PrimeWest Health policy

Authorization > Physician and Professional Services Authorization Standards

Authorization > Physician and Professional Services Authorization Standards is a public PrimeWest Health policy. It lists 57 CPT or HCPCS codes. Not a coverage decision; the payer's own document governs.

View the original policy ↗

Payer
PrimeWest Health
Line of business
Medicaid
States
MN
Source
www.primewest.org

Codes in this policy

The CPT and HCPCS codes the policy names. A policy can name a code it excludes.

CodeOther PrimeWest Health policies
0159TPolicies naming 0159T
36475Policies naming 36475
36478Policies naming 36478
58150Policies naming 58150
58152Policies naming 58152
58180Policies naming 58180
58200Policies naming 58200
58210Policies naming 58210
58260Policies naming 58260
58262Policies naming 58262
58263Policies naming 58263
58267Policies naming 58267
58270Policies naming 58270
58275Policies naming 58275
58280Policies naming 58280
58285Policies naming 58285
58290Policies naming 58290
58291Policies naming 58291
58292Policies naming 58292
58293Policies naming 58293
58294Policies naming 58294
58550Policies naming 58550
58552Policies naming 58552
58553Policies naming 58553
58554Policies naming 58554
58570Policies naming 58570
58571Policies naming 58571
58572Policies naming 58572
58573Policies naming 58573
58578Policies naming 58578
59525Policies naming 59525
63688Policies naming 63688
64568Policies naming 64568
64569Policies naming 64569
64585Policies naming 64585
64595Policies naming 64595
64633Policies naming 64633
64634Policies naming 64634
64640Policies naming 64640
77058Policies naming 77058
77059Policies naming 77059
83890Policies naming 83890
83909Policies naming 83909
C8903Policies naming C8903
C8904Policies naming C8904
C8905Policies naming C8905
C8906Policies naming C8906
C8907Policies naming C8907
C8908Policies naming C8908
J0585Policies naming J0585
J0586Policies naming J0586
J0587Policies naming J0587
J0588Policies naming J0588
L8680Policies naming L8680
L8686Policies naming L8686
S3818Policies naming S3818
S3823Policies naming S3823

All PrimeWest Health policies

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.