Peach State Health Plan prior authorization, page 3
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 |
|---|---|---|
| 96131 | Neuropsychological and Psychological Testing | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 96132 | Neuropsychological and Psychological Testing | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 96133 | Neuropsychological and Psychological Testing | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 96136 | Neuropsychological and Psychological Testing | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 96137 | Neuropsychological and Psychological Testing | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 96138 | Neuropsychological and Psychological Testing | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 96139 | Neuropsychological and Psychological Testing | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 96146 | Neuropsychological and Psychological Testing | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0889T | Psychological and psychiatric evaluation and therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0890T | Psychological and psychiatric evaluation and therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0891T | Psychological and psychiatric evaluation and therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0892T | Psychological and psychiatric evaluation and therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 90791 | Psychological and psychiatric evaluation and therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 90792 | Psychological and psychiatric evaluation and therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 90832 | Psychological and psychiatric evaluation and therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 90833 | Psychological and psychiatric evaluation and therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 90834 | Psychological and psychiatric evaluation and therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 90836 | Psychological and psychiatric evaluation and therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 90837 | Psychological and psychiatric evaluation and therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 90846 | Psychological and psychiatric evaluation and therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 90847 | Psychological and psychiatric evaluation and therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 90849 | Psychological and psychiatric evaluation and therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 90853 | Psychological and psychiatric evaluation and therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 90870 | Psychological and psychiatric evaluation and therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 96156 | Psychological and psychiatric evaluation and therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 96165 | Psychological and psychiatric evaluation and therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| C9782 | Psychological and psychiatric evaluation and therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| C9783 | Psychological and psychiatric evaluation and therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0747T | Conversion of cardiac rhythm | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 93656 | Conversion of cardiac rhythm | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| C9778 | Conversion of cardiac rhythm | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| C9784 | Conversion of cardiac rhythm | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| C9785 | Conversion of cardiac rhythm | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 4110F | Coronary artery bypass graft (CABG) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33510 | Coronary artery bypass graft (CABG) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33511 | Coronary artery bypass graft (CABG) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33512 | Coronary artery bypass graft (CABG) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33513 | Coronary artery bypass graft (CABG) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33514 | Coronary artery bypass graft (CABG) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33516 | Coronary artery bypass graft (CABG) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33517 | Coronary artery bypass graft (CABG) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33518 | Coronary artery bypass graft (CABG) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33519 | Coronary artery bypass graft (CABG) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33521 | Coronary artery bypass graft (CABG) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33522 | Coronary artery bypass graft (CABG) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33523 | Coronary artery bypass graft (CABG) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33530 | Coronary artery bypass graft (CABG) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33533 | Coronary artery bypass graft (CABG) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33534 | Coronary artery bypass graft (CABG) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33535 | Coronary artery bypass graft (CABG) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |