54164 prior authorization | Peach State Health Plan

54164: Diagnostic procedures, male genital (includes minor surgery). Imported Peach State Health Plan source reference; confirm plan-specific review requirements in the original document. Not a coverage or referral decision.

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Code: 54164
Description: Diagnostic procedures, male genital (includes minor surgery)
Source: CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy

Peach State Health Plan prior authorization

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