Peach State Health Plan prior authorization, page 54
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 |
|---|---|---|
| S9124 | Nonhospital-based care (e.g., home health care, hospice) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| S9125 | Nonhospital-based care (e.g., home health care, hospice) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| S9127 | Nonhospital-based care (e.g., home health care, hospice) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| S9381 | Nonhospital-based care (e.g., home health care, hospice) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| G9006 | Supplemental & State-Waiver Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| S5108 | Supplemental & State-Waiver Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| S5109 | Supplemental & State-Waiver Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| S5110 | Supplemental & State-Waiver Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| S5111 | Supplemental & State-Waiver Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| S5115 | Supplemental & State-Waiver Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| S5116 | Supplemental & State-Waiver Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| S5130 | Supplemental & State-Waiver Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| S5131 | Supplemental & State-Waiver Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| S5165 | Supplemental & State-Waiver Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| S5180 | Supplemental & State-Waiver Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| S5181 | Supplemental & State-Waiver Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| S5190 | Supplemental & State-Waiver Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| T2022 | Supplemental & State-Waiver Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| T2023 | Supplemental & State-Waiver Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| T2042 | Supplemental & State-Waiver Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| T2043 | Supplemental & State-Waiver Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| T2050 | Supplemental & State-Waiver Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| T2051 | Supplemental & State-Waiver Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 15820 | Blepharoplasty and Brow Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 15821 | Blepharoplasty and Brow Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 15822 | Blepharoplasty and Brow Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 15823 | Blepharoplasty and Brow Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 67900 | Blepharoplasty and Brow Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 67901 | Blepharoplasty and Brow Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 67902 | Blepharoplasty and Brow Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 67903 | Blepharoplasty and Brow Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 67904 | Blepharoplasty and Brow Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 67906 | Blepharoplasty and Brow Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 67909 | Blepharoplasty and Brow Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 67911 | Blepharoplasty and Brow Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 67912 | Blepharoplasty and Brow Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 67999 | Blepharoplasty and Brow Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 0945T | Breast Reconstruction and Mastectomy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 19300 | Breast Reconstruction and Mastectomy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 19301 | Breast Reconstruction and Mastectomy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 19316 | Breast Reconstruction and Mastectomy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 19318 | Breast Reconstruction and Mastectomy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 19324 | Breast Reconstruction and Mastectomy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 19325 | Breast Reconstruction and Mastectomy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 19328 | Breast Reconstruction and Mastectomy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 19330 | Breast Reconstruction and Mastectomy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 19340 | Breast Reconstruction and Mastectomy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 19342 | Breast Reconstruction and Mastectomy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 19350 | Breast Reconstruction and Mastectomy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |
| 19355 | Breast Reconstruction and Mastectomy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 11 Original policy |