Peach State Health Plan prior authorization, page 6
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 |
|---|---|---|
| 33244 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33249 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33262 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33263 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33264 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33267 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33268 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33269 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33270 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33271 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33274 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33275 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33276 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33277 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33285 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33286 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33288 | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0681T | Lobectomy, Pneumonectomy, and Mediastinal Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 31599 | Lobectomy, Pneumonectomy, and Mediastinal Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 31647 | Lobectomy, Pneumonectomy, and Mediastinal Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 31899 | Lobectomy, Pneumonectomy, and Mediastinal Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 32850 | Lobectomy, Pneumonectomy, and Mediastinal Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 32851 | Lobectomy, Pneumonectomy, and Mediastinal Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 32852 | Lobectomy, Pneumonectomy, and Mediastinal Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 32853 | Lobectomy, Pneumonectomy, and Mediastinal Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 32854 | Lobectomy, Pneumonectomy, and Mediastinal Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 32856 | Lobectomy, Pneumonectomy, and Mediastinal Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 32999 | Lobectomy, Pneumonectomy, and Mediastinal Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 39499 | Lobectomy, Pneumonectomy, and Mediastinal Procedures | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 33999 | Mechanical Circulatory Support and Transplantation | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| C9792 | Mechanical Circulatory Support and Transplantation | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 3 Original policy |
| 0075T | Percutaneous transluminal coronary angioplasty (PTCA) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 0076T | Percutaneous transluminal coronary angioplasty (PTCA) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 0126T | Percutaneous transluminal coronary angioplasty (PTCA) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 0290T | Percutaneous transluminal coronary angioplasty (PTCA) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 0620T | Percutaneous transluminal coronary angioplasty (PTCA) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 0913T | Percutaneous transluminal coronary angioplasty (PTCA) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 0914T | Percutaneous transluminal coronary angioplasty (PTCA) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 92928 | Percutaneous transluminal coronary angioplasty (PTCA) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 92929 | Percutaneous transluminal coronary angioplasty (PTCA) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 92933 | Percutaneous transluminal coronary angioplasty (PTCA) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 92934 | Percutaneous transluminal coronary angioplasty (PTCA) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 92937 | Percutaneous transluminal coronary angioplasty (PTCA) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 92938 | Percutaneous transluminal coronary angioplasty (PTCA) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 92943 | Percutaneous transluminal coronary angioplasty (PTCA) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 92944 | Percutaneous transluminal coronary angioplasty (PTCA) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 92972 | Percutaneous transluminal coronary angioplasty (PTCA) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| C9600 | Percutaneous transluminal coronary angioplasty (PTCA) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| C9601 | Percutaneous transluminal coronary angioplasty (PTCA) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| C9602 | Percutaneous transluminal coronary angioplasty (PTCA) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |