Peach State Health Plan prior authorization, page 40

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
L5640	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5642	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5643	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5644	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5645	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5646	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5647	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5648	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5649	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5650	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5651	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5652	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5653	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5657	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5661	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5665	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5671	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5673	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5677	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5679	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5681	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5682	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5683	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5700	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5701	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5702	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5703	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5704	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5705	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5706	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5707	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5711	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5712	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5714	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5716	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5718	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5722	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5724	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5726	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5728	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5780	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5781	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5782	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5783	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5785	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5790	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5795	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5810	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5811	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L5812	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