Peach State Health Plan prior authorization, page 22
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 |
|---|---|---|
| 93304 | Diagnostic ultrasound of heart (echocardiogram) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 93306 | Diagnostic ultrasound of heart (echocardiogram) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 93307 | Diagnostic ultrasound of heart (echocardiogram) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 93308 | Diagnostic ultrasound of heart (echocardiogram) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 93312 | Diagnostic ultrasound of heart (echocardiogram) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 93313 | Diagnostic ultrasound of heart (echocardiogram) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 93314 | Diagnostic ultrasound of heart (echocardiogram) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 93315 | Diagnostic ultrasound of heart (echocardiogram) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 93316 | Diagnostic ultrasound of heart (echocardiogram) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 93317 | Diagnostic ultrasound of heart (echocardiogram) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 93318 | Diagnostic ultrasound of heart (echocardiogram) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 93319 | Diagnostic ultrasound of heart (echocardiogram) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 93350 | Diagnostic ultrasound of heart (echocardiogram) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 93351 | Diagnostic ultrasound of heart (echocardiogram) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 0295T | Electrographic cardiac monitoring | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 0296T | Electrographic cardiac monitoring | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 0297T | Electrographic cardiac monitoring | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 0298T | Electrographic cardiac monitoring | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 0695T | Electrographic cardiac monitoring | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 0696T | Electrographic cardiac monitoring | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 0716T | Electrographic cardiac monitoring | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 0745T | Electrographic cardiac monitoring | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 0746T | Electrographic cardiac monitoring | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 0764T | Electrographic cardiac monitoring | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 0765T | Electrographic cardiac monitoring | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 0897T | Electrographic cardiac monitoring | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 0933T | Electrographic cardiac monitoring | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 0962T | Electrographic cardiac monitoring | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 0981T | Electrographic cardiac monitoring | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 93745 | Electrographic cardiac monitoring | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 0106T | Electroencephalogram (EEG), Sleep Studies, and Neurodiagnostics | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 0107T | Electroencephalogram (EEG), Sleep Studies, and Neurodiagnostics | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 0108T | Electroencephalogram (EEG), Sleep Studies, and Neurodiagnostics | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 0109T | Electroencephalogram (EEG), Sleep Studies, and Neurodiagnostics | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 0110T | Electroencephalogram (EEG), Sleep Studies, and Neurodiagnostics | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 0228T | Electroencephalogram (EEG), Sleep Studies, and Neurodiagnostics | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 0229T | Electroencephalogram (EEG), Sleep Studies, and Neurodiagnostics | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 0230T | Electroencephalogram (EEG), Sleep Studies, and Neurodiagnostics | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 0231T | Electroencephalogram (EEG), Sleep Studies, and Neurodiagnostics | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 95712 | Electroencephalogram (EEG), Sleep Studies, and Neurodiagnostics | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 95713 | Electroencephalogram (EEG), Sleep Studies, and Neurodiagnostics | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 95724 | Electroencephalogram (EEG), Sleep Studies, and Neurodiagnostics | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 95782 | Electroencephalogram (EEG), Sleep Studies, and Neurodiagnostics | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 95783 | Electroencephalogram (EEG), Sleep Studies, and Neurodiagnostics | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 95800 | Electroencephalogram (EEG), Sleep Studies, and Neurodiagnostics | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 95801 | Electroencephalogram (EEG), Sleep Studies, and Neurodiagnostics | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 95803 | Electroencephalogram (EEG), Sleep Studies, and Neurodiagnostics | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 95805 | Electroencephalogram (EEG), Sleep Studies, and Neurodiagnostics | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 95806 | Electroencephalogram (EEG), Sleep Studies, and Neurodiagnostics | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |
| 95807 | Electroencephalogram (EEG), Sleep Studies, and Neurodiagnostics | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy |