Peach State Health Plan prior authorization, page 50
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 |
|---|---|---|
| S9211 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| S9212 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| S9213 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| S9214 | Minor Gyn, Non-Hysterectomy & Maternity | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58661 | Other gynecological surgery (Ovary/Tubal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58662 | Other gynecological surgery (Ovary/Tubal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58672 | Other gynecological surgery (Ovary/Tubal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58673 | Other gynecological surgery (Ovary/Tubal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58679 | Other gynecological surgery (Ovary/Tubal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58740 | Other gynecological surgery (Ovary/Tubal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58750 | Other gynecological surgery (Ovary/Tubal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58752 | Other gynecological surgery (Ovary/Tubal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58760 | Other gynecological surgery (Ovary/Tubal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58770 | Other gynecological surgery (Ovary/Tubal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58943 | Other gynecological surgery (Ovary/Tubal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58950 | Other gynecological surgery (Ovary/Tubal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58951 | Other gynecological surgery (Ovary/Tubal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58952 | Other gynecological surgery (Ovary/Tubal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58953 | Other gynecological surgery (Ovary/Tubal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58954 | Other gynecological surgery (Ovary/Tubal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58956 | Other gynecological surgery (Ovary/Tubal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58958 | Other gynecological surgery (Ovary/Tubal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 58960 | Other gynecological surgery (Ovary/Tubal) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 0901T | Bone marrow transplant | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 38204 | Bone marrow transplant | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 38205 | Bone marrow transplant | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 38206 | Bone marrow transplant | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 38207 | Bone marrow transplant | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 38208 | Bone marrow transplant | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 38209 | Bone marrow transplant | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 38210 | Bone marrow transplant | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 38211 | Bone marrow transplant | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 38212 | Bone marrow transplant | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 38213 | Bone marrow transplant | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 38214 | Bone marrow transplant | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 38215 | Bone marrow transplant | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 38230 | Bone marrow transplant | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 38232 | Bone marrow transplant | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 38240 | Bone marrow transplant | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 38241 | Bone marrow transplant | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 38242 | Bone marrow transplant | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 38243 | Bone marrow transplant | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 38129 | Lymph Node and Hemic System Surgery | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 38589 | Lymph Node and Hemic System Surgery | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 38999 | Lymph Node and Hemic System Surgery | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 0659T | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 77261 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 77262 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 77263 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 77280 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |