Peach State Health Plan prior authorization code reference, page 97

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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
23465	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
23466	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
23470	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
23472	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
23473	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
23474	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
27130	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
27132	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
27134	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
27137	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
27138	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
27332	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
27333	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
27446	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
27447	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
27486	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
27487	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29805	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29806	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29807	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29819	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29820	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29821	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29822	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29823	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29824	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29825	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29826	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29827	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29828	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29860	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29861	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29862	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29863	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29866	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29867	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29868	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29870	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29873	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29874	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29875	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29876	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29877	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29879	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29880	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29881	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29882	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29883	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29884	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
29885	Major Joint Reconstruction & Arthroscopy	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy

Sources

CMS Final Rule 0057-F Prior Authorization Requirements