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Peach State Health Plan prior authorization code reference, page 100

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Source code lookup

Each row links an imported source code to its service or category label. Check the original document for the complete plan scope, review type and qualifications.

Source code index

Imported source codes and labels; verify the complete review requirements in the original document
CodeDescriptionSource
97535PT/OT/Speech therapyCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
97545PT/OT/Speech therapyCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
S8930PT/OT/Speech therapyCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
97016Therapy Modalities (Ultrasound, Traction, Stim)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
97022Therapy Modalities (Ultrasound, Traction, Stim)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
97024Therapy Modalities (Ultrasound, Traction, Stim)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
97750Therapy Modalities (Ultrasound, Traction, Stim)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
97760Therapy Modalities (Ultrasound, Traction, Stim)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
97761Therapy Modalities (Ultrasound, Traction, Stim)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15780Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15781Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15782Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15783Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15786Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15787Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15788Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15789Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15792Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15793Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15824Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15825Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15826Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15828Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15829Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15830Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15832Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15833Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15834Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15835Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15836Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15837Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15838Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15839Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15840Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15841Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15842Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15845Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15847Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15876Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15877Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15878Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
15879Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
40799Cosmetic & Functional Reconstructive SurgeryCMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
30400Plastic procedures on nose (Rhinoplasty)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
30410Plastic procedures on nose (Rhinoplasty)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
30420Plastic procedures on nose (Rhinoplasty)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
30430Plastic procedures on nose (Rhinoplasty)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
30435Plastic procedures on nose (Rhinoplasty)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
30450Plastic procedures on nose (Rhinoplasty)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy
30460Plastic procedures on nose (Rhinoplasty)CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 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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