Peach State Health Plan prior authorization code reference, page 99
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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 |
|---|---|---|
| 63003 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63005 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63011 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63012 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63015 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63016 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63017 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63020 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63030 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63040 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63042 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63045 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63046 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63047 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63050 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63051 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63055 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63056 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63064 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63066 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63075 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63077 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63078 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63085 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63086 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63185 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63190 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 63191 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| C9757 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| G0276 | Spine Surgery (Fusion, Laminectomy, & Deformity) | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 98929 | Chiropractic Services | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 0278T | PT/OT/Speech therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 0693T | PT/OT/Speech therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 0733T | PT/OT/Speech therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 0734T | PT/OT/Speech therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 0770T | PT/OT/Speech therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 0771T | PT/OT/Speech therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 0772T | PT/OT/Speech therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 0773T | PT/OT/Speech therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 0774T | PT/OT/Speech therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 0778T | PT/OT/Speech therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 97110 | PT/OT/Speech therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 97112 | PT/OT/Speech therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 97113 | PT/OT/Speech therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 97116 | PT/OT/Speech therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 97124 | PT/OT/Speech therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 97127 | PT/OT/Speech therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 97140 | PT/OT/Speech therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 97530 | PT/OT/Speech therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |
| 97533 | PT/OT/Speech therapy | CMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy |