Peach State Health Plan prior authorization, page 39

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
L5050	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5060	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5100	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5105	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5150	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5160	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5200	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5210	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5220	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5230	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5250	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5270	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5280	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5301	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5321	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5331	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5341	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5400	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5410	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5420	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5430	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5450	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5460	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5500	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5505	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5510	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5520	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5530	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5535	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5540	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5560	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 8 Original policy
L5570	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5580	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5585	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5590	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5595	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5600	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5610	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5611	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5613	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5614	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5615	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5616	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5617	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5626	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5628	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5630	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5631	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5638	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5639	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy

Sources

CMS Final Rule 0057-F Prior Authorization Requirements