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Peach State Health Plan prior authorization, page 23

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
95808Electroencephalogram (EEG), Sleep Studies, and NeurodiagnosticsCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
95810Electroencephalogram (EEG), Sleep Studies, and NeurodiagnosticsCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
95811Electroencephalogram (EEG), Sleep Studies, and NeurodiagnosticsCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
95999Electroencephalogram (EEG), Sleep Studies, and NeurodiagnosticsCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
G0398Electroencephalogram (EEG), Sleep Studies, and NeurodiagnosticsCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
G0399Electroencephalogram (EEG), Sleep Studies, and NeurodiagnosticsCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
G0400Electroencephalogram (EEG), Sleep Studies, and NeurodiagnosticsCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
36299Arterio- or Venogram (Including Aortography)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
75635Arterio- or Venogram (Including Aortography)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
0042TComputerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
0174TComputerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
0623TComputerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
0624TComputerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
0625TComputerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
0626TComputerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
0691TComputerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
0710TComputerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
0711TComputerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
0712TComputerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
0713TComputerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
0721TComputerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
0743TComputerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
0807TComputerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
0808TComputerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
0877TComputerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
0878TComputerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
0879TComputerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
0880TComputerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
70450Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
70460Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
70470Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
70480Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
70481Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
70482Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
70486Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
70487Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
70488Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
70490Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
70491Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
70492Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
70496Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
70498Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
71250Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
71260Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
71270Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
71271Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
71275Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
72125Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
72126Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
72127Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 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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