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Peach State Health Plan prior authorization, page 45

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
CodeDescriptionSource
42145Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
42299Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
42699Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
42820Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
42830Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
42831Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
42835Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
42836Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
42999Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
69090Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
69300Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
69540Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
69550Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
69552Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
69554Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
69610Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
69631Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
69641Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
69716Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
69719Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
69726Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
69727Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
69729Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
69799Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
69930Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
69949Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
69979Diagnostic procedures on nose, mouth, pharynx, and earCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
69421MyringotomyCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
69433MyringotomyCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
69436MyringotomyCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
0647TGastrostomy, temporary and permanentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
S9474Gastrostomy, temporary and permanentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
0085TGastrointestinal endoscopy (and Diagnostics)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
0355TGastrointestinal endoscopy (and Diagnostics)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
0651TGastrointestinal endoscopy (and Diagnostics)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
0652TGastrointestinal endoscopy (and Diagnostics)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
0653TGastrointestinal endoscopy (and Diagnostics)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
0654TGastrointestinal endoscopy (and Diagnostics)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
0736TGastrointestinal endoscopy (and Diagnostics)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
0779TGastrointestinal endoscopy (and Diagnostics)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
0780TGastrointestinal endoscopy (and Diagnostics)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
0868TGastrointestinal endoscopy (and Diagnostics)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
0870TGastrointestinal endoscopy (and Diagnostics)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
0871TGastrointestinal endoscopy (and Diagnostics)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
0873TGastrointestinal endoscopy (and Diagnostics)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
0874TGastrointestinal endoscopy (and Diagnostics)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
0884TGastrointestinal endoscopy (and Diagnostics)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
0885TGastrointestinal endoscopy (and Diagnostics)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
0886TGastrointestinal endoscopy (and Diagnostics)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy
0967TGastrointestinal endoscopy (and Diagnostics)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy

Sources

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.

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