Peach State Health Plan prior authorization, page 88
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 |
|---|---|---|
| S0172 | Medications (Injections, infusions and other forms) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| S0175 | Medications (Injections, infusions and other forms) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| S0178 | Medications (Injections, infusions and other forms) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| S0182 | Medications (Injections, infusions and other forms) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| S0190 | Medications (Injections, infusions and other forms) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| S0199 | Medications (Injections, infusions and other forms) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0662T | Incision and excision of CNS | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0663T | Incision and excision of CNS | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0735T | Incision and excision of CNS | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0776T | Incision and excision of CNS | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0947T | Incision and excision of CNS | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0956T | Incision and excision of CNS | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 61736 | Incision and excision of CNS | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 61737 | Incision and excision of CNS | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 64999 | Incision and excision of CNS | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0674T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0675T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0676T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0677T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0678T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0679T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0680T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0766T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0767T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0783T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0784T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0786T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0816T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0817T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0908T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0909T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0910T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0968T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 61889 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62320 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62321 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62322 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62323 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62324 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62325 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62326 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62327 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62350 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62351 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62360 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62361 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62362 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62380 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 63650 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 63655 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |