Peach State Health Plan prior authorization, page 5
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 |
|---|---|---|
| 0574T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0580T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0682T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0683T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0684T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0685T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0699T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0795T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0796T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0797T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0798T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0799T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0800T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0801T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0802T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0803T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0915T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0916T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0917T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0918T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0919T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0920T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0921T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0922T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0923T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0924T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0925T | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33202 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33203 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33206 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33207 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33208 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33210 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33211 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33212 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33213 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33214 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33221 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33225 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33227 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33228 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33229 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33230 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33231 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33233 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33236 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33237 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33240 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33241 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33243 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |