Peach State Health Plan prior authorization, page 47
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 |
|---|---|---|
| 60210 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 60212 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 60220 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 60225 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 60240 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 60252 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 60254 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 60260 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 60270 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 60271 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 60502 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 60505 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 60659 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 60699 | Exploratory laparotomy (and Major Open Abdominal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43282 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43289 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43497 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43499 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43620 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43621 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43622 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43631 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43632 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43633 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43634 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43644 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43645 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43659 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43770 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43771 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43772 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43773 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43774 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43775 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43842 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43843 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43845 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43846 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43847 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43848 | Gastric bypass and volume reduction (Bariatric) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 0748T | Gastric, Esophageal, and Bariatric Structural Surgery | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43850 | Gastric, Esophageal, and Bariatric Structural Surgery | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43855 | Gastric, Esophageal, and Bariatric Structural Surgery | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43860 | Gastric, Esophageal, and Bariatric Structural Surgery | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43865 | Gastric, Esophageal, and Bariatric Structural Surgery | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43886 | Gastric, Esophageal, and Bariatric Structural Surgery | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 43999 | Gastric, Esophageal, and Bariatric Structural Surgery | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 44238 | Laparoscopy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 49329 | Laparoscopy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 39599 | Other hernia repair | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |