945	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7946	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7947	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7948	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7949	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7950	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7951	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7953	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7955	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7960	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7963	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7970	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7971	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7972	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7980	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7981	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7982	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7983	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7990	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7991	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7995	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7996	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7997	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7998	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D7999	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D8010	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D8020	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D8030	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D8040	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D8050	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D8060	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D8070	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D8080	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D8090	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D8210	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D8220	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D8660	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D8670	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D8680	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D8690	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D8691	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D8692	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D8693	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D8694	Oral and Dental Services	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
D8999	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