Peach State Health Plan prior authorization code reference, page 104

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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
Code	Description	Source
0950T	Transurethral resection of prostate (TURP)	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 18 Original policy

Sources

CMS Final Rule 0057-F Prior Authorization Requirements

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