Peach State Health Plan prior authorization code reference, page 91
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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
| Code | Description | Source |
|---|---|---|
| 92355 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 92358 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 92370 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 92371 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| 92499 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| S0500 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| S0504 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| S0506 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| S0508 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| S0510 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| S0512 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| S0514 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| S0516 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| S0518 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| S0580 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| S0581 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| S0590 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| S0592 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| S0595 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2020 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2025 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2100 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2101 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2102 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2103 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2104 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2105 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2106 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2107 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2108 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2109 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2110 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2111 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2112 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2113 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2114 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2115 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2118 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2121 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2199 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2200 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2201 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2202 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2203 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2204 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2205 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2206 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2207 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2208 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |
| V2209 | Visual aids and other optical supplies | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy |