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Peach State Health Plan prior authorization, page 26

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
C8900Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
C8901Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
C8902Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
C8903Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
C8905Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
C8906Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
C8908Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
C8909Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
C8910Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
C8911Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
C8912Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
C8913Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
C8914Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
C8918Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
C8919Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
C8920Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
C8931Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
C8932Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
C8933Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
C8934Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
C8935Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
C8936Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
C9791Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
S8037Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
S8042Magnetic resonance imaging (MRI/MRA)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
0351TMammographyCMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
0352TMammographyCMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
0353TMammographyCMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
0354TMammographyCMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
0694TMammographyCMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
0689TOther diagnostic ultrasoundCMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
0690TOther diagnostic ultrasoundCMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
0876TOther diagnostic ultrasoundCMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
76979Other diagnostic ultrasoundCMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
78429Radioisotope scan, PET, and Nuclear MedicineCMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
78430Radioisotope scan, PET, and Nuclear MedicineCMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
78431Radioisotope scan, PET, and Nuclear MedicineCMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
78432Radioisotope scan, PET, and Nuclear MedicineCMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
78433Radioisotope scan, PET, and Nuclear MedicineCMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
78451Radioisotope scan, PET, and Nuclear MedicineCMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
78452Radioisotope scan, PET, and Nuclear MedicineCMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
78453Radioisotope scan, PET, and Nuclear MedicineCMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
78454Radioisotope scan, PET, and Nuclear MedicineCMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
78459Radioisotope scan, PET, and Nuclear MedicineCMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
78466Radioisotope scan, PET, and Nuclear MedicineCMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
78468Radioisotope scan, PET, and Nuclear MedicineCMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
78469Radioisotope scan, PET, and Nuclear MedicineCMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
78472Radioisotope scan, PET, and Nuclear MedicineCMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
78473Radioisotope scan, PET, and Nuclear MedicineCMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
78481Radioisotope scan, PET, and Nuclear MedicineCMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 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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