Peach State Health Plan prior authorization, page 43

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
L6695	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6696	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6697	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6698	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6700	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6704	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6707	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6708	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6709	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6881	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6882	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6883	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6884	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6885	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6895	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6900	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6905	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6910	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6915	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6920	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6925	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6930	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6935	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6940	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6945	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6950	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6955	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6960	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6965	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6970	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L6975	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L7007	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L7008	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L7009	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L7040	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L7045	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L7170	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L7180	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L7181	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L7185	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L7186	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L7190	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L7191	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L7259	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L7364	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L7366	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L7368	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L7404	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L7405	Orthotics, Prosthetics, and OPPS Devices	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
L7406	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