Peach State Health Plan prior authorization, page 49
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 |
|---|---|---|
| 58542 | Hysterectomy, abdominal and vaginal | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58543 | Hysterectomy, abdominal and vaginal | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58544 | Hysterectomy, abdominal and vaginal | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58548 | Hysterectomy, abdominal and vaginal | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58550 | Hysterectomy, abdominal and vaginal | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58552 | Hysterectomy, abdominal and vaginal | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58553 | Hysterectomy, abdominal and vaginal | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58554 | Hysterectomy, abdominal and vaginal | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58571 | Hysterectomy, abdominal and vaginal | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58572 | Hysterectomy, abdominal and vaginal | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58573 | Hysterectomy, abdominal and vaginal | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 0058T | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 0071T | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 56805 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 57287 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 57288 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 57700 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58140 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58146 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58321 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58322 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58323 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58350 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58545 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58546 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58558 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58560 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58561 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58970 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58974 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58976 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58999 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 59840 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 59841 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 59850 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 59851 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 59852 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 59855 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 59856 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 59857 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 59866 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 59898 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 59899 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| S2260 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| S2265 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| S2266 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| S2267 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| S9002 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| S9208 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| S9209 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |