Peach State Health Plan prior authorization, page 52
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 |
|---|---|---|
| 77768 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 77770 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 77771 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 77772 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 77778 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 77789 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 77790 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| 77799 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| C1721 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| C1722 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| C2617 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| C2619 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| C2620 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| C2621 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| C2623 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| C2625 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 10 Original policy |
| C9789 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| G0339 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| G0340 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| G0563 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| G6002 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| G6003 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| G6004 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| G6005 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| G6006 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| G6007 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| G6008 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| G6009 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| G6010 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| G6011 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| G6012 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| G6013 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| G6014 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| G6015 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| G6016 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| G6017 | Therapeutic radiology (Radiation Oncology) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| S9098 | Home Infusion Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| S9335 | Home Infusion Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| S9339 | Home Infusion Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| S9347 | Home Infusion Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| S9563 | Home Infusion Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| S9802 | Home Infusion Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| S9803 | Home Infusion Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| S9810 | Home Infusion Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| G0299 | Home Nursing Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| T1000 | Home Nursing Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| T1002 | Home Nursing Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| T1004 | Home Nursing Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| T1005 | Home Nursing Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| T1017 | Home Nursing Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |