Peach State Health Plan prior authorization, page 7
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 |
|---|---|---|
| C9603 | Percutaneous transluminal coronary angioplasty (PTCA) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| C9604 | Percutaneous transluminal coronary angioplasty (PTCA) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| C9605 | Percutaneous transluminal coronary angioplasty (PTCA) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| C9606 | Percutaneous transluminal coronary angioplasty (PTCA) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| C9607 | Percutaneous transluminal coronary angioplasty (PTCA) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| C9608 | Percutaneous transluminal coronary angioplasty (PTCA) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 0744T | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 35556 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 35558 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 35566 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 35571 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 35583 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 35585 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 35587 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 35656 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 35661 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 35666 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 35671 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 35700 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 35881 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 35883 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 35884 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 36836 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 36837 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 37220 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 37221 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 37224 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 37225 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 37226 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 37227 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 37228 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 37229 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 37230 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 37231 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 37232 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 37233 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 37234 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 37235 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 37236 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 37237 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 37238 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 37239 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 37243 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 37246 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 37247 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 37248 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 37249 | Peripheral vascular bypass | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 36468 | Varicose vein stripping, lower limb | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 36470 | Varicose vein stripping, lower limb | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |
| 36471 | Varicose vein stripping, lower limb | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy |