Peach State Health Plan prior authorization, page 46
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
| Code | Description | Source |
|---|---|---|
| 0976T | Gastrointestinal endoscopy (and Diagnostics) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy |
| 0977T | Gastrointestinal endoscopy (and Diagnostics) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy |
| 43279 | Gastrointestinal endoscopy (and Diagnostics) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy |
| 44360 | Gastrointestinal endoscopy (and Diagnostics) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy |
| 44361 | Gastrointestinal endoscopy (and Diagnostics) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy |
| 44363 | Gastrointestinal endoscopy (and Diagnostics) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy |
| 44364 | Gastrointestinal endoscopy (and Diagnostics) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy |
| 44365 | Gastrointestinal endoscopy (and Diagnostics) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy |
| 44366 | Gastrointestinal endoscopy (and Diagnostics) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy |
| 44369 | Gastrointestinal endoscopy (and Diagnostics) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy |
| 44370 | Gastrointestinal endoscopy (and Diagnostics) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy |
| 44372 | Gastrointestinal endoscopy (and Diagnostics) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy |
| 44373 | Gastrointestinal endoscopy (and Diagnostics) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy |
| 44377 | Gastrointestinal endoscopy (and Diagnostics) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy |
| 44378 | Gastrointestinal endoscopy (and Diagnostics) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy |
| 44379 | Gastrointestinal endoscopy (and Diagnostics) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy |
| 45999 | Gastrointestinal endoscopy (and Diagnostics) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy |
| 91113 | Gastrointestinal endoscopy (and Diagnostics) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy |
| 91299 | Gastrointestinal endoscopy (and Diagnostics) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy |
| A9268 | Gastrointestinal endoscopy (and Diagnostics) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy |
| A9269 | Gastrointestinal endoscopy (and Diagnostics) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy |
| C1062 | Gastrointestinal endoscopy (and Diagnostics) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy |
| G0448 | Gastrointestinal endoscopy (and Diagnostics) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 9 Original policy |
| 44979 | Appendectomy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 47579 | Cholecystectomy and common duct exploration | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 47999 | Cholecystectomy and common duct exploration | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 0673T | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 0686T | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 0944T | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 45499 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 47133 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 47135 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 47140 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 47141 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 47142 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 47143 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 47144 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 47145 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 47146 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 47147 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 47379 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 47399 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 48160 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 48550 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 48551 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 48552 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 48554 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 48556 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 48999 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 49999 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |