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Peach State Health Plan prior authorization, page 24

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
72128Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
72129Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
72130Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
72131Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
72132Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
72133Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
72191Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
72192Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
72193Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
72194Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
72198Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
73200Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
73201Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
73202Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
73206Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
73700Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
73701Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
73702Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
73706Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
73718Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
73719Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
73720Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
73721Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
73722Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
73723Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
73725Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
74150Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
74160Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
74170Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
74174Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
74175Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
74176Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
74177Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
74178Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
74261Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
74262Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
74263Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
75571Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
75572Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
75573Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
75574Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
G0288Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
S8032Computerized axial tomography (CT) ImagingCMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
0697TMagnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
0723TMagnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
0898TMagnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
0899TMagnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
0900TMagnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
70540Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 6 Original policy
70542Magnetic resonance imaging (MRI/MRA)CMS 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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