Peach State Health Plan prior authorization code reference, page 88
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
| Code | Description | Source |
|---|---|---|
| S0172 | Medications (Injections, infusions and other forms) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| S0175 | Medications (Injections, infusions and other forms) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| S0178 | Medications (Injections, infusions and other forms) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| S0182 | Medications (Injections, infusions and other forms) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| S0190 | Medications (Injections, infusions and other forms) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| S0199 | Medications (Injections, infusions and other forms) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0662T | Incision and excision of CNS | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0663T | Incision and excision of CNS | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0735T | Incision and excision of CNS | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0776T | Incision and excision of CNS | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0947T | Incision and excision of CNS | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0956T | Incision and excision of CNS | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 61736 | Incision and excision of CNS | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 61737 | Incision and excision of CNS | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 64999 | Incision and excision of CNS | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0674T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0675T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0676T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0677T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0678T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0679T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0680T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0766T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0767T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0783T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0784T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0786T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0816T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0817T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0908T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0909T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0910T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 0968T | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 61889 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62320 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62321 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62322 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62323 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62324 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62325 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62326 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62327 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62350 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62351 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62360 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62361 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62362 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 62380 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 63650 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 63655 | Insertion of catheter or spinal stimulator | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |