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Peach State Health Plan prior authorization, page 9

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

Prior authorization codes
CodeDescriptionSource
G0422Consultation, evaluation, and preventative careCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
G0423Consultation, evaluation, and preventative careCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
G0567Consultation, evaluation, and preventative careCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
S0209Consultation, evaluation, and preventative careCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
S0270Consultation, evaluation, and preventative careCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
S0271Consultation, evaluation, and preventative careCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
S0272Consultation, evaluation, and preventative careCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
S0273Consultation, evaluation, and preventative careCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
S0274Consultation, evaluation, and preventative careCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
S0280Consultation, evaluation, and preventative careCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
S0281Consultation, evaluation, and preventative careCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
S0345Consultation, evaluation, and preventative careCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
S0346Consultation, evaluation, and preventative careCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
S9452Consultation, evaluation, and preventative careCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
S9455Consultation, evaluation, and preventative careCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
S9460Consultation, evaluation, and preventative careCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
S9465Consultation, evaluation, and preventative careCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
S9470Consultation, evaluation, and preventative careCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
S9472Consultation, evaluation, and preventative careCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
0964TOral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
0965TOral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
0966TOral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0120Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0140Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0145Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0150Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0160Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0170Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0180Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0210Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0220Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0230Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0240Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0250Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0260Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0270Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0272Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0273Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0274Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0277Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0290Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0310Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0320Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0321Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0322Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0330Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0340Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0350Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0363Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy
D0393Oral and Dental ServicesCMS Final Rule 0057-F Prior Authorization Requirements, Pg 4 Original policy

Sources

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.

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