Peach State Health Plan prior authorization code reference, page 98
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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 |
|---|---|---|
| 29886 | Major Joint Reconstruction & Arthroscopy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 29887 | Major Joint Reconstruction & Arthroscopy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 29888 | Major Joint Reconstruction & Arthroscopy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 29889 | Major Joint Reconstruction & Arthroscopy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 29891 | Major Joint Reconstruction & Arthroscopy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 29892 | Major Joint Reconstruction & Arthroscopy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 29893 | Major Joint Reconstruction & Arthroscopy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 29894 | Major Joint Reconstruction & Arthroscopy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 29895 | Major Joint Reconstruction & Arthroscopy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 29898 | Major Joint Reconstruction & Arthroscopy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 29899 | Major Joint Reconstruction & Arthroscopy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 29914 | Major Joint Reconstruction & Arthroscopy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 29915 | Major Joint Reconstruction & Arthroscopy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 29916 | Major Joint Reconstruction & Arthroscopy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 29999 | Major Joint Reconstruction & Arthroscopy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| C8003 | Major Joint Reconstruction & Arthroscopy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| G0289 | Major Joint Reconstruction & Arthroscopy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| S2118 | Major Joint Reconstruction & Arthroscopy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 29799 | Orthopedic Supplies, Casting, & Wound Care | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 0202T | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 0219T | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 0220T | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 0221T | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 0222T | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 0274T | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 0275T | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 0375T | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 0656T | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 0657T | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 0790T | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 22533 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 22548 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 22551 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 22552 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 22554 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 22558 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 22590 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 22595 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 22600 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 22612 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 22614 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 22630 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 22633 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 22830 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 22836 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 22837 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 22838 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 22847 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 22849 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63001 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |