Peach State Health Plan prior authorization, page 38

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
L2180	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L2330	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L2340	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L2350	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L2510	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L2520	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L2525	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L2526	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L2540	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L2570	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L2580	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L2627	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L2628	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L2999	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3671	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3720	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3730	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3740	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3760	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3763	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3764	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3765	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3766	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3900	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3901	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3904	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3905	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3915	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3916	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3960	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3961	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3962	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3967	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3971	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3973	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3975	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3976	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3977	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3978	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L3999	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L4000	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L4010	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L4020	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L4030	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L4130	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L4205	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L4631	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5000	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5010	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5020	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy

Sources

CMS Final Rule 0057-F Prior Authorization Requirements