Peach State Health Plan prior authorization, page 30

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
Code	Description	Source
E0325	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0326	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0328	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0371	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0372	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0373	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0445	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0455	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0465	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0466	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0468	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0469	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0470	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0471	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0480	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0481	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0482	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0483	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0490	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0491	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0492	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0493	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0500	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0530	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0574	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0601	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0604	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0616	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0617	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0619	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0630	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0635	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0637	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0638	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0658	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0659	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0677	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0678	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0679	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0680	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0681	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0682	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0683	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0711	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0715	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0721	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0732	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0733	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0734	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy
E0735	DME and supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 7 Original policy

Sources

CMS Final Rule 0057-F Prior Authorization Requirements