Page 1 of 51
Prior Authorization Crosswalk TableMay 2019
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
11401 11400 Site of Service (SOS) Office Based Programs
11404 11400 Site of Service (SOS) Office Based Programs
11400 11401 Site of Service (SOS) Office Based Programs
11404 11401 Site of Service (SOS) Office Based Programs
11403 11402 Site of Service (SOS) Office Based Programs
11406 11402 Site of Service (SOS) Office Based Programs
11422 11402 Site of Service (SOS) Office Based Programs
46922 11402 Site of Service (SOS) Office Based Programs
11406 11403 Site of Service (SOS) Office Based Programs
11422 11403 Site of Service (SOS) Office Based Programs
11400 11404 Site of Service (SOS) Office Based Programs
11401 11404 Site of Service (SOS) Office Based Programs
46922 11406 Site of Service (SOS) Office Based Programs
21931 11406 Site of Service (SOS) Office Based Programs
11421 11420 Site of Service (SOS) Office Based Programs
11423 11420 Site of Service (SOS) Office Based Programs
11424 11420 Site of Service (SOS) Office Based Programs
11426 11420 Site of Service (SOS) Office Based Programs
11442 11420 Site of Service (SOS) Office Based Programs
11420 11421 Site of Service (SOS) Office Based Programs
11423 11421 Site of Service (SOS) Office Based Programs
11424 11421 Site of Service (SOS) Office Based Programs
11426 11421 Site of Service (SOS) Office Based Programs
11442 11421 Site of Service (SOS) Office Based Programs
11403 11422 Site of Service (SOS) Office Based Programs
11406 11422 Site of Service (SOS) Office Based Programs
11400 11422 Site of Service (SOS) Office Based Programs
11402 11422 Site of Service (SOS) Office Based Programs
11442 11422 Site of Service (SOS) Office Based Programs
11420 11423 Site of Service (SOS) Office Based Programs
11421 11423 Site of Service (SOS) Office Based Programs
11424 11423 Site of Service (SOS) Office Based Programs
11426 11423 Site of Service (SOS) Office Based Programs
11442 11423 Site of Service (SOS) Office Based Programs
11420 11424 Site of Service (SOS) Office Based Programs
11421 11424 Site of Service (SOS) Office Based Programs
11423 11424 Site of Service (SOS) Office Based Programs
11426 11424 Site of Service (SOS) Office Based Programs
11442 11424 Site of Service (SOS) Office Based Programs
11420 11426 Site of Service (SOS) Office Based Programs
11421 11426 Site of Service (SOS) Office Based Programs
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
11423 11426 Site of Service (SOS) Office Based Programs
11424 11426 Site of Service (SOS) Office Based Programs
11442 11426 Site of Service (SOS) Office Based Programs
11420 11442 Site of Service (SOS) Office Based Programs
11421 11442 Site of Service (SOS) Office Based Programs
11422 11442 Site of Service (SOS) Office Based Programs
11423 11442 Site of Service (SOS) Office Based Programs
11424 11442 Site of Service (SOS) Office Based Programs
11426 11442 Site of Service (SOS) Office Based Programs
13132 13101 Site of Service (SOS) OPH to ASC
14001 14000 Gender Dysphoria Treatment w diagnosis code
14301 14000 Gender Dysphoria Treatment w diagnosis code
14020 14000 Gender Dysphoria Treatment w diagnosis code
14041 14000 Gender Dysphoria Treatment w diagnosis code
14021 14000 Gender Dysphoria Treatment w diagnosis code
14301 14001 Gender Dysphoria Treatment w diagnosis code
14041 14001 Gender Dysphoria Treatment w diagnosis code
14021 14001 Gender Dysphoria Treatment w diagnosis code
14021 14020 Gender Dysphoria Treatment w diagnosis code
14301 14020 Gender Dysphoria Treatment w diagnosis code
14041 14020 Gender Dysphoria Treatment w diagnosis code
14001 14020 Gender Dysphoria Treatment w diagnosis code
14301 14021 Gender Dysphoria Treatment w diagnosis code
14041 14021 Gender Dysphoria Treatment w diagnosis code
14060 14040 Site of Service (SOS) OPH to ASC
14301 14040 Site of Service (SOS) OPH to ASC
14301 14041 Gender Dysphoria Treatment w diagnosis code
14301 14060 Site of Service (SOS) OPH to ASC
15757 15734 Gender Dysphoria Treatment w diagnosis code
15758 15734 Gender Dysphoria Treatment w diagnosis code
15734 15738 Gender Dysphoria Treatment w diagnosis code
15757 15738 Gender Dysphoria Treatment w diagnosis code
15758 15738 Gender Dysphoria Treatment w diagnosis code
15734 15750 Gender Dysphoria Treatment w diagnosis code
15738 15750 Gender Dysphoria Treatment w diagnosis code
15757 15750 Gender Dysphoria Treatment w diagnosis code
15758 15750 Gender Dysphoria Treatment w diagnosis code
15758 15757 Gender Dysphoria Treatment w diagnosis code
15821 15820 Cosmetic & Reconstructive
15823 15820 Cosmetic & Reconstructive
15821 15822 Cosmetic & Reconstructive
Page 2 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
15823 15822 Cosmetic & Reconstructive
15830 15847 Cosmetic & Reconstructive
17107 17106 Cosmetic & Reconstructive
17108 17106 Cosmetic & Reconstructive
17108 17107 Cosmetic & Reconstructive
19303 19304 Gender Dysphoria Treatment w diagnosis code
19318 19316 Breast Reconstruction (Non-Mastectomy)
19316 19324 Breast Reconstruction (Non-Mastectomy)
19318 19324 Breast Reconstruction (Non-Mastectomy)
19325 19324 Breast Reconstruction (Non-Mastectomy)
19316 19325 Breast Reconstruction (Non-Mastectomy)
19318 19325 Breast Reconstruction (Non-Mastectomy)
19330 19328 Breast Reconstruction (Non-Mastectomy)
19340 19342 Breast Reconstruction (Non-Mastectomy)
19357 19350 Breast Reconstruction (Non-Mastectomy)
19361 19350 Breast Reconstruction (Non-Mastectomy)
19364 19350 Breast Reconstruction (Non-Mastectomy)
19366 19350 Breast Reconstruction (Non-Mastectomy)
19367 19350 Breast Reconstruction (Non-Mastectomy)
19368 19350 Breast Reconstruction (Non-Mastectomy)
19369 19350 Breast Reconstruction (Non-Mastectomy)
19380 19350 Breast Reconstruction (Non-Mastectomy)
19361 19357 Breast Reconstruction (Non-Mastectomy)
19364 19357 Breast Reconstruction (Non-Mastectomy)
19367 19357 Breast Reconstruction (Non-Mastectomy)
19368 19357 Breast Reconstruction (Non-Mastectomy)
19369 19357 Breast Reconstruction (Non-Mastectomy)
19364 19361 Breast Reconstruction (Non-Mastectomy)
19367 19361 Breast Reconstruction (Non-Mastectomy)
19368 19361 Breast Reconstruction (Non-Mastectomy)
19369 19361 Breast Reconstruction (Non-Mastectomy)
19357 19366 Breast Reconstruction (Non-Mastectomy)
19361 19366 Breast Reconstruction (Non-Mastectomy)
19364 19366 Breast Reconstruction (Non-Mastectomy)
19367 19366 Breast Reconstruction (Non-Mastectomy)
19368 19366 Breast Reconstruction (Non-Mastectomy)
19369 19366 Breast Reconstruction (Non-Mastectomy)
19364 19367 Breast Reconstruction (Non-Mastectomy)
19368 19367 Breast Reconstruction (Non-Mastectomy)
19369 19367 Breast Reconstruction (Non-Mastectomy)
19364 19368 Breast Reconstruction (Non-Mastectomy)
19364 19369 Breast Reconstruction (Non-Mastectomy)
19368 19369 Breast Reconstruction (Non-Mastectomy)
19371 19370 Breast Reconstruction (Non-Mastectomy)
19357 19380 Breast Reconstruction (Non-Mastectomy)
19361 19380 Breast Reconstruction (Non-Mastectomy)
19364 19380 Breast Reconstruction (Non-Mastectomy)
19366 19380 Breast Reconstruction (Non-Mastectomy)
19367 19380 Breast Reconstruction (Non-Mastectomy)
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
19368 19380 Breast Reconstruction (Non-Mastectomy)
19369 19380 Breast Reconstruction (Non-Mastectomy)
20975 20974 Bone Growth Stimulator
20974 20979 Bone Growth Stimulator
20975 20979 Bone Growth Stimulator
21122 21121 Orthognathic Surgery
21123 21121 Orthognathic Surgery
21125 21121 Orthognathic Surgery
21127 21121 Orthognathic Surgery
21123 21125 Orthognathic Surgery
21127 21125 Orthognathic Surgery
21138 21137 Cosmetic & Reconstructive
21139 21137 Cosmetic & Reconstructive
21181 21137 Cosmetic & Reconstructive
21172 21137 Cosmetic & Reconstructive
21175 21137 Cosmetic & Reconstructive
21179 21137 Cosmetic & Reconstructive
21180 21137 Cosmetic & Reconstructive
21182 21137 Cosmetic & Reconstructive
21183 21137 Cosmetic & Reconstructive
21184 21137 Cosmetic & Reconstructive
21139 21138 Cosmetic & Reconstructive
21172 21138 Cosmetic & Reconstructive
21175 21138 Cosmetic & Reconstructive
21179 21138 Cosmetic & Reconstructive
21180 21138 Cosmetic & Reconstructive
21182 21138 Cosmetic & Reconstructive
21183 21138 Cosmetic & Reconstructive
21184 21138 Cosmetic & Reconstructive
21172 21139 Cosmetic & Reconstructive
21179 21139 Cosmetic & Reconstructive
21180 21139 Cosmetic & Reconstructive
21182 21139 Cosmetic & Reconstructive
21183 21139 Cosmetic & Reconstructive
21184 21139 Cosmetic & Reconstructive
21142 21141 Orthognathic Surgery
21143 21141 Orthognathic Surgery
21145 21141 Orthognathic Surgery
21146 21141 Orthognathic Surgery
21147 21141 Orthognathic Surgery
21150 21141 Orthognathic Surgery
21151 21141 Orthognathic Surgery
21154 21141 Orthognathic Surgery
21155 21141 Orthognathic Surgery
21159 21141 Orthognathic Surgery
21160 21141 Orthognathic Surgery
21188 21141 Orthognathic Surgery
21143 21142 Orthognathic Surgery
21145 21142 Orthognathic Surgery
Page 3 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
21146 21142 Orthognathic Surgery
21147 21142 Orthognathic Surgery
21150 21142 Orthognathic Surgery
21151 21142 Orthognathic Surgery
21154 21142 Orthognathic Surgery
21155 21142 Orthognathic Surgery
21159 21142 Orthognathic Surgery
21160 21142 Orthognathic Surgery
21188 21142 Orthognathic Surgery
21145 21143 Orthognathic Surgery
21146 21143 Orthognathic Surgery
21147 21143 Orthognathic Surgery
21150 21143 Orthognathic Surgery
21151 21143 Orthognathic Surgery
21154 21143 Orthognathic Surgery
21155 21143 Orthognathic Surgery
21159 21143 Orthognathic Surgery
21160 21143 Orthognathic Surgery
21188 21143 Orthognathic Surgery
21146 21145 Orthognathic Surgery
21147 21145 Orthognathic Surgery
21150 21145 Orthognathic Surgery
21151 21145 Orthognathic Surgery
21154 21145 Orthognathic Surgery
21155 21145 Orthognathic Surgery
21159 21145 Orthognathic Surgery
21160 21145 Orthognathic Surgery
21188 21145 Orthognathic Surgery
21147 21146 Orthognathic Surgery
21151 21146 Orthognathic Surgery
21154 21146 Orthognathic Surgery
21155 21146 Orthognathic Surgery
21159 21146 Orthognathic Surgery
21160 21146 Orthognathic Surgery
21150 21146 Orthognathic Surgery
21151 21147 Orthognathic Surgery
21154 21147 Orthognathic Surgery
21155 21147 Orthognathic Surgery
21159 21147 Orthognathic Surgery
21160 21147 Orthognathic Surgery
21150 21147 Orthognathic Surgery
21146 21150 Orthognathic Surgery
21147 21150 Orthognathic Surgery
21151 21150 Orthognathic Surgery
21154 21150 Orthognathic Surgery
21155 21150 Orthognathic Surgery
21159 21150 Orthognathic Surgery
21160 21150 Orthognathic Surgery
21188 21150 Orthognathic Surgery
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
21154 21151 Orthognathic Surgery
21155 21151 Orthognathic Surgery
21159 21151 Orthognathic Surgery
21160 21151 Orthognathic Surgery
21155 21154 Orthognathic Surgery
21159 21154 Orthognathic Surgery
21160 21154 Orthognathic Surgery
21159 21155 Orthognathic Surgery
21160 21155 Orthognathic Surgery
21160 21159 Orthognathic Surgery
21175 21172 Cosmetic & Reconstructive
21182 21172 Cosmetic & Reconstructive
21183 21172 Cosmetic & Reconstructive
21184 21172 Cosmetic & Reconstructive
21183 21175 Cosmetic & Reconstructive
21184 21175 Cosmetic & Reconstructive
21172 21179 Cosmetic & Reconstructive
21175 21179 Cosmetic & Reconstructive
21180 21179 Cosmetic & Reconstructive
21182 21179 Cosmetic & Reconstructive
21183 21179 Cosmetic & Reconstructive
21184 21179 Cosmetic & Reconstructive
21172 21180 Cosmetic & Reconstructive
21175 21180 Cosmetic & Reconstructive
21182 21180 Cosmetic & Reconstructive
21183 21180 Cosmetic & Reconstructive
21184 21180 Cosmetic & Reconstructive
21172 21181 Cosmetic & Reconstructive
21175 21181 Cosmetic & Reconstructive
21179 21181 Cosmetic & Reconstructive
21180 21181 Cosmetic & Reconstructive
21182 21181 Cosmetic & Reconstructive
21183 21181 Cosmetic & Reconstructive
21184 21181 Cosmetic & Reconstructive
21172 21182 Cosmetic & Reconstructive
21175 21182 Cosmetic & Reconstructive
21183 21182 Cosmetic & Reconstructive
21184 21182 Cosmetic & Reconstructive
21184 21183 Cosmetic & Reconstructive
21146 21188 Orthognathic Surgery
21147 21188 Orthognathic Surgery
21151 21188 Orthognathic Surgery
21154 21188 Orthognathic Surgery
21155 21188 Orthognathic Surgery
21159 21188 Orthognathic Surgery
21160 21188 Orthognathic Surgery
21194 21193 Orthognathic Surgery
21195 21193 Orthognathic Surgery
21196 21193 Orthognathic Surgery
Page 4 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
21206 21193 Orthognathic Surgery
21247 21193 Orthognathic Surgery
21196 21194 Orthognathic Surgery
21247 21194 Orthognathic Surgery
21194 21195 Orthognathic Surgery
21196 21195 Orthognathic Surgery
21247 21195 Orthognathic Surgery
21247 21196 Orthognathic Surgery
21193 21198 Orthognathic Surgery
21194 21198 Orthognathic Surgery
21195 21198 Orthognathic Surgery
21196 21198 Orthognathic Surgery
21206 21198 Orthognathic Surgery
21247 21198 Orthognathic Surgery
21193 21199 Orthognathic Surgery
21194 21199 Orthognathic Surgery
21195 21199 Orthognathic Surgery
21196 21199 Orthognathic Surgery
21198 21199 Orthognathic Surgery
21206 21199 Orthognathic Surgery
21244 21199 Orthognathic Surgery
21247 21199 Orthognathic Surgery
21194 21206 Orthognathic Surgery
21195 21206 Orthognathic Surgery
21196 21206 Orthognathic Surgery
21247 21206 Orthognathic Surgery
21248 21208 Orthognathic Surgery
21249 21208 Orthognathic Surgery
21255 21208 Orthognathic Surgery
21256 21208 Orthognathic Surgery
21260 21208 Orthognathic Surgery
21261 21208 Orthognathic Surgery
21263 21208 Orthognathic Surgery
21267 21208 Orthognathic Surgery
21268 21208 Orthognathic Surgery
21208 21209 Orthognathic Surgery
21230 21209 Orthognathic Surgery
21248 21209 Orthognathic Surgery
21249 21209 Orthognathic Surgery
21255 21209 Orthognathic Surgery
21256 21209 Orthognathic Surgery
21260 21209 Orthognathic Surgery
21261 21209 Orthognathic Surgery
21263 21209 Orthognathic Surgery
21267 21209 Orthognathic Surgery
21268 21209 Orthognathic Surgery
21270 21209 Orthognathic Surgery
21275 21209 Orthognathic Surgery
21193 21210 Orthognathic Surgery
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
21194 21210 Orthognathic Surgery
21195 21210 Orthognathic Surgery
21196 21210 Orthognathic Surgery
21198 21210 Orthognathic Surgery
21199 21210 Orthognathic Surgery
21206 21210 Orthognathic Surgery
21215 21210 Orthognathic Surgery
21244 21210 Orthognathic Surgery
21245 21210 Orthognathic Surgery
21247 21210 Orthognathic Surgery
21193 21215 Orthognathic Surgery
21194 21215 Orthognathic Surgery
21195 21215 Orthognathic Surgery
21196 21215 Orthognathic Surgery
21198 21215 Orthognathic Surgery
21199 21215 Orthognathic Surgery
21206 21215 Orthognathic Surgery
21244 21215 Orthognathic Surgery
21247 21215 Orthognathic Surgery
21208 21230 Cosmetic & Reconstructive
21248 21230 Cosmetic & Reconstructive
21249 21230 Cosmetic & Reconstructive
21255 21230 Cosmetic & Reconstructive
21256 21230 Cosmetic & Reconstructive
21260 21230 Cosmetic & Reconstructive
21261 21230 Cosmetic & Reconstructive
21263 21230 Cosmetic & Reconstructive
21267 21230 Cosmetic & Reconstructive
21268 21230 Cosmetic & Reconstructive
21270 21230 Cosmetic & Reconstructive
21275 21230 Cosmetic & Reconstructive
21208 21235 Cosmetic & Reconstructive
21209 21235 Cosmetic & Reconstructive
21230 21235 Cosmetic & Reconstructive
21248 21235 Cosmetic & Reconstructive
21249 21235 Cosmetic & Reconstructive
21255 21235 Cosmetic & Reconstructive
21256 21235 Cosmetic & Reconstructive
21260 21235 Cosmetic & Reconstructive
21261 21235 Cosmetic & Reconstructive
21263 21235 Cosmetic & Reconstructive
21267 21235 Cosmetic & Reconstructive
21268 21235 Cosmetic & Reconstructive
21270 21235 Cosmetic & Reconstructive
21275 21235 Cosmetic & Reconstructive
21280 21235 Cosmetic & Reconstructive
21240 21242 Orthognathic Surgery
21193 21244 Orthognathic Surgery
21194 21244 Orthognathic Surgery
Page 5 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
21195 21244 Orthognathic Surgery
21196 21244 Orthognathic Surgery
21198 21244 Orthognathic Surgery
21206 21244 Orthognathic Surgery
21247 21244 Orthognathic Surgery
21193 21245 Orthognathic Surgery
21194 21245 Orthognathic Surgery
21195 21245 Orthognathic Surgery
21196 21245 Orthognathic Surgery
21198 21245 Orthognathic Surgery
21199 21245 Orthognathic Surgery
21206 21245 Orthognathic Surgery
21215 21245 Orthognathic Surgery
21244 21245 Orthognathic Surgery
21246 21245 Orthognathic Surgery
21247 21245 Orthognathic Surgery
21193 21246 Orthognathic Surgery
21194 21246 Orthognathic Surgery
21195 21246 Orthognathic Surgery
21196 21246 Orthognathic Surgery
21198 21246 Orthognathic Surgery
21199 21246 Orthognathic Surgery
21206 21246 Orthognathic Surgery
21215 21246 Orthognathic Surgery
21244 21246 Orthognathic Surgery
21245 21246 Orthognathic Surgery
21247 21246 Orthognathic Surgery
21249 21248 Orthognathic Surgery
21255 21248 Orthognathic Surgery
21256 21248 Orthognathic Surgery
21260 21248 Orthognathic Surgery
21261 21248 Orthognathic Surgery
21263 21248 Orthognathic Surgery
21267 21248 Orthognathic Surgery
21268 21248 Orthognathic Surgery
21255 21249 Orthognathic Surgery
21260 21249 Orthognathic Surgery
21261 21249 Orthognathic Surgery
21263 21249 Orthognathic Surgery
21267 21249 Orthognathic Surgery
21268 21249 Orthognathic Surgery
21261 21255 Orthognathic Surgery
21263 21255 Orthognathic Surgery
21267 21255 Orthognathic Surgery
21268 21255 Orthognathic Surgery
21249 21256 Cosmetic & Reconstructive
21255 21256 Cosmetic & Reconstructive
21260 21256 Cosmetic & Reconstructive
21261 21256 Cosmetic & Reconstructive
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
21263 21256 Cosmetic & Reconstructive
21267 21256 Cosmetic & Reconstructive
21268 21256 Cosmetic & Reconstructive
21255 21260 Cosmetic & Reconstructive
21261 21260 Cosmetic & Reconstructive
21263 21260 Cosmetic & Reconstructive
21267 21260 Cosmetic & Reconstructive
21268 21260 Cosmetic & Reconstructive
21261 21263 Cosmetic & Reconstructive
21261 21267 Cosmetic & Reconstructive
21263 21267 Cosmetic & Reconstructive
21268 21267 Cosmetic & Reconstructive
21261 21268 Cosmetic & Reconstructive
21263 21268 Cosmetic & Reconstructive
21208 21275 Cosmetic & Reconstructive
21248 21275 Cosmetic & Reconstructive
21249 21275 Cosmetic & Reconstructive
21255 21275 Cosmetic & Reconstructive
21256 21275 Cosmetic & Reconstructive
21260 21275 Cosmetic & Reconstructive
21261 21275 Cosmetic & Reconstructive
21263 21275 Cosmetic & Reconstructive
21267 21275 Cosmetic & Reconstructive
21268 21275 Cosmetic & Reconstructive
21208 21280 Cosmetic & Reconstructive
21209 21280 Cosmetic & Reconstructive
21230 21280 Cosmetic & Reconstructive
21248 21280 Cosmetic & Reconstructive
21249 21280 Cosmetic & Reconstructive
21255 21280 Cosmetic & Reconstructive
21256 21280 Cosmetic & Reconstructive
21260 21280 Cosmetic & Reconstructive
21261 21280 Cosmetic & Reconstructive
21263 21280 Cosmetic & Reconstructive
21267 21280 Cosmetic & Reconstructive
21268 21280 Cosmetic & Reconstructive
21270 21280 Cosmetic & Reconstructive
21275 21280 Cosmetic & Reconstructive
21208 21282 Cosmetic & Reconstructive
21209 21282 Cosmetic & Reconstructive
21230 21282 Cosmetic & Reconstructive
21235 21282 Cosmetic & Reconstructive
21248 21282 Cosmetic & Reconstructive
21249 21282 Cosmetic & Reconstructive
21255 21282 Cosmetic & Reconstructive
21256 21282 Cosmetic & Reconstructive
21260 21282 Cosmetic & Reconstructive
21261 21282 Cosmetic & Reconstructive
21263 21282 Cosmetic & Reconstructive
Page 6 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
21267 21282 Cosmetic & Reconstructive
21268 21282 Cosmetic & Reconstructive
21270 21282 Cosmetic & Reconstructive
21275 21282 Cosmetic & Reconstructive
21280 21282 Cosmetic & Reconstructive
21296 21282 Cosmetic & Reconstructive
21208 21295 Cosmetic & Reconstructive
21209 21295 Cosmetic & Reconstructive
21230 21295 Cosmetic & Reconstructive
21235 21295 Cosmetic & Reconstructive
21248 21295 Cosmetic & Reconstructive
21249 21295 Cosmetic & Reconstructive
21255 21295 Cosmetic & Reconstructive
21256 21295 Cosmetic & Reconstructive
21260 21295 Cosmetic & Reconstructive
21261 21295 Cosmetic & Reconstructive
21263 21295 Cosmetic & Reconstructive
21267 21295 Cosmetic & Reconstructive
21268 21295 Cosmetic & Reconstructive
21270 21295 Cosmetic & Reconstructive
21275 21295 Cosmetic & Reconstructive
21280 21295 Cosmetic & Reconstructive
21282 21295 Cosmetic & Reconstructive
21296 21295 Cosmetic & Reconstructive
21208 21296 Orthognathic Surgery
21209 21296 Orthognathic Surgery
21230 21296 Orthognathic Surgery
21235 21296 Orthognathic Surgery
21248 21296 Orthognathic Surgery
21249 21296 Orthognathic Surgery
21255 21296 Orthognathic Surgery
21256 21296 Orthognathic Surgery
21260 21296 Orthognathic Surgery
21261 21296 Orthognathic Surgery
21263 21296 Orthognathic Surgery
21267 21296 Orthognathic Surgery
21268 21296 Orthognathic Surgery
21270 21296 Orthognathic Surgery
21275 21296 Orthognathic Surgery
21280 21296 Orthognathic Surgery
30140 21320 Site of Service (SOS) OPH to ASC
30520 21320 Site of Service (SOS) OPH to ASC
69436 21320 Site of Service (SOS) OPH to ASC
69631 21320 Site of Service (SOS) OPH to ASC
21931 21552 Site of Service (SOS) OPH to ASC
22110 22100 Spine Surgery
22112 22101 Spine Surgery
22114 22102 Spine Surgery
22804 22212 Spine Surgery
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
22206 22212 Spine Surgery
22222 22212 Spine Surgery
22633 22214 Spine Surgery
22207 22214 Spine Surgery
22224 22214 Spine Surgery
22210 22220 Spine Surgery
22207 22224 Spine Surgery
22510 22512 Spine Surgery
22511 22512 Spine Surgery
22513 22515 Spine Surgery
22514 22515 Spine Surgery
22633 22533 Spine Surgery
22532 22534 Spine Surgery
22533 22534 Spine Surgery
14301 22551 Spine Surgery
22548 22551 Spine Surgery
22551 22552 Spine Surgery
22548 22554 Spine Surgery
22551 22554 Spine Surgery
22590 22554 Spine Surgery
22595 22554 Spine Surgery
22600 22554 Spine Surgery
22532 22556 Spine Surgery
22533 22558 Spine Surgery
22612 22558 Spine Surgery
22630 22558 Spine Surgery
22633 22558 Spine Surgery
22554 22585 Spine Surgery
22556 22585 Spine Surgery
22558 22585 Spine Surgery
22548 22590 Spine Surgery
22551 22590 Spine Surgery
22548 22595 Spine Surgery
22551 22595 Spine Surgery
22590 22595 Spine Surgery
63051 22600 Spine Surgery
22548 22600 Spine Surgery
22551 22600 Spine Surgery
22590 22600 Spine Surgery
22595 22600 Spine Surgery
22532 22610 Spine Surgery
22556 22610 Spine Surgery
22533 22612 Spine Surgery
22633 22612 Spine Surgery
22600 22614 Spine Surgery
22610 22614 Spine Surgery
22612 22614 Spine Surgery
22630 22614 Spine Surgery
22633 22614 Spine Surgery
Page 7 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
22533 22630 Spine Surgery
22612 22630 Spine Surgery
22633 22630 Spine Surgery
22612 22632 Spine Surgery
22614 22632 Spine Surgery
22630 22632 Spine Surgery
22633 22632 Spine Surgery
22634 22632 Spine Surgery
22612 22634 Spine Surgery
22630 22634 Spine Surgery
22633 22634 Spine Surgery
22802 22800 Spine Surgery
22804 22800 Spine Surgery
22808 22800 Spine Surgery
22810 22800 Spine Surgery
22812 22800 Spine Surgery
22804 22802 Spine Surgery
22812 22802 Spine Surgery
22802 22808 Spine Surgery
22804 22808 Spine Surgery
22810 22808 Spine Surgery
22812 22808 Spine Surgery
22802 22810 Spine Surgery
22804 22810 Spine Surgery
22812 22810 Spine Surgery
22804 22812 Spine Surgery
22819 22818 Spine Surgery
22100 22840 Spine Surgery
22101 22840 Spine Surgery
22102 22840 Spine Surgery
22110 22840 Spine Surgery
22112 22840 Spine Surgery
22114 22840 Spine Surgery
22206 22840 Spine Surgery
22207 22840 Spine Surgery
22210 22840 Spine Surgery
22212 22840 Spine Surgery
22214 22840 Spine Surgery
22220 22840 Spine Surgery
22222 22840 Spine Surgery
22224 22840 Spine Surgery
22318 22840 Spine Surgery
22319 22840 Spine Surgery
22325 22840 Spine Surgery
22326 22840 Spine Surgery
22327 22840 Spine Surgery
22532 22840 Spine Surgery
22533 22840 Spine Surgery
22548 22840 Spine Surgery
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
22551 22840 Spine Surgery
22554 22840 Spine Surgery
22556 22840 Spine Surgery
22558 22840 Spine Surgery
22590 22840 Spine Surgery
22595 22840 Spine Surgery
22600 22840 Spine Surgery
22610 22840 Spine Surgery
22612 22840 Spine Surgery
22630 22840 Spine Surgery
22633 22840 Spine Surgery
22800 22840 Spine Surgery
22802 22840 Spine Surgery
22804 22840 Spine Surgery
22808 22840 Spine Surgery
22810 22840 Spine Surgery
22812 22840 Spine Surgery
63001 22840 Spine Surgery
63003 22840 Spine Surgery
63005 22840 Spine Surgery
63011 22840 Spine Surgery
63012 22840 Spine Surgery
63015 22840 Spine Surgery
63016 22840 Spine Surgery
63017 22840 Spine Surgery
63020 22840 Spine Surgery
63030 22840 Spine Surgery
63040 22840 Spine Surgery
63042 22840 Spine Surgery
63045 22840 Spine Surgery
63046 22840 Spine Surgery
63047 22840 Spine Surgery
63050 22840 Spine Surgery
63051 22840 Spine Surgery
63055 22840 Spine Surgery
63056 22840 Spine Surgery
63064 22840 Spine Surgery
63075 22840 Spine Surgery
63077 22840 Spine Surgery
63081 22840 Spine Surgery
63085 22840 Spine Surgery
63087 22840 Spine Surgery
63090 22840 Spine Surgery
63101 22840 Spine Surgery
63102 22840 Spine Surgery
63170 22840 Spine Surgery
63172 22840 Spine Surgery
63173 22840 Spine Surgery
63180 22840 Spine Surgery
Page 8 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
63182 22840 Spine Surgery
63185 22840 Spine Surgery
63190 22840 Spine Surgery
63191 22840 Spine Surgery
63194 22840 Spine Surgery
63195 22840 Spine Surgery
63196 22840 Spine Surgery
63197 22840 Spine Surgery
63198 22840 Spine Surgery
63199 22840 Spine Surgery
63200 22840 Spine Surgery
63250 22840 Spine Surgery
63251 22840 Spine Surgery
63252 22840 Spine Surgery
63265 22840 Spine Surgery
63266 22840 Spine Surgery
63267 22840 Spine Surgery
63268 22840 Spine Surgery
63270 22840 Spine Surgery
63271 22840 Spine Surgery
63272 22840 Spine Surgery
63273 22840 Spine Surgery
63275 22840 Spine Surgery
63276 22840 Spine Surgery
63277 22840 Spine Surgery
63278 22840 Spine Surgery
63280 22840 Spine Surgery
63281 22840 Spine Surgery
63282 22840 Spine Surgery
63283 22840 Spine Surgery
63285 22840 Spine Surgery
63286 22840 Spine Surgery
63287 22840 Spine Surgery
63290 22840 Spine Surgery
63300 22840 Spine Surgery
63301 22840 Spine Surgery
63302 22840 Spine Surgery
63303 22840 Spine Surgery
63304 22840 Spine Surgery
63305 22840 Spine Surgery
63306 22840 Spine Surgery
63307 22840 Spine Surgery
22843 22842 Spine Surgery
22100 22842 Spine Surgery
22101 22842 Spine Surgery
22102 22842 Spine Surgery
22110 22842 Spine Surgery
22112 22842 Spine Surgery
22114 22842 Spine Surgery
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
22206 22842 Spine Surgery
22207 22842 Spine Surgery
22210 22842 Spine Surgery
22212 22842 Spine Surgery
22214 22842 Spine Surgery
22220 22842 Spine Surgery
22222 22842 Spine Surgery
22224 22842 Spine Surgery
22318 22842 Spine Surgery
22319 22842 Spine Surgery
22325 22842 Spine Surgery
22326 22842 Spine Surgery
22327 22842 Spine Surgery
22532 22842 Spine Surgery
22533 22842 Spine Surgery
22548 22842 Spine Surgery
22551 22842 Spine Surgery
22554 22842 Spine Surgery
22556 22842 Spine Surgery
22558 22842 Spine Surgery
22590 22842 Spine Surgery
22595 22842 Spine Surgery
22600 22842 Spine Surgery
22610 22842 Spine Surgery
22612 22842 Spine Surgery
22630 22842 Spine Surgery
22633 22842 Spine Surgery
22800 22842 Spine Surgery
22802 22842 Spine Surgery
22804 22842 Spine Surgery
22808 22842 Spine Surgery
22810 22842 Spine Surgery
22812 22842 Spine Surgery
63001 22842 Spine Surgery
63003 22842 Spine Surgery
63005 22842 Spine Surgery
63011 22842 Spine Surgery
63012 22842 Spine Surgery
63015 22842 Spine Surgery
63016 22842 Spine Surgery
63017 22842 Spine Surgery
63020 22842 Spine Surgery
63030 22842 Spine Surgery
63040 22842 Spine Surgery
63042 22842 Spine Surgery
63045 22842 Spine Surgery
63046 22842 Spine Surgery
63047 22842 Spine Surgery
63050 22842 Spine Surgery
Page 9 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
63051 22842 Spine Surgery
63055 22842 Spine Surgery
63056 22842 Spine Surgery
63064 22842 Spine Surgery
63075 22842 Spine Surgery
63077 22842 Spine Surgery
63081 22842 Spine Surgery
63085 22842 Spine Surgery
63087 22842 Spine Surgery
63090 22842 Spine Surgery
63101 22842 Spine Surgery
63102 22842 Spine Surgery
63170 22842 Spine Surgery
63172 22842 Spine Surgery
63173 22842 Spine Surgery
63180 22842 Spine Surgery
63182 22842 Spine Surgery
63185 22842 Spine Surgery
63190 22842 Spine Surgery
63191 22842 Spine Surgery
63194 22842 Spine Surgery
63195 22842 Spine Surgery
63196 22842 Spine Surgery
63197 22842 Spine Surgery
63198 22842 Spine Surgery
63199 22842 Spine Surgery
63200 22842 Spine Surgery
63250 22842 Spine Surgery
63251 22842 Spine Surgery
63252 22842 Spine Surgery
63265 22842 Spine Surgery
63266 22842 Spine Surgery
63267 22842 Spine Surgery
63268 22842 Spine Surgery
63270 22842 Spine Surgery
63271 22842 Spine Surgery
63272 22842 Spine Surgery
63273 22842 Spine Surgery
63275 22842 Spine Surgery
63276 22842 Spine Surgery
63277 22842 Spine Surgery
63278 22842 Spine Surgery
63280 22842 Spine Surgery
63281 22842 Spine Surgery
63282 22842 Spine Surgery
63283 22842 Spine Surgery
63285 22842 Spine Surgery
63286 22842 Spine Surgery
63287 22842 Spine Surgery
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
63290 22842 Spine Surgery
63300 22842 Spine Surgery
63301 22842 Spine Surgery
63302 22842 Spine Surgery
63303 22842 Spine Surgery
63304 22842 Spine Surgery
63305 22842 Spine Surgery
63306 22842 Spine Surgery
63307 22842 Spine Surgery
22100 22843 Spine Surgery
22101 22843 Spine Surgery
22110 22843 Spine Surgery
22112 22843 Spine Surgery
22114 22843 Spine Surgery
22206 22843 Spine Surgery
22207 22843 Spine Surgery
22210 22843 Spine Surgery
22212 22843 Spine Surgery
22214 22843 Spine Surgery
22220 22843 Spine Surgery
22222 22843 Spine Surgery
22224 22843 Spine Surgery
22318 22843 Spine Surgery
22319 22843 Spine Surgery
22325 22843 Spine Surgery
22326 22843 Spine Surgery
22327 22843 Spine Surgery
22532 22843 Spine Surgery
22533 22843 Spine Surgery
22548 22843 Spine Surgery
22551 22843 Spine Surgery
22554 22843 Spine Surgery
22556 22843 Spine Surgery
22558 22843 Spine Surgery
22590 22843 Spine Surgery
22595 22843 Spine Surgery
22600 22843 Spine Surgery
22610 22843 Spine Surgery
22612 22843 Spine Surgery
22630 22843 Spine Surgery
22633 22843 Spine Surgery
22800 22843 Spine Surgery
22802 22843 Spine Surgery
22804 22843 Spine Surgery
22808 22843 Spine Surgery
22810 22843 Spine Surgery
22812 22843 Spine Surgery
63001 22843 Spine Surgery
63003 22843 Spine Surgery
Page 10 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
63005 22843 Spine Surgery
63011 22843 Spine Surgery
63012 22843 Spine Surgery
63015 22843 Spine Surgery
63016 22843 Spine Surgery
63017 22843 Spine Surgery
63020 22843 Spine Surgery
63030 22843 Spine Surgery
63040 22843 Spine Surgery
63042 22843 Spine Surgery
63045 22843 Spine Surgery
63046 22843 Spine Surgery
63047 22843 Spine Surgery
63050 22843 Spine Surgery
63051 22843 Spine Surgery
63055 22843 Spine Surgery
63056 22843 Spine Surgery
63064 22843 Spine Surgery
63075 22843 Spine Surgery
63077 22843 Spine Surgery
63081 22843 Spine Surgery
63085 22843 Spine Surgery
63087 22843 Spine Surgery
63090 22843 Spine Surgery
63101 22843 Spine Surgery
63102 22843 Spine Surgery
63170 22843 Spine Surgery
63172 22843 Spine Surgery
63173 22843 Spine Surgery
63180 22843 Spine Surgery
63182 22843 Spine Surgery
63185 22843 Spine Surgery
63190 22843 Spine Surgery
63191 22843 Spine Surgery
63194 22843 Spine Surgery
63195 22843 Spine Surgery
63196 22843 Spine Surgery
63197 22843 Spine Surgery
63198 22843 Spine Surgery
63199 22843 Spine Surgery
63200 22843 Spine Surgery
63250 22843 Spine Surgery
63251 22843 Spine Surgery
63252 22843 Spine Surgery
63265 22843 Spine Surgery
63266 22843 Spine Surgery
63267 22843 Spine Surgery
63268 22843 Spine Surgery
63270 22843 Spine Surgery
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
63271 22843 Spine Surgery
63272 22843 Spine Surgery
63273 22843 Spine Surgery
63275 22843 Spine Surgery
63276 22843 Spine Surgery
63277 22843 Spine Surgery
63278 22843 Spine Surgery
63280 22843 Spine Surgery
63281 22843 Spine Surgery
63282 22843 Spine Surgery
63283 22843 Spine Surgery
63285 22843 Spine Surgery
63286 22843 Spine Surgery
63287 22843 Spine Surgery
63290 22843 Spine Surgery
63300 22843 Spine Surgery
63301 22843 Spine Surgery
63302 22843 Spine Surgery
63303 22843 Spine Surgery
63304 22843 Spine Surgery
63305 22843 Spine Surgery
63306 22843 Spine Surgery
63307 22843 Spine Surgery
22110 22844 Spine Surgery
22112 22844 Spine Surgery
22114 22844 Spine Surgery
22206 22844 Spine Surgery
22207 22844 Spine Surgery
22210 22844 Spine Surgery
22212 22844 Spine Surgery
22214 22844 Spine Surgery
22220 22844 Spine Surgery
22222 22844 Spine Surgery
22224 22844 Spine Surgery
22318 22844 Spine Surgery
22319 22844 Spine Surgery
22325 22844 Spine Surgery
22326 22844 Spine Surgery
22327 22844 Spine Surgery
22532 22844 Spine Surgery
22533 22844 Spine Surgery
22548 22844 Spine Surgery
22551 22844 Spine Surgery
22554 22844 Spine Surgery
22556 22844 Spine Surgery
22558 22844 Spine Surgery
22590 22844 Spine Surgery
22595 22844 Spine Surgery
22600 22844 Spine Surgery
Page 11 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
22610 22844 Spine Surgery
22612 22844 Spine Surgery
22630 22844 Spine Surgery
22633 22844 Spine Surgery
22800 22844 Spine Surgery
22802 22844 Spine Surgery
22804 22844 Spine Surgery
22808 22844 Spine Surgery
22810 22844 Spine Surgery
22812 22844 Spine Surgery
63001 22844 Spine Surgery
63003 22844 Spine Surgery
63005 22844 Spine Surgery
63011 22844 Spine Surgery
63012 22844 Spine Surgery
63015 22844 Spine Surgery
63016 22844 Spine Surgery
63017 22844 Spine Surgery
63020 22844 Spine Surgery
63040 22844 Spine Surgery
63042 22844 Spine Surgery
63045 22844 Spine Surgery
63046 22844 Spine Surgery
63047 22844 Spine Surgery
63050 22844 Spine Surgery
63051 22844 Spine Surgery
63055 22844 Spine Surgery
63056 22844 Spine Surgery
63064 22844 Spine Surgery
63075 22844 Spine Surgery
63077 22844 Spine Surgery
63081 22844 Spine Surgery
63085 22844 Spine Surgery
63087 22844 Spine Surgery
63090 22844 Spine Surgery
63101 22844 Spine Surgery
63102 22844 Spine Surgery
63170 22844 Spine Surgery
63172 22844 Spine Surgery
63173 22844 Spine Surgery
63180 22844 Spine Surgery
63182 22844 Spine Surgery
63185 22844 Spine Surgery
63190 22844 Spine Surgery
63191 22844 Spine Surgery
63194 22844 Spine Surgery
63195 22844 Spine Surgery
63196 22844 Spine Surgery
63197 22844 Spine Surgery
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
63198 22844 Spine Surgery
63199 22844 Spine Surgery
63200 22844 Spine Surgery
63250 22844 Spine Surgery
63251 22844 Spine Surgery
63252 22844 Spine Surgery
63265 22844 Spine Surgery
63266 22844 Spine Surgery
63267 22844 Spine Surgery
63268 22844 Spine Surgery
63270 22844 Spine Surgery
63271 22844 Spine Surgery
63272 22844 Spine Surgery
63273 22844 Spine Surgery
63275 22844 Spine Surgery
63276 22844 Spine Surgery
63277 22844 Spine Surgery
63278 22844 Spine Surgery
63280 22844 Spine Surgery
63281 22844 Spine Surgery
63282 22844 Spine Surgery
63283 22844 Spine Surgery
63285 22844 Spine Surgery
63286 22844 Spine Surgery
63287 22844 Spine Surgery
63290 22844 Spine Surgery
63300 22844 Spine Surgery
63301 22844 Spine Surgery
63302 22844 Spine Surgery
63303 22844 Spine Surgery
63304 22844 Spine Surgery
63305 22844 Spine Surgery
63306 22844 Spine Surgery
63307 22844 Spine Surgery
22100 22845 Spine Surgery
22101 22845 Spine Surgery
22102 22845 Spine Surgery
22110 22845 Spine Surgery
22112 22845 Spine Surgery
22114 22845 Spine Surgery
22206 22845 Spine Surgery
22207 22845 Spine Surgery
22210 22845 Spine Surgery
22212 22845 Spine Surgery
22214 22845 Spine Surgery
22220 22845 Spine Surgery
22222 22845 Spine Surgery
22224 22845 Spine Surgery
22318 22845 Spine Surgery
Page 12 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
22319 22845 Spine Surgery
22325 22845 Spine Surgery
22326 22845 Spine Surgery
22327 22845 Spine Surgery
22532 22845 Spine Surgery
22533 22845 Spine Surgery
22548 22845 Spine Surgery
22551 22845 Spine Surgery
22554 22845 Spine Surgery
22556 22845 Spine Surgery
22558 22845 Spine Surgery
22590 22845 Spine Surgery
22595 22845 Spine Surgery
22600 22845 Spine Surgery
22610 22845 Spine Surgery
22612 22845 Spine Surgery
22630 22845 Spine Surgery
22633 22845 Spine Surgery
22800 22845 Spine Surgery
22802 22845 Spine Surgery
22804 22845 Spine Surgery
22808 22845 Spine Surgery
22810 22845 Spine Surgery
22812 22845 Spine Surgery
63001 22845 Spine Surgery
63003 22845 Spine Surgery
63005 22845 Spine Surgery
63011 22845 Spine Surgery
63012 22845 Spine Surgery
63015 22845 Spine Surgery
63016 22845 Spine Surgery
63017 22845 Spine Surgery
63020 22845 Spine Surgery
63030 22845 Spine Surgery
63040 22845 Spine Surgery
63042 22845 Spine Surgery
63045 22845 Spine Surgery
63046 22845 Spine Surgery
63047 22845 Spine Surgery
63050 22845 Spine Surgery
63051 22845 Spine Surgery
63055 22845 Spine Surgery
63056 22845 Spine Surgery
63064 22845 Spine Surgery
63075 22845 Spine Surgery
63077 22845 Spine Surgery
63081 22845 Spine Surgery
63085 22845 Spine Surgery
63087 22845 Spine Surgery
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
63090 22845 Spine Surgery
63101 22845 Spine Surgery
63102 22845 Spine Surgery
63170 22845 Spine Surgery
63172 22845 Spine Surgery
63173 22845 Spine Surgery
63180 22845 Spine Surgery
63182 22845 Spine Surgery
63185 22845 Spine Surgery
63190 22845 Spine Surgery
63191 22845 Spine Surgery
63194 22845 Spine Surgery
63195 22845 Spine Surgery
63196 22845 Spine Surgery
63197 22845 Spine Surgery
63198 22845 Spine Surgery
63199 22845 Spine Surgery
63200 22845 Spine Surgery
63250 22845 Spine Surgery
63251 22845 Spine Surgery
63252 22845 Spine Surgery
63265 22845 Spine Surgery
63266 22845 Spine Surgery
63267 22845 Spine Surgery
63268 22845 Spine Surgery
63270 22845 Spine Surgery
63271 22845 Spine Surgery
63272 22845 Spine Surgery
63273 22845 Spine Surgery
63275 22845 Spine Surgery
63276 22845 Spine Surgery
63277 22845 Spine Surgery
63278 22845 Spine Surgery
63280 22845 Spine Surgery
63281 22845 Spine Surgery
63282 22845 Spine Surgery
63283 22845 Spine Surgery
63285 22845 Spine Surgery
63286 22845 Spine Surgery
63287 22845 Spine Surgery
63290 22845 Spine Surgery
63300 22845 Spine Surgery
63301 22845 Spine Surgery
63302 22845 Spine Surgery
63303 22845 Spine Surgery
63304 22845 Spine Surgery
63305 22845 Spine Surgery
63306 22845 Spine Surgery
63307 22845 Spine Surgery
Page 13 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
22100 22846 Spine Surgery
22101 22846 Spine Surgery
22102 22846 Spine Surgery
22110 22846 Spine Surgery
22112 22846 Spine Surgery
22114 22846 Spine Surgery
22206 22846 Spine Surgery
22207 22846 Spine Surgery
22210 22846 Spine Surgery
22212 22846 Spine Surgery
22214 22846 Spine Surgery
22220 22846 Spine Surgery
22222 22846 Spine Surgery
22224 22846 Spine Surgery
22318 22846 Spine Surgery
22319 22846 Spine Surgery
22325 22846 Spine Surgery
22326 22846 Spine Surgery
22327 22846 Spine Surgery
22532 22846 Spine Surgery
22533 22846 Spine Surgery
22548 22846 Spine Surgery
22551 22846 Spine Surgery
22554 22846 Spine Surgery
22556 22846 Spine Surgery
22558 22846 Spine Surgery
22590 22846 Spine Surgery
22595 22846 Spine Surgery
22600 22846 Spine Surgery
22610 22846 Spine Surgery
22612 22846 Spine Surgery
22630 22846 Spine Surgery
22633 22846 Spine Surgery
22800 22846 Spine Surgery
22802 22846 Spine Surgery
22804 22846 Spine Surgery
22808 22846 Spine Surgery
22810 22846 Spine Surgery
22812 22846 Spine Surgery
63001 22846 Spine Surgery
63003 22846 Spine Surgery
63005 22846 Spine Surgery
63011 22846 Spine Surgery
63012 22846 Spine Surgery
63015 22846 Spine Surgery
63016 22846 Spine Surgery
63017 22846 Spine Surgery
63020 22846 Spine Surgery
63030 22846 Spine Surgery
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
63040 22846 Spine Surgery
63042 22846 Spine Surgery
63045 22846 Spine Surgery
63046 22846 Spine Surgery
63047 22846 Spine Surgery
63050 22846 Spine Surgery
63051 22846 Spine Surgery
63055 22846 Spine Surgery
63056 22846 Spine Surgery
63064 22846 Spine Surgery
63075 22846 Spine Surgery
63077 22846 Spine Surgery
63081 22846 Spine Surgery
63085 22846 Spine Surgery
63087 22846 Spine Surgery
63090 22846 Spine Surgery
63101 22846 Spine Surgery
63102 22846 Spine Surgery
63170 22846 Spine Surgery
63172 22846 Spine Surgery
63173 22846 Spine Surgery
63180 22846 Spine Surgery
63182 22846 Spine Surgery
63185 22846 Spine Surgery
63190 22846 Spine Surgery
63191 22846 Spine Surgery
63194 22846 Spine Surgery
63195 22846 Spine Surgery
63196 22846 Spine Surgery
63197 22846 Spine Surgery
63198 22846 Spine Surgery
63199 22846 Spine Surgery
63200 22846 Spine Surgery
63250 22846 Spine Surgery
63251 22846 Spine Surgery
63252 22846 Spine Surgery
63265 22846 Spine Surgery
63266 22846 Spine Surgery
63267 22846 Spine Surgery
63268 22846 Spine Surgery
63270 22846 Spine Surgery
63271 22846 Spine Surgery
63272 22846 Spine Surgery
63273 22846 Spine Surgery
63275 22846 Spine Surgery
63276 22846 Spine Surgery
63277 22846 Spine Surgery
63278 22846 Spine Surgery
63280 22846 Spine Surgery
Page 14 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
63281 22846 Spine Surgery
63282 22846 Spine Surgery
63283 22846 Spine Surgery
63285 22846 Spine Surgery
63286 22846 Spine Surgery
63287 22846 Spine Surgery
63290 22846 Spine Surgery
63300 22846 Spine Surgery
63301 22846 Spine Surgery
63302 22846 Spine Surgery
63303 22846 Spine Surgery
63304 22846 Spine Surgery
63305 22846 Spine Surgery
63306 22846 Spine Surgery
63307 22846 Spine Surgery
22100 22847 Spine Surgery
22101 22847 Spine Surgery
22110 22847 Spine Surgery
22112 22847 Spine Surgery
22114 22847 Spine Surgery
22206 22847 Spine Surgery
22207 22847 Spine Surgery
22210 22847 Spine Surgery
22212 22847 Spine Surgery
22214 22847 Spine Surgery
22220 22847 Spine Surgery
22222 22847 Spine Surgery
22224 22847 Spine Surgery
22318 22847 Spine Surgery
22319 22847 Spine Surgery
22325 22847 Spine Surgery
22326 22847 Spine Surgery
22327 22847 Spine Surgery
22532 22847 Spine Surgery
22533 22847 Spine Surgery
22548 22847 Spine Surgery
22551 22847 Spine Surgery
22554 22847 Spine Surgery
22556 22847 Spine Surgery
22558 22847 Spine Surgery
22590 22847 Spine Surgery
22595 22847 Spine Surgery
22600 22847 Spine Surgery
22610 22847 Spine Surgery
22612 22847 Spine Surgery
22630 22847 Spine Surgery
22633 22847 Spine Surgery
22800 22847 Spine Surgery
22802 22847 Spine Surgery
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
22804 22847 Spine Surgery
22808 22847 Spine Surgery
22810 22847 Spine Surgery
22812 22847 Spine Surgery
63001 22847 Spine Surgery
63003 22847 Spine Surgery
63005 22847 Spine Surgery
63011 22847 Spine Surgery
63012 22847 Spine Surgery
63015 22847 Spine Surgery
63016 22847 Spine Surgery
63017 22847 Spine Surgery
63020 22847 Spine Surgery
63030 22847 Spine Surgery
63040 22847 Spine Surgery
63042 22847 Spine Surgery
63045 22847 Spine Surgery
63046 22847 Spine Surgery
63047 22847 Spine Surgery
63050 22847 Spine Surgery
63051 22847 Spine Surgery
63055 22847 Spine Surgery
63056 22847 Spine Surgery
63064 22847 Spine Surgery
63075 22847 Spine Surgery
63077 22847 Spine Surgery
63081 22847 Spine Surgery
63085 22847 Spine Surgery
63087 22847 Spine Surgery
63090 22847 Spine Surgery
63101 22847 Spine Surgery
63102 22847 Spine Surgery
63170 22847 Spine Surgery
63172 22847 Spine Surgery
63173 22847 Spine Surgery
63180 22847 Spine Surgery
63182 22847 Spine Surgery
63185 22847 Spine Surgery
63190 22847 Spine Surgery
63191 22847 Spine Surgery
63194 22847 Spine Surgery
63195 22847 Spine Surgery
63196 22847 Spine Surgery
63197 22847 Spine Surgery
63198 22847 Spine Surgery
63199 22847 Spine Surgery
63200 22847 Spine Surgery
63250 22847 Spine Surgery
63251 22847 Spine Surgery
Page 15 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
63252 22847 Spine Surgery
63265 22847 Spine Surgery
63266 22847 Spine Surgery
63267 22847 Spine Surgery
63268 22847 Spine Surgery
63270 22847 Spine Surgery
63271 22847 Spine Surgery
63272 22847 Spine Surgery
63273 22847 Spine Surgery
63275 22847 Spine Surgery
63276 22847 Spine Surgery
63277 22847 Spine Surgery
63278 22847 Spine Surgery
63280 22847 Spine Surgery
63281 22847 Spine Surgery
63282 22847 Spine Surgery
63283 22847 Spine Surgery
63285 22847 Spine Surgery
63286 22847 Spine Surgery
63287 22847 Spine Surgery
63290 22847 Spine Surgery
63300 22847 Spine Surgery
63301 22847 Spine Surgery
63302 22847 Spine Surgery
63303 22847 Spine Surgery
63304 22847 Spine Surgery
63305 22847 Spine Surgery
63306 22847 Spine Surgery
63307 22847 Spine Surgery
22100 22848 Spine Surgery
22101 22848 Spine Surgery
22102 22848 Spine Surgery
22110 22848 Spine Surgery
22112 22848 Spine Surgery
22114 22848 Spine Surgery
22206 22848 Spine Surgery
22207 22848 Spine Surgery
22210 22848 Spine Surgery
22212 22848 Spine Surgery
22214 22848 Spine Surgery
22220 22848 Spine Surgery
22222 22848 Spine Surgery
22224 22848 Spine Surgery
22318 22848 Spine Surgery
22319 22848 Spine Surgery
22325 22848 Spine Surgery
22326 22848 Spine Surgery
22327 22848 Spine Surgery
22532 22848 Spine Surgery
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
22533 22848 Spine Surgery
22548 22848 Spine Surgery
22551 22848 Spine Surgery
22552 22848 Spine Surgery
22554 22848 Spine Surgery
22556 22848 Spine Surgery
22558 22848 Spine Surgery
22590 22848 Spine Surgery
22595 22848 Spine Surgery
22600 22848 Spine Surgery
22610 22848 Spine Surgery
22612 22848 Spine Surgery
22630 22848 Spine Surgery
22633 22848 Spine Surgery
22634 22848 Spine Surgery
22800 22848 Spine Surgery
22802 22848 Spine Surgery
22804 22848 Spine Surgery
22808 22848 Spine Surgery
22810 22848 Spine Surgery
22812 22848 Spine Surgery
63001 22848 Spine Surgery
63003 22848 Spine Surgery
63005 22848 Spine Surgery
63011 22848 Spine Surgery
63012 22848 Spine Surgery
63015 22848 Spine Surgery
63016 22848 Spine Surgery
63017 22848 Spine Surgery
63020 22848 Spine Surgery
63030 22848 Spine Surgery
63040 22848 Spine Surgery
63042 22848 Spine Surgery
63045 22848 Spine Surgery
63046 22848 Spine Surgery
63047 22848 Spine Surgery
63050 22848 Spine Surgery
63051 22848 Spine Surgery
63055 22848 Spine Surgery
63056 22848 Spine Surgery
63064 22848 Spine Surgery
63075 22848 Spine Surgery
63077 22848 Spine Surgery
63081 22848 Spine Surgery
63085 22848 Spine Surgery
63087 22848 Spine Surgery
63090 22848 Spine Surgery
63101 22848 Spine Surgery
63102 22848 Spine Surgery
Page 16 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
63170 22848 Spine Surgery
63172 22848 Spine Surgery
63173 22848 Spine Surgery
63180 22848 Spine Surgery
63182 22848 Spine Surgery
63185 22848 Spine Surgery
63190 22848 Spine Surgery
63191 22848 Spine Surgery
63194 22848 Spine Surgery
63195 22848 Spine Surgery
63196 22848 Spine Surgery
63197 22848 Spine Surgery
63198 22848 Spine Surgery
63199 22848 Spine Surgery
63200 22848 Spine Surgery
63250 22848 Spine Surgery
63251 22848 Spine Surgery
63252 22848 Spine Surgery
63265 22848 Spine Surgery
63266 22848 Spine Surgery
63267 22848 Spine Surgery
63268 22848 Spine Surgery
63270 22848 Spine Surgery
63271 22848 Spine Surgery
63272 22848 Spine Surgery
63273 22848 Spine Surgery
63275 22848 Spine Surgery
63276 22848 Spine Surgery
63277 22848 Spine Surgery
63278 22848 Spine Surgery
63280 22848 Spine Surgery
63281 22848 Spine Surgery
63282 22848 Spine Surgery
63283 22848 Spine Surgery
63285 22848 Spine Surgery
63286 22848 Spine Surgery
63287 22848 Spine Surgery
63290 22848 Spine Surgery
63300 22848 Spine Surgery
63301 22848 Spine Surgery
63302 22848 Spine Surgery
63303 22848 Spine Surgery
63304 22848 Spine Surgery
63305 22848 Spine Surgery
63306 22848 Spine Surgery
63307 22848 Spine Surgery
22850 22852 Spine Surgery
22854 22853 Spine Surgery
22859 22853 Spine Surgery
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
22100 22853 Spine Surgery
22101 22853 Spine Surgery
22102 22853 Spine Surgery
22110 22853 Spine Surgery
22112 22853 Spine Surgery
22114 22853 Spine Surgery
22206 22853 Spine Surgery
22207 22853 Spine Surgery
22210 22853 Spine Surgery
22212 22853 Spine Surgery
22214 22853 Spine Surgery
22220 22853 Spine Surgery
22222 22853 Spine Surgery
22224 22853 Spine Surgery
22318 22853 Spine Surgery
22319 22853 Spine Surgery
22325 22853 Spine Surgery
22326 22853 Spine Surgery
22327 22853 Spine Surgery
22532 22853 Spine Surgery
22533 22853 Spine Surgery
22548 22853 Spine Surgery
22551 22853 Spine Surgery
22552 22853 Spine Surgery
22554 22853 Spine Surgery
22556 22853 Spine Surgery
22558 22853 Spine Surgery
22590 22853 Spine Surgery
22595 22853 Spine Surgery
22600 22853 Spine Surgery
22610 22853 Spine Surgery
22612 22853 Spine Surgery
22630 22853 Spine Surgery
22633 22853 Spine Surgery
22634 22853 Spine Surgery
22800 22853 Spine Surgery
22802 22853 Spine Surgery
22804 22853 Spine Surgery
22808 22853 Spine Surgery
22810 22853 Spine Surgery
22812 22853 Spine Surgery
63001 22853 Spine Surgery
63003 22853 Spine Surgery
63005 22853 Spine Surgery
63011 22853 Spine Surgery
63012 22853 Spine Surgery
63015 22853 Spine Surgery
63016 22853 Spine Surgery
63017 22853 Spine Surgery
Page 17 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
63020 22853 Spine Surgery
63030 22853 Spine Surgery
63040 22853 Spine Surgery
63042 22853 Spine Surgery
63045 22853 Spine Surgery
63046 22853 Spine Surgery
63047 22853 Spine Surgery
63050 22853 Spine Surgery
63051 22853 Spine Surgery
63055 22853 Spine Surgery
63056 22853 Spine Surgery
63064 22853 Spine Surgery
63075 22853 Spine Surgery
63077 22853 Spine Surgery
63081 22853 Spine Surgery
63085 22853 Spine Surgery
63087 22853 Spine Surgery
63090 22853 Spine Surgery
63101 22853 Spine Surgery
63102 22853 Spine Surgery
63170 22853 Spine Surgery
63172 22853 Spine Surgery
63173 22853 Spine Surgery
63180 22853 Spine Surgery
63182 22853 Spine Surgery
63185 22853 Spine Surgery
63190 22853 Spine Surgery
63191 22853 Spine Surgery
63194 22853 Spine Surgery
63195 22853 Spine Surgery
63196 22853 Spine Surgery
63197 22853 Spine Surgery
63198 22853 Spine Surgery
63199 22853 Spine Surgery
63200 22853 Spine Surgery
63250 22853 Spine Surgery
63251 22853 Spine Surgery
63252 22853 Spine Surgery
63265 22853 Spine Surgery
63266 22853 Spine Surgery
63267 22853 Spine Surgery
63268 22853 Spine Surgery
63270 22853 Spine Surgery
63271 22853 Spine Surgery
63272 22853 Spine Surgery
63273 22853 Spine Surgery
63275 22853 Spine Surgery
63276 22853 Spine Surgery
63277 22853 Spine Surgery
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
63278 22853 Spine Surgery
63280 22853 Spine Surgery
63281 22853 Spine Surgery
63282 22853 Spine Surgery
63283 22853 Spine Surgery
63285 22853 Spine Surgery
63286 22853 Spine Surgery
63287 22853 Spine Surgery
63290 22853 Spine Surgery
63300 22853 Spine Surgery
63301 22853 Spine Surgery
63302 22853 Spine Surgery
63303 22853 Spine Surgery
63304 22853 Spine Surgery
63305 22853 Spine Surgery
63306 22853 Spine Surgery
63307 22853 Spine Surgery
22859 22854 Spine Surgery
22100 22854 Spine Surgery
22101 22854 Spine Surgery
22102 22854 Spine Surgery
22110 22854 Spine Surgery
22112 22854 Spine Surgery
22114 22854 Spine Surgery
22206 22854 Spine Surgery
22207 22854 Spine Surgery
22210 22854 Spine Surgery
22212 22854 Spine Surgery
22214 22854 Spine Surgery
22220 22854 Spine Surgery
22222 22854 Spine Surgery
22224 22854 Spine Surgery
22318 22854 Spine Surgery
22319 22854 Spine Surgery
22325 22854 Spine Surgery
22326 22854 Spine Surgery
22327 22854 Spine Surgery
22532 22854 Spine Surgery
22533 22854 Spine Surgery
22548 22854 Spine Surgery
22551 22854 Spine Surgery
22552 22854 Spine Surgery
22554 22854 Spine Surgery
22556 22854 Spine Surgery
22558 22854 Spine Surgery
22590 22854 Spine Surgery
22595 22854 Spine Surgery
22600 22854 Spine Surgery
22610 22854 Spine Surgery
Page 18 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
22612 22854 Spine Surgery
22630 22854 Spine Surgery
22633 22854 Spine Surgery
22634 22854 Spine Surgery
22800 22854 Spine Surgery
22802 22854 Spine Surgery
22804 22854 Spine Surgery
22808 22854 Spine Surgery
22810 22854 Spine Surgery
22812 22854 Spine Surgery
63001 22854 Spine Surgery
63003 22854 Spine Surgery
63005 22854 Spine Surgery
63011 22854 Spine Surgery
63012 22854 Spine Surgery
63015 22854 Spine Surgery
63016 22854 Spine Surgery
63017 22854 Spine Surgery
63020 22854 Spine Surgery
63030 22854 Spine Surgery
63040 22854 Spine Surgery
63042 22854 Spine Surgery
63045 22854 Spine Surgery
63046 22854 Spine Surgery
63047 22854 Spine Surgery
63050 22854 Spine Surgery
63051 22854 Spine Surgery
63055 22854 Spine Surgery
63056 22854 Spine Surgery
63064 22854 Spine Surgery
63075 22854 Spine Surgery
63077 22854 Spine Surgery
63081 22854 Spine Surgery
63085 22854 Spine Surgery
63087 22854 Spine Surgery
63090 22854 Spine Surgery
63101 22854 Spine Surgery
63102 22854 Spine Surgery
63170 22854 Spine Surgery
63172 22854 Spine Surgery
63173 22854 Spine Surgery
63180 22854 Spine Surgery
63182 22854 Spine Surgery
63185 22854 Spine Surgery
63190 22854 Spine Surgery
63191 22854 Spine Surgery
63194 22854 Spine Surgery
63195 22854 Spine Surgery
63196 22854 Spine Surgery
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
63197 22854 Spine Surgery
63198 22854 Spine Surgery
63199 22854 Spine Surgery
63200 22854 Spine Surgery
63250 22854 Spine Surgery
63251 22854 Spine Surgery
63252 22854 Spine Surgery
63265 22854 Spine Surgery
63266 22854 Spine Surgery
63267 22854 Spine Surgery
63268 22854 Spine Surgery
63270 22854 Spine Surgery
63271 22854 Spine Surgery
63272 22854 Spine Surgery
63273 22854 Spine Surgery
63275 22854 Spine Surgery
63276 22854 Spine Surgery
63277 22854 Spine Surgery
63278 22854 Spine Surgery
63280 22854 Spine Surgery
63281 22854 Spine Surgery
63282 22854 Spine Surgery
63283 22854 Spine Surgery
63285 22854 Spine Surgery
63286 22854 Spine Surgery
63287 22854 Spine Surgery
63290 22854 Spine Surgery
63300 22854 Spine Surgery
63301 22854 Spine Surgery
63302 22854 Spine Surgery
63303 22854 Spine Surgery
63304 22854 Spine Surgery
63305 22854 Spine Surgery
63306 22854 Spine Surgery
63307 22854 Spine Surgery
22861 22856 Spine Surgery
22864 22856 Spine Surgery
22862 22857 Spine Surgery
22865 22857 Spine Surgery
22856 22858 Spine Surgery
22854 22859 Spine Surgery
22100 22859 Spine Surgery
22101 22859 Spine Surgery
22102 22859 Spine Surgery
22110 22859 Spine Surgery
22112 22859 Spine Surgery
22114 22859 Spine Surgery
22206 22859 Spine Surgery
22207 22859 Spine Surgery
Page 19 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
22210 22859 Spine Surgery
22212 22859 Spine Surgery
22214 22859 Spine Surgery
22220 22859 Spine Surgery
22222 22859 Spine Surgery
22224 22859 Spine Surgery
22318 22859 Spine Surgery
22319 22859 Spine Surgery
22325 22859 Spine Surgery
22326 22859 Spine Surgery
22327 22859 Spine Surgery
22532 22859 Spine Surgery
22533 22859 Spine Surgery
22548 22859 Spine Surgery
22551 22859 Spine Surgery
22552 22859 Spine Surgery
22554 22859 Spine Surgery
22556 22859 Spine Surgery
22558 22859 Spine Surgery
22590 22859 Spine Surgery
22595 22859 Spine Surgery
22600 22859 Spine Surgery
22610 22859 Spine Surgery
22612 22859 Spine Surgery
22630 22859 Spine Surgery
22633 22859 Spine Surgery
22634 22859 Spine Surgery
22800 22859 Spine Surgery
22802 22859 Spine Surgery
22804 22859 Spine Surgery
22808 22859 Spine Surgery
22810 22859 Spine Surgery
22812 22859 Spine Surgery
63001 22859 Spine Surgery
63003 22859 Spine Surgery
63005 22859 Spine Surgery
63011 22859 Spine Surgery
63012 22859 Spine Surgery
63015 22859 Spine Surgery
63016 22859 Spine Surgery
63017 22859 Spine Surgery
63020 22859 Spine Surgery
63030 22859 Spine Surgery
63040 22859 Spine Surgery
63042 22859 Spine Surgery
63045 22859 Spine Surgery
63046 22859 Spine Surgery
63047 22859 Spine Surgery
63050 22859 Spine Surgery
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
63051 22859 Spine Surgery
63055 22859 Spine Surgery
63056 22859 Spine Surgery
63064 22859 Spine Surgery
63075 22859 Spine Surgery
63077 22859 Spine Surgery
63081 22859 Spine Surgery
63085 22859 Spine Surgery
63087 22859 Spine Surgery
63090 22859 Spine Surgery
63101 22859 Spine Surgery
63102 22859 Spine Surgery
63170 22859 Spine Surgery
63172 22859 Spine Surgery
63173 22859 Spine Surgery
63180 22859 Spine Surgery
63182 22859 Spine Surgery
63185 22859 Spine Surgery
63190 22859 Spine Surgery
63191 22859 Spine Surgery
63194 22859 Spine Surgery
63195 22859 Spine Surgery
63196 22859 Spine Surgery
63197 22859 Spine Surgery
63198 22859 Spine Surgery
63199 22859 Spine Surgery
63200 22859 Spine Surgery
63250 22859 Spine Surgery
63251 22859 Spine Surgery
63252 22859 Spine Surgery
63265 22859 Spine Surgery
63266 22859 Spine Surgery
63267 22859 Spine Surgery
63268 22859 Spine Surgery
63270 22859 Spine Surgery
63271 22859 Spine Surgery
63272 22859 Spine Surgery
63273 22859 Spine Surgery
63275 22859 Spine Surgery
63276 22859 Spine Surgery
63277 22859 Spine Surgery
63278 22859 Spine Surgery
63280 22859 Spine Surgery
63281 22859 Spine Surgery
63282 22859 Spine Surgery
63283 22859 Spine Surgery
63285 22859 Spine Surgery
63286 22859 Spine Surgery
63287 22859 Spine Surgery
Page 20 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
63290 22859 Spine Surgery
63300 22859 Spine Surgery
63301 22859 Spine Surgery
63302 22859 Spine Surgery
63303 22859 Spine Surgery
63304 22859 Spine Surgery
63305 22859 Spine Surgery
63306 22859 Spine Surgery
63307 22859 Spine Surgery
22864 22861 Spine Surgery
22861 22864 Spine Surgery
22862 22865 Spine Surgery
23472 23470 Arthroplasty
23473 23470 Arthroplasty
23474 23470 Arthroplasty
23473 23472 Arthroplasty
23474 23472 Arthroplasty
23474 23473 Arthroplasty
24361 24360 Arthroplasty
24362 24360 Arthroplasty
24363 24360 Arthroplasty
24370 24360 Arthroplasty
24371 24360 Arthroplasty
24362 24361 Arthroplasty
24363 24361 Arthroplasty
24370 24361 Arthroplasty
24371 24361 Arthroplasty
24363 24362 Arthroplasty
24370 24362 Arthroplasty
24371 24362 Arthroplasty
24370 24363 Arthroplasty
24371 24363 Arthroplasty
24371 24370 Arthroplasty
64493 27096 Site of Service (SOS) Office Based Programs
64494 27096 Site of Service (SOS) Office Based Programs
64495 27096 Site of Service (SOS) Office Based Programs
27130 27120 Arthroplasty
27132 27120 Arthroplasty
27134 27120 Arthroplasty
27137 27120 Arthroplasty
27138 27120 Arthroplasty
27120 27122 Arthroplasty
27125 27122 Arthroplasty
27130 27122 Arthroplasty
27132 27122 Arthroplasty
27134 27122 Arthroplasty
27137 27122 Arthroplasty
27138 27122 Arthroplasty
27120 27125 Arthroplasty
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
27130 27125 Arthroplasty
27132 27125 Arthroplasty
27134 27125 Arthroplasty
27137 27125 Arthroplasty
27138 27125 Arthroplasty
27132 27130 Arthroplasty
27134 27130 Arthroplasty
27137 27130 Arthroplasty
27138 27130 Arthroplasty
27134 27132 Arthroplasty
27132 27137 Arthroplasty
27134 27137 Arthroplasty
27138 27137 Arthroplasty
27132 27138 Arthroplasty
27134 27138 Arthroplasty
27280 27279 Spine Surgery
J7330 27412 Cartilage Implants
27438 27437 Arthroplasty
27440 27437 Arthroplasty
27441 27437 Arthroplasty
27442 27437 Arthroplasty
27443 27437 Arthroplasty
27445 27437 Arthroplasty
27446 27437 Arthroplasty
27447 27437 Arthroplasty
27486 27437 Arthroplasty
27487 27437 Arthroplasty
27442 27438 Arthroplasty
27445 27438 Arthroplasty
27446 27438 Arthroplasty
27447 27438 Arthroplasty
27486 27438 Arthroplasty
27487 27438 Arthroplasty
27438 27440 Arthroplasty
27441 27440 Arthroplasty
27442 27440 Arthroplasty
27443 27440 Arthroplasty
27445 27440 Arthroplasty
27446 27440 Arthroplasty
27447 27440 Arthroplasty
27486 27440 Arthroplasty
27487 27440 Arthroplasty
27438 27441 Arthroplasty
27442 27441 Arthroplasty
27445 27441 Arthroplasty
27446 27441 Arthroplasty
27447 27441 Arthroplasty
27486 27441 Arthroplasty
27487 27441 Arthroplasty
Page 21 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
27445 27442 Arthroplasty
27446 27442 Arthroplasty
27447 27442 Arthroplasty
27486 27442 Arthroplasty
27487 27442 Arthroplasty
27438 27443 Arthroplasty
27441 27443 Arthroplasty
27442 27443 Arthroplasty
27445 27443 Arthroplasty
27446 27443 Arthroplasty
27447 27443 Arthroplasty
27486 27443 Arthroplasty
27487 27443 Arthroplasty
27447 27445 Arthroplasty
27486 27445 Arthroplasty
27487 27445 Arthroplasty
27445 27446 Arthroplasty
27447 27446 Arthroplasty
27486 27446 Arthroplasty
27487 27446 Arthroplasty
27486 27447 Arthroplasty
27487 27447 Arthroplasty
27487 27486 Arthroplasty
28291 28289 Foot Surgery
28296 28292 Foot Surgery
28297 28292 Foot Surgery
28298 28292 Foot Surgery
28293 28292 Foot Surgery
28299 28292 Foot Surgery
28297 28296 Foot Surgery
28299 28296 Foot Surgery
28296 28298 Foot Surgery
28297 28298 Foot Surgery
28299 28298 Foot Surgery
28297 28299 Foot Surgery
29806 29805 Arthroscopy
29807 29805 Arthroscopy
29819 29805 Arthroscopy
29820 29805 Arthroscopy
29821 29805 Arthroscopy
29822 29805 Arthroscopy
29823 29805 Arthroscopy
29824 29805 Arthroscopy
29825 29805 Arthroscopy
29827 29805 Arthroscopy
29828 29805 Arthroscopy
29806 29807 Arthroscopy
29827 29807 Arthroscopy
29806 29819 Arthroscopy
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
29807 29819 Arthroscopy
29823 29819 Arthroscopy
29824 29819 Arthroscopy
29827 29819 Arthroscopy
29828 29819 Arthroscopy
29806 29820 Arthroscopy
29807 29820 Arthroscopy
29819 29820 Arthroscopy
29821 29820 Arthroscopy
29822 29820 Arthroscopy
29823 29820 Arthroscopy
29824 29820 Arthroscopy
29825 29820 Arthroscopy
29827 29820 Arthroscopy
29828 29820 Arthroscopy
29806 29821 Arthroscopy
29807 29821 Arthroscopy
29819 29821 Arthroscopy
29823 29821 Arthroscopy
29824 29821 Arthroscopy
29827 29821 Arthroscopy
29828 29821 Arthroscopy
29806 29822 Arthroscopy
29807 29822 Arthroscopy
29819 29822 Arthroscopy
29821 29822 Arthroscopy
29823 29822 Arthroscopy
29824 29822 Arthroscopy
29825 29822 Arthroscopy
29827 29822 Arthroscopy
29828 29822 Arthroscopy
29806 29823 Arthroscopy
29807 29823 Arthroscopy
29824 29823 Arthroscopy
29827 29823 Arthroscopy
29828 29823 Arthroscopy
29806 29824 Arthroscopy
29807 29824 Arthroscopy
29827 29824 Arthroscopy
29828 29824 Arthroscopy
29806 29825 Arthroscopy
29807 29825 Arthroscopy
29819 29825 Arthroscopy
29821 29825 Arthroscopy
29823 29825 Arthroscopy
29824 29825 Arthroscopy
29827 29825 Arthroscopy
29828 29825 Arthroscopy
29805 29826 Arthroscopy
Page 22 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
29806 29826 Arthroscopy
29807 29826 Arthroscopy
29819 29826 Arthroscopy
29820 29826 Arthroscopy
29821 29826 Arthroscopy
29822 29826 Arthroscopy
29823 29826 Arthroscopy
29824 29826 Arthroscopy
29825 29826 Arthroscopy
29827 29826 Arthroscopy
29828 29826 Arthroscopy
29806 29827 Arthroscopy
29806 29828 Arthroscopy
29807 29828 Arthroscopy
29827 29828 Arthroscopy
29834 29830 Arthroscopy
29835 29830 Arthroscopy
29836 29830 Arthroscopy
29837 29830 Arthroscopy
29838 29830 Arthroscopy
29835 29834 Arthroscopy
29836 29834 Arthroscopy
29837 29834 Arthroscopy
29838 29834 Arthroscopy
29836 29835 Arthroscopy
29837 29835 Arthroscopy
29838 29835 Arthroscopy
29838 29836 Arthroscopy
29836 29837 Arthroscopy
29838 29837 Arthroscopy
29843 29840 Arthroscopy
29844 29840 Arthroscopy
29845 29840 Arthroscopy
29846 29840 Arthroscopy
29847 29840 Arthroscopy
29848 29840 Arthroscopy
29844 29843 Arthroscopy
29845 29843 Arthroscopy
29846 29843 Arthroscopy
29847 29843 Arthroscopy
29848 29843 Arthroscopy
29845 29844 Arthroscopy
29846 29844 Arthroscopy
29847 29844 Arthroscopy
29848 29844 Arthroscopy
29845 29846 Arthroscopy
29847 29846 Arthroscopy
29845 29847 Arthroscopy
29845 29848 Arthroscopy
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
29846 29848 Arthroscopy
29847 29848 Arthroscopy
29861 29860 Arthroscopy
29862 29860 Arthroscopy
29863 29860 Arthroscopy
29914 29860 Arthroscopy
29915 29860 Arthroscopy
29916 29860 Arthroscopy
29862 29861 Arthroscopy
29863 29861 Arthroscopy
29914 29861 Arthroscopy
29915 29861 Arthroscopy
29916 29861 Arthroscopy
29914 29862 Arthroscopy
29915 29862 Arthroscopy
29916 29862 Arthroscopy
29862 29863 Arthroscopy
29914 29863 Arthroscopy
29915 29863 Arthroscopy
29916 29863 Arthroscopy
29867 29866 Cartilage Implants
29868 29866 Cartilage Implants
29868 29867 Cartilage Implants
29871 29870 Arthroscopy
29873 29870 Arthroscopy
29874 29870 Arthroscopy
29875 29870 Arthroscopy
29876 29870 Arthroscopy
29877 29870 Arthroscopy
29879 29870 Arthroscopy
29880 29870 Arthroscopy
29881 29870 Arthroscopy
29882 29870 Arthroscopy
29883 29870 Arthroscopy
29884 29870 Arthroscopy
29885 29870 Arthroscopy
29886 29870 Arthroscopy
29887 29870 Arthroscopy
29888 29870 Arthroscopy
29889 29870 Arthroscopy
29873 29871 Arthroscopy
29874 29871 Arthroscopy
29876 29871 Arthroscopy
29877 29871 Arthroscopy
29879 29871 Arthroscopy
29880 29871 Arthroscopy
29881 29871 Arthroscopy
29882 29871 Arthroscopy
29883 29871 Arthroscopy
Page 23 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
29884 29871 Arthroscopy
29885 29871 Arthroscopy
29886 29871 Arthroscopy
29887 29871 Arthroscopy
29888 29871 Arthroscopy
29889 29871 Arthroscopy
29874 29873 Arthroscopy
29876 29873 Arthroscopy
29877 29873 Arthroscopy
29879 29873 Arthroscopy
29880 29873 Arthroscopy
29881 29873 Arthroscopy
29882 29873 Arthroscopy
29883 29873 Arthroscopy
29884 29873 Arthroscopy
29885 29873 Arthroscopy
29886 29873 Arthroscopy
29887 29873 Arthroscopy
29888 29873 Arthroscopy
29889 29873 Arthroscopy
29876 29874 Arthroscopy
29877 29874 Arthroscopy
29879 29874 Arthroscopy
29880 29874 Arthroscopy
29881 29874 Arthroscopy
29882 29874 Arthroscopy
29883 29874 Arthroscopy
29884 29874 Arthroscopy
29885 29874 Arthroscopy
29886 29874 Arthroscopy
29887 29874 Arthroscopy
29888 29874 Arthroscopy
29889 29874 Arthroscopy
29871 29875 Arthroscopy
29873 29875 Arthroscopy
29874 29875 Arthroscopy
29876 29875 Arthroscopy
29877 29875 Arthroscopy
29879 29875 Arthroscopy
29880 29875 Arthroscopy
29881 29875 Arthroscopy
29882 29875 Arthroscopy
29883 29875 Arthroscopy
29884 29875 Arthroscopy
29885 29875 Arthroscopy
29886 29875 Arthroscopy
29887 29875 Arthroscopy
29888 29875 Arthroscopy
29889 29875 Arthroscopy
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
29879 29876 Arthroscopy
29882 29876 Arthroscopy
29883 29876 Arthroscopy
29885 29876 Arthroscopy
29887 29876 Arthroscopy
29888 29876 Arthroscopy
29889 29876 Arthroscopy
29876 29877 Arthroscopy
29879 29877 Arthroscopy
29882 29877 Arthroscopy
29883 29877 Arthroscopy
29885 29877 Arthroscopy
29886 29877 Arthroscopy
29887 29877 Arthroscopy
29888 29877 Arthroscopy
29889 29877 Arthroscopy
29882 29879 Arthroscopy
29883 29879 Arthroscopy
29885 29879 Arthroscopy
29887 29879 Arthroscopy
29888 29879 Arthroscopy
29889 29879 Arthroscopy
29876 29880 Arthroscopy
29877 29880 Arthroscopy
29879 29880 Arthroscopy
29882 29880 Arthroscopy
29883 29880 Arthroscopy
29884 29880 Arthroscopy
29885 29880 Arthroscopy
29886 29880 Arthroscopy
29887 29880 Arthroscopy
29888 29880 Arthroscopy
29889 29880 Arthroscopy
29876 29881 Arthroscopy
29877 29881 Arthroscopy
29879 29881 Arthroscopy
29880 29881 Arthroscopy
29882 29881 Arthroscopy
29883 29881 Arthroscopy
29884 29881 Arthroscopy
29885 29881 Arthroscopy
29886 29881 Arthroscopy
29887 29881 Arthroscopy
29888 29881 Arthroscopy
29889 29881 Arthroscopy
29883 29882 Arthroscopy
29885 29882 Arthroscopy
29887 29882 Arthroscopy
29888 29882 Arthroscopy
Page 24 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
29889 29882 Arthroscopy
29888 29883 Arthroscopy
29889 29883 Arthroscopy
29876 29884 Arthroscopy
29877 29884 Arthroscopy
29879 29884 Arthroscopy
29882 29884 Arthroscopy
29883 29884 Arthroscopy
29885 29884 Arthroscopy
29886 29884 Arthroscopy
29887 29884 Arthroscopy
29888 29884 Arthroscopy
29889 29884 Arthroscopy
29883 29885 Arthroscopy
29888 29885 Arthroscopy
29889 29885 Arthroscopy
29876 29886 Arthroscopy
29879 29886 Arthroscopy
29882 29886 Arthroscopy
29883 29886 Arthroscopy
29885 29886 Arthroscopy
29887 29886 Arthroscopy
29888 29886 Arthroscopy
29889 29886 Arthroscopy
29883 29887 Arthroscopy
29885 29887 Arthroscopy
29888 29887 Arthroscopy
29889 29887 Arthroscopy
29889 29888 Arthroscopy
29891 29892 Arthroscopy
29891 29893 Arthroscopy
29892 29893 Arthroscopy
29897 29894 Arthroscopy
29898 29894 Arthroscopy
29899 29894 Arthroscopy
29894 29895 Arthroscopy
29897 29895 Arthroscopy
29898 29895 Arthroscopy
29899 29895 Arthroscopy
29898 29897 Arthroscopy
29899 29897 Arthroscopy
29899 29898 Arthroscopy
29915 29914 Arthroscopy
29916 29914 Arthroscopy
29916 29915 Arthroscopy
21320 30140 Site of Service (SOS) OPH to ASC
30520 30140 Site of Service (SOS) OPH to ASC
30410 30400 Rhinoplasty
30420 30400 Rhinoplasty
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
30435 30400 Rhinoplasty
30450 30400 Rhinoplasty
30462 30400 Rhinoplasty
30420 30410 Rhinoplasty
30435 30410 Rhinoplasty
30450 30410 Rhinoplasty
30462 30410 Rhinoplasty
30450 30420 Rhinoplasty
30462 30420 Rhinoplasty
30400 30430 Rhinoplasty
30410 30430 Rhinoplasty
30420 30430 Rhinoplasty
30435 30430 Rhinoplasty
30450 30430 Rhinoplasty
30462 30430 Rhinoplasty
30410 30435 Rhinoplasty
30420 30435 Rhinoplasty
30450 30435 Rhinoplasty
30462 30435 Rhinoplasty
30400 30460 Rhinoplasty
30410 30460 Rhinoplasty
30420 30460 Rhinoplasty
30430 30460 Rhinoplasty
30435 30460 Rhinoplasty
30450 30460 Rhinoplasty
30462 30460 Rhinoplasty
30450 30462 Rhinoplasty
21320 30520 Site of Service (SOS) OPH to ASC
30140 30520 Site of Service (SOS) OPH to ASC
30465 30540 Cosmetic & Reconstructive
30545 30540 Cosmetic & Reconstructive
30465 30545 Cosmetic & Reconstructive
30465 30560 Cosmetic & Reconstructive
30540 30560 Cosmetic & Reconstructive
30545 30560 Cosmetic & Reconstructive
30620 30560 Cosmetic & Reconstructive
30465 30620 Cosmetic & Reconstructive
30540 30620 Cosmetic & Reconstructive
30545 30620 Cosmetic & Reconstructive
31239 31253 Functional Endoscopic Sinus Surgery (FESS)
31255 31254 Functional Endoscopic Sinus Surgery (FESS)
31239 31254 Functional Endoscopic Sinus Surgery (FESS)
31253 31254 Functional Endoscopic Sinus Surgery (FESS)
31257 31254 Functional Endoscopic Sinus Surgery (FESS)
31259 31254 Functional Endoscopic Sinus Surgery (FESS)
31239 31255 Functional Endoscopic Sinus Surgery (FESS)
31253 31255 Functional Endoscopic Sinus Surgery (FESS)
31257 31255 Functional Endoscopic Sinus Surgery (FESS)
31259 31255 Functional Endoscopic Sinus Surgery (FESS)
Page 25 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
31239 31256 Functional Endoscopic Sinus Surgery (FESS)
31267 31256 Functional Endoscopic Sinus Surgery (FESS)
31239 31257 Functional Endoscopic Sinus Surgery (FESS)
31239 31259 Functional Endoscopic Sinus Surgery (FESS)
31257 31259 Functional Endoscopic Sinus Surgery (FESS)
31239 31267 Functional Endoscopic Sinus Surgery (FESS)
31253 31276 Functional Endoscopic Sinus Surgery (FESS)
31239 31276 Functional Endoscopic Sinus Surgery (FESS)
31288 31287 Functional Endoscopic Sinus Surgery (FESS)
31239 31287 Functional Endoscopic Sinus Surgery (FESS)
31257 31287 Functional Endoscopic Sinus Surgery (FESS)
31259 31287 Functional Endoscopic Sinus Surgery (FESS)
31239 31288 Functional Endoscopic Sinus Surgery (FESS)
31257 31288 Functional Endoscopic Sinus Surgery (FESS)
31259 31288 Functional Endoscopic Sinus Surgery (FESS)
31296 31295 Sinuplasty
31298 31295 Sinuplasty
31298 31296 Sinuplasty
31295 31297 Sinuplasty
31296 31297 Sinuplasty
31298 31297 Sinuplasty
31575 31579 Site of Service (SOS) Office Based Programs
32852 32851 Optum Transplant - Lung
32854 32853 Optum Transplant - Lung
32856 32855 Services related to Transplant
33255 33251 Congenital Heart Disease
33256 33251 Congenital Heart Disease
33251 33254 Congenital Heart Disease
33255 33254 Congenital Heart Disease
33256 33254 Congenital Heart Disease
33261 33254 Congenital Heart Disease
33256 33255 Congenital Heart Disease
33258 33257 Congenital Heart Disease
33259 33257 Congenital Heart Disease
33251 33257 Congenital Heart Disease
33254 33257 Congenital Heart Disease
33255 33257 Congenital Heart Disease
33256 33257 Congenital Heart Disease
33261 33257 Congenital Heart Disease
33120 33257 Congenital Heart Disease
33130 33257 Congenital Heart Disease
33250 33257 Congenital Heart Disease
33300 33257 Congenital Heart Disease
33305 33257 Congenital Heart Disease
33310 33257 Congenital Heart Disease
33315 33257 Congenital Heart Disease
33320 33257 Congenital Heart Disease
33321 33257 Congenital Heart Disease
33322 33257 Congenital Heart Disease
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
33330 33257 Congenital Heart Disease
33335 33257 Congenital Heart Disease
33390 33257 Congenital Heart Disease
33391 33257 Congenital Heart Disease
33404 33257 Congenital Heart Disease
33405 33257 Congenital Heart Disease
33406 33257 Congenital Heart Disease
33410 33257 Congenital Heart Disease
33411 33257 Congenital Heart Disease
33412 33257 Congenital Heart Disease
33413 33257 Congenital Heart Disease
33414 33257 Congenital Heart Disease
33415 33257 Congenital Heart Disease
33416 33257 Congenital Heart Disease
33417 33257 Congenital Heart Disease
33420 33257 Congenital Heart Disease
33422 33257 Congenital Heart Disease
33425 33257 Congenital Heart Disease
33426 33257 Congenital Heart Disease
33427 33257 Congenital Heart Disease
33430 33257 Congenital Heart Disease
33460 33257 Congenital Heart Disease
33463 33257 Congenital Heart Disease
33464 33257 Congenital Heart Disease
33465 33257 Congenital Heart Disease
33468 33257 Congenital Heart Disease
33470 33257 Congenital Heart Disease
33471 33257 Congenital Heart Disease
33474 33257 Congenital Heart Disease
33475 33257 Congenital Heart Disease
33476 33257 Congenital Heart Disease
33478 33257 Congenital Heart Disease
33496 33257 Congenital Heart Disease
33500 33257 Congenital Heart Disease
33501 33257 Congenital Heart Disease
33502 33257 Congenital Heart Disease
33503 33257 Congenital Heart Disease
33504 33257 Congenital Heart Disease
33505 33257 Congenital Heart Disease
33506 33257 Congenital Heart Disease
33507 33257 Congenital Heart Disease
33510 33257 Congenital Heart Disease
33511 33257 Congenital Heart Disease
33512 33257 Congenital Heart Disease
33513 33257 Congenital Heart Disease
33514 33257 Congenital Heart Disease
33516 33257 Congenital Heart Disease
33533 33257 Congenital Heart Disease
33534 33257 Congenital Heart Disease
Page 26 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
33535 33257 Congenital Heart Disease
33536 33257 Congenital Heart Disease
33542 33257 Congenital Heart Disease
33545 33257 Congenital Heart Disease
33548 33257 Congenital Heart Disease
33600 33257 Congenital Heart Disease
33602 33257 Congenital Heart Disease
33606 33257 Congenital Heart Disease
33608 33257 Congenital Heart Disease
33610 33257 Congenital Heart Disease
33611 33257 Congenital Heart Disease
33612 33257 Congenital Heart Disease
33615 33257 Congenital Heart Disease
33617 33257 Congenital Heart Disease
33619 33257 Congenital Heart Disease
33641 33257 Congenital Heart Disease
33645 33257 Congenital Heart Disease
33647 33257 Congenital Heart Disease
33660 33257 Congenital Heart Disease
33665 33257 Congenital Heart Disease
33670 33257 Congenital Heart Disease
33675 33257 Congenital Heart Disease
33676 33257 Congenital Heart Disease
33677 33257 Congenital Heart Disease
33681 33257 Congenital Heart Disease
33684 33257 Congenital Heart Disease
33688 33257 Congenital Heart Disease
33690 33257 Congenital Heart Disease
33692 33257 Congenital Heart Disease
33694 33257 Congenital Heart Disease
33697 33257 Congenital Heart Disease
33702 33257 Congenital Heart Disease
33710 33257 Congenital Heart Disease
33720 33257 Congenital Heart Disease
33722 33257 Congenital Heart Disease
33724 33257 Congenital Heart Disease
33726 33257 Congenital Heart Disease
33730 33257 Congenital Heart Disease
33732 33257 Congenital Heart Disease
33735 33257 Congenital Heart Disease
33736 33257 Congenital Heart Disease
33737 33257 Congenital Heart Disease
33750 33257 Congenital Heart Disease
33755 33257 Congenital Heart Disease
33762 33257 Congenital Heart Disease
33764 33257 Congenital Heart Disease
33766 33257 Congenital Heart Disease
33767 33257 Congenital Heart Disease
33770 33257 Congenital Heart Disease
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
33771 33257 Congenital Heart Disease
33774 33257 Congenital Heart Disease
33775 33257 Congenital Heart Disease
33776 33257 Congenital Heart Disease
33777 33257 Congenital Heart Disease
33778 33257 Congenital Heart Disease
33779 33257 Congenital Heart Disease
33780 33257 Congenital Heart Disease
33781 33257 Congenital Heart Disease
33782 33257 Congenital Heart Disease
33783 33257 Congenital Heart Disease
33786 33257 Congenital Heart Disease
33788 33257 Congenital Heart Disease
33800 33257 Congenital Heart Disease
33802 33257 Congenital Heart Disease
33803 33257 Congenital Heart Disease
33813 33257 Congenital Heart Disease
33814 33257 Congenital Heart Disease
33840 33257 Congenital Heart Disease
33845 33257 Congenital Heart Disease
33851 33257 Congenital Heart Disease
33852 33257 Congenital Heart Disease
33853 33257 Congenital Heart Disease
33860 33257 Congenital Heart Disease
33863 33257 Congenital Heart Disease
33864 33257 Congenital Heart Disease
33870 33257 Congenital Heart Disease
33875 33257 Congenital Heart Disease
33877 33257 Congenital Heart Disease
33910 33257 Congenital Heart Disease
33915 33257 Congenital Heart Disease
33916 33257 Congenital Heart Disease
33917 33257 Congenital Heart Disease
33920 33257 Congenital Heart Disease
33922 33257 Congenital Heart Disease
33925 33257 Congenital Heart Disease
33926 33257 Congenital Heart Disease
33935 33257 Congenital Heart Disease
33945 33257 Congenital Heart Disease
33975 33257 Congenital Heart Disease
33976 33257 Congenital Heart Disease
33977 33257 Congenital Heart Disease
33978 33257 Congenital Heart Disease
33979 33257 Congenital Heart Disease
33980 33257 Congenital Heart Disease
33259 33258 Congenital Heart Disease
33251 33258 Congenital Heart Disease
33254 33258 Congenital Heart Disease
33255 33258 Congenital Heart Disease
Page 27 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
33256 33258 Congenital Heart Disease
33261 33258 Congenital Heart Disease
33130 33258 Congenital Heart Disease
33250 33258 Congenital Heart Disease
33300 33258 Congenital Heart Disease
33310 33258 Congenital Heart Disease
33320 33258 Congenital Heart Disease
33321 33258 Congenital Heart Disease
33330 33258 Congenital Heart Disease
33390 33258 Congenital Heart Disease
33391 33258 Congenital Heart Disease
33414 33258 Congenital Heart Disease
33415 33258 Congenital Heart Disease
33416 33258 Congenital Heart Disease
33417 33258 Congenital Heart Disease
33420 33258 Congenital Heart Disease
33470 33258 Congenital Heart Disease
33471 33258 Congenital Heart Disease
33501 33258 Congenital Heart Disease
33502 33258 Congenital Heart Disease
33503 33258 Congenital Heart Disease
33510 33258 Congenital Heart Disease
33511 33258 Congenital Heart Disease
33512 33258 Congenital Heart Disease
33513 33258 Congenital Heart Disease
33514 33258 Congenital Heart Disease
33516 33258 Congenital Heart Disease
33533 33258 Congenital Heart Disease
33534 33258 Congenital Heart Disease
33535 33258 Congenital Heart Disease
33536 33258 Congenital Heart Disease
33690 33258 Congenital Heart Disease
33735 33258 Congenital Heart Disease
33737 33258 Congenital Heart Disease
33800 33258 Congenital Heart Disease
33802 33258 Congenital Heart Disease
33803 33258 Congenital Heart Disease
33813 33258 Congenital Heart Disease
33840 33258 Congenital Heart Disease
33845 33258 Congenital Heart Disease
33851 33258 Congenital Heart Disease
33852 33258 Congenital Heart Disease
33915 33258 Congenital Heart Disease
33925 33258 Congenital Heart Disease
33251 33259 Congenital Heart Disease
33254 33259 Congenital Heart Disease
33255 33259 Congenital Heart Disease
33256 33259 Congenital Heart Disease
33261 33259 Congenital Heart Disease
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
33120 33259 Congenital Heart Disease
33305 33259 Congenital Heart Disease
33315 33259 Congenital Heart Disease
33322 33259 Congenital Heart Disease
33335 33259 Congenital Heart Disease
33390 33259 Congenital Heart Disease
33391 33259 Congenital Heart Disease
33404 33259 Congenital Heart Disease
33405 33259 Congenital Heart Disease
33406 33259 Congenital Heart Disease
33410 33259 Congenital Heart Disease
33411 33259 Congenital Heart Disease
33412 33259 Congenital Heart Disease
33413 33259 Congenital Heart Disease
33422 33259 Congenital Heart Disease
33425 33259 Congenital Heart Disease
33426 33259 Congenital Heart Disease
33427 33259 Congenital Heart Disease
33430 33259 Congenital Heart Disease
33460 33259 Congenital Heart Disease
33463 33259 Congenital Heart Disease
33464 33259 Congenital Heart Disease
33465 33259 Congenital Heart Disease
33468 33259 Congenital Heart Disease
33474 33259 Congenital Heart Disease
33475 33259 Congenital Heart Disease
33476 33259 Congenital Heart Disease
33478 33259 Congenital Heart Disease
33496 33259 Congenital Heart Disease
33500 33259 Congenital Heart Disease
33504 33259 Congenital Heart Disease
33505 33259 Congenital Heart Disease
33506 33259 Congenital Heart Disease
33507 33259 Congenital Heart Disease
33510 33259 Congenital Heart Disease
33511 33259 Congenital Heart Disease
33512 33259 Congenital Heart Disease
33513 33259 Congenital Heart Disease
33514 33259 Congenital Heart Disease
33516 33259 Congenital Heart Disease
33533 33259 Congenital Heart Disease
33534 33259 Congenital Heart Disease
33535 33259 Congenital Heart Disease
33536 33259 Congenital Heart Disease
33542 33259 Congenital Heart Disease
33545 33259 Congenital Heart Disease
33548 33259 Congenital Heart Disease
33600 33259 Congenital Heart Disease
33602 33259 Congenital Heart Disease
Page 28 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
33606 33259 Congenital Heart Disease
33608 33259 Congenital Heart Disease
33610 33259 Congenital Heart Disease
33611 33259 Congenital Heart Disease
33612 33259 Congenital Heart Disease
33615 33259 Congenital Heart Disease
33617 33259 Congenital Heart Disease
33619 33259 Congenital Heart Disease
33620 33259 Congenital Heart Disease
33621 33259 Congenital Heart Disease
33622 33259 Congenital Heart Disease
33641 33259 Congenital Heart Disease
33645 33259 Congenital Heart Disease
33647 33259 Congenital Heart Disease
33660 33259 Congenital Heart Disease
33665 33259 Congenital Heart Disease
33670 33259 Congenital Heart Disease
33675 33259 Congenital Heart Disease
33676 33259 Congenital Heart Disease
33677 33259 Congenital Heart Disease
33681 33259 Congenital Heart Disease
33684 33259 Congenital Heart Disease
33688 33259 Congenital Heart Disease
33692 33259 Congenital Heart Disease
33694 33259 Congenital Heart Disease
33697 33259 Congenital Heart Disease
33702 33259 Congenital Heart Disease
33710 33259 Congenital Heart Disease
33720 33259 Congenital Heart Disease
33722 33259 Congenital Heart Disease
33730 33259 Congenital Heart Disease
33732 33259 Congenital Heart Disease
33736 33259 Congenital Heart Disease
33750 33259 Congenital Heart Disease
33755 33259 Congenital Heart Disease
33762 33259 Congenital Heart Disease
33764 33259 Congenital Heart Disease
33766 33259 Congenital Heart Disease
33767 33259 Congenital Heart Disease
33770 33259 Congenital Heart Disease
33771 33259 Congenital Heart Disease
33774 33259 Congenital Heart Disease
33775 33259 Congenital Heart Disease
33776 33259 Congenital Heart Disease
33777 33259 Congenital Heart Disease
33778 33259 Congenital Heart Disease
33779 33259 Congenital Heart Disease
33780 33259 Congenital Heart Disease
33781 33259 Congenital Heart Disease
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
33786 33259 Congenital Heart Disease
33788 33259 Congenital Heart Disease
33814 33259 Congenital Heart Disease
33853 33259 Congenital Heart Disease
33860 33259 Congenital Heart Disease
33863 33259 Congenital Heart Disease
33864 33259 Congenital Heart Disease
33870 33259 Congenital Heart Disease
33875 33259 Congenital Heart Disease
33877 33259 Congenital Heart Disease
33910 33259 Congenital Heart Disease
33916 33259 Congenital Heart Disease
33917 33259 Congenital Heart Disease
33920 33259 Congenital Heart Disease
33922 33259 Congenital Heart Disease
33926 33259 Congenital Heart Disease
33935 33259 Congenital Heart Disease
33945 33259 Congenital Heart Disease
33975 33259 Congenital Heart Disease
33976 33259 Congenital Heart Disease
33977 33259 Congenital Heart Disease
33978 33259 Congenital Heart Disease
33979 33259 Congenital Heart Disease
33980 33259 Congenital Heart Disease
33251 33261 Congenital Heart Disease
33255 33261 Congenital Heart Disease
33256 33261 Congenital Heart Disease
33362 33361 Potentially Unproven Services
33363 33361 Potentially Unproven Services
33364 33361 Potentially Unproven Services
33365 33361 Potentially Unproven Services
33366 33361 Potentially Unproven Services
33364 33362 Potentially Unproven Services
33365 33362 Potentially Unproven Services
33366 33362 Potentially Unproven Services
33364 33363 Potentially Unproven Services
33365 33363 Potentially Unproven Services
33366 33363 Potentially Unproven Services
33365 33364 Potentially Unproven Services
33366 33364 Potentially Unproven Services
33366 33365 Potentially Unproven Services
33361 33369 Potentially Unproven Services
33362 33369 Potentially Unproven Services
33363 33369 Potentially Unproven Services
33364 33369 Potentially Unproven Services
33365 33369 Potentially Unproven Services
33366 33369 Potentially Unproven Services
33418 33369 Potentially Unproven Services
33477 33369 Potentially Unproven Services
Page 29 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
33414 33415 Congenital Heart Disease
33414 33416 Congenital Heart Disease
33415 33416 Congenital Heart Disease
33414 33417 Congenital Heart Disease
33415 33417 Congenital Heart Disease
33416 33417 Congenital Heart Disease
33404 33476 Congenital Heart Disease
33478 33476 Congenital Heart Disease
33404 33478 Congenital Heart Disease
33505 33500 Congenital Heart Disease
33506 33500 Congenital Heart Disease
33507 33500 Congenital Heart Disease
33608 33500 Congenital Heart Disease
33610 33500 Congenital Heart Disease
33611 33500 Congenital Heart Disease
33612 33500 Congenital Heart Disease
33615 33500 Congenital Heart Disease
33617 33500 Congenital Heart Disease
33619 33500 Congenital Heart Disease
33641 33500 Congenital Heart Disease
33647 33500 Congenital Heart Disease
33660 33500 Congenital Heart Disease
33665 33500 Congenital Heart Disease
33670 33500 Congenital Heart Disease
33710 33500 Congenital Heart Disease
33726 33500 Congenital Heart Disease
33730 33500 Congenital Heart Disease
33732 33500 Congenital Heart Disease
33500 33501 Congenital Heart Disease
33502 33501 Congenital Heart Disease
33503 33501 Congenital Heart Disease
33504 33501 Congenital Heart Disease
33505 33501 Congenital Heart Disease
33506 33501 Congenital Heart Disease
33507 33501 Congenital Heart Disease
33608 33501 Congenital Heart Disease
33610 33501 Congenital Heart Disease
33611 33501 Congenital Heart Disease
33612 33501 Congenital Heart Disease
33615 33501 Congenital Heart Disease
33617 33501 Congenital Heart Disease
33619 33501 Congenital Heart Disease
33641 33501 Congenital Heart Disease
33647 33501 Congenital Heart Disease
33660 33501 Congenital Heart Disease
33665 33501 Congenital Heart Disease
33670 33501 Congenital Heart Disease
33702 33501 Congenital Heart Disease
33710 33501 Congenital Heart Disease
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
33720 33501 Congenital Heart Disease
33724 33501 Congenital Heart Disease
33726 33501 Congenital Heart Disease
33730 33501 Congenital Heart Disease
33732 33501 Congenital Heart Disease
33503 33502 Congenital Heart Disease
33500 33502 Congenital Heart Disease
33504 33502 Congenital Heart Disease
33505 33502 Congenital Heart Disease
33506 33502 Congenital Heart Disease
33507 33502 Congenital Heart Disease
33608 33502 Congenital Heart Disease
33610 33502 Congenital Heart Disease
33611 33502 Congenital Heart Disease
33612 33502 Congenital Heart Disease
33615 33502 Congenital Heart Disease
33617 33502 Congenital Heart Disease
33619 33502 Congenital Heart Disease
33641 33502 Congenital Heart Disease
33647 33502 Congenital Heart Disease
33660 33502 Congenital Heart Disease
33665 33502 Congenital Heart Disease
33670 33502 Congenital Heart Disease
33702 33502 Congenital Heart Disease
33710 33502 Congenital Heart Disease
33720 33502 Congenital Heart Disease
33724 33502 Congenital Heart Disease
33726 33502 Congenital Heart Disease
33730 33502 Congenital Heart Disease
33732 33502 Congenital Heart Disease
33504 33503 Congenital Heart Disease
33500 33503 Congenital Heart Disease
33505 33503 Congenital Heart Disease
33506 33503 Congenital Heart Disease
33507 33503 Congenital Heart Disease
33608 33503 Congenital Heart Disease
33610 33503 Congenital Heart Disease
33611 33503 Congenital Heart Disease
33612 33503 Congenital Heart Disease
33615 33503 Congenital Heart Disease
33617 33503 Congenital Heart Disease
33619 33503 Congenital Heart Disease
33641 33503 Congenital Heart Disease
33647 33503 Congenital Heart Disease
33660 33503 Congenital Heart Disease
33665 33503 Congenital Heart Disease
33670 33503 Congenital Heart Disease
33702 33503 Congenital Heart Disease
33710 33503 Congenital Heart Disease
Page 30 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
33720 33503 Congenital Heart Disease
33724 33503 Congenital Heart Disease
33726 33503 Congenital Heart Disease
33730 33503 Congenital Heart Disease
33732 33503 Congenital Heart Disease
33500 33504 Congenital Heart Disease
33505 33504 Congenital Heart Disease
33506 33504 Congenital Heart Disease
33507 33504 Congenital Heart Disease
33608 33504 Congenital Heart Disease
33610 33504 Congenital Heart Disease
33611 33504 Congenital Heart Disease
33612 33504 Congenital Heart Disease
33615 33504 Congenital Heart Disease
33617 33504 Congenital Heart Disease
33619 33504 Congenital Heart Disease
33641 33504 Congenital Heart Disease
33647 33504 Congenital Heart Disease
33660 33504 Congenital Heart Disease
33665 33504 Congenital Heart Disease
33670 33504 Congenital Heart Disease
33702 33504 Congenital Heart Disease
33710 33504 Congenital Heart Disease
33720 33504 Congenital Heart Disease
33724 33504 Congenital Heart Disease
33726 33504 Congenital Heart Disease
33730 33504 Congenital Heart Disease
33732 33504 Congenital Heart Disease
33617 33505 Congenital Heart Disease
33619 33505 Congenital Heart Disease
33505 33506 Congenital Heart Disease
33617 33506 Congenital Heart Disease
33619 33506 Congenital Heart Disease
33505 33507 Congenital Heart Disease
33506 33507 Congenital Heart Disease
33608 33507 Congenital Heart Disease
33610 33507 Congenital Heart Disease
33611 33507 Congenital Heart Disease
33612 33507 Congenital Heart Disease
33615 33507 Congenital Heart Disease
33617 33507 Congenital Heart Disease
33619 33507 Congenital Heart Disease
33647 33507 Congenital Heart Disease
33660 33507 Congenital Heart Disease
33665 33507 Congenital Heart Disease
33670 33507 Congenital Heart Disease
33710 33507 Congenital Heart Disease
33726 33507 Congenital Heart Disease
33730 33507 Congenital Heart Disease
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
33675 33600 Congenital Heart Disease
33676 33600 Congenital Heart Disease
33677 33600 Congenital Heart Disease
33681 33600 Congenital Heart Disease
33684 33600 Congenital Heart Disease
33688 33600 Congenital Heart Disease
33786 33600 Congenital Heart Disease
33600 33602 Congenital Heart Disease
33675 33602 Congenital Heart Disease
33676 33602 Congenital Heart Disease
33677 33602 Congenital Heart Disease
33681 33602 Congenital Heart Disease
33684 33602 Congenital Heart Disease
33688 33602 Congenital Heart Disease
33786 33602 Congenital Heart Disease
33505 33608 Congenital Heart Disease
33506 33608 Congenital Heart Disease
33611 33608 Congenital Heart Disease
33612 33608 Congenital Heart Disease
33615 33608 Congenital Heart Disease
33617 33608 Congenital Heart Disease
33619 33608 Congenital Heart Disease
33647 33608 Congenital Heart Disease
33665 33608 Congenital Heart Disease
33670 33608 Congenital Heart Disease
33710 33608 Congenital Heart Disease
33726 33608 Congenital Heart Disease
33730 33608 Congenital Heart Disease
33505 33610 Congenital Heart Disease
33506 33610 Congenital Heart Disease
33608 33610 Congenital Heart Disease
33611 33610 Congenital Heart Disease
33612 33610 Congenital Heart Disease
33615 33610 Congenital Heart Disease
33617 33610 Congenital Heart Disease
33619 33610 Congenital Heart Disease
33647 33610 Congenital Heart Disease
33665 33610 Congenital Heart Disease
33670 33610 Congenital Heart Disease
33710 33610 Congenital Heart Disease
33726 33610 Congenital Heart Disease
33730 33610 Congenital Heart Disease
33505 33611 Congenital Heart Disease
33506 33611 Congenital Heart Disease
33615 33611 Congenital Heart Disease
33617 33611 Congenital Heart Disease
33619 33611 Congenital Heart Disease
33665 33611 Congenital Heart Disease
33670 33611 Congenital Heart Disease
Page 31 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
33710 33611 Congenital Heart Disease
33726 33611 Congenital Heart Disease
33730 33611 Congenital Heart Disease
33612 33611 Congenital Heart Disease
33505 33612 Congenital Heart Disease
33506 33612 Congenital Heart Disease
33617 33612 Congenital Heart Disease
33619 33612 Congenital Heart Disease
33710 33612 Congenital Heart Disease
33726 33612 Congenital Heart Disease
33730 33612 Congenital Heart Disease
33505 33615 Congenital Heart Disease
33506 33615 Congenital Heart Disease
33612 33615 Congenital Heart Disease
33617 33615 Congenital Heart Disease
33619 33615 Congenital Heart Disease
33710 33615 Congenital Heart Disease
33726 33615 Congenital Heart Disease
33730 33615 Congenital Heart Disease
33619 33617 Congenital Heart Disease
33505 33641 Congenital Heart Disease
33506 33641 Congenital Heart Disease
33507 33641 Congenital Heart Disease
33608 33641 Congenital Heart Disease
33610 33641 Congenital Heart Disease
33611 33641 Congenital Heart Disease
33612 33641 Congenital Heart Disease
33615 33641 Congenital Heart Disease
33617 33641 Congenital Heart Disease
33619 33641 Congenital Heart Disease
33647 33641 Congenital Heart Disease
33660 33641 Congenital Heart Disease
33665 33641 Congenital Heart Disease
33670 33641 Congenital Heart Disease
33710 33641 Congenital Heart Disease
33726 33641 Congenital Heart Disease
33730 33641 Congenital Heart Disease
33732 33641 Congenital Heart Disease
33606 33645 Congenital Heart Disease
33505 33647 Congenital Heart Disease
33506 33647 Congenital Heart Disease
33611 33647 Congenital Heart Disease
33612 33647 Congenital Heart Disease
33615 33647 Congenital Heart Disease
33617 33647 Congenital Heart Disease
33619 33647 Congenital Heart Disease
33665 33647 Congenital Heart Disease
33670 33647 Congenital Heart Disease
33710 33647 Congenital Heart Disease
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
33726 33647 Congenital Heart Disease
33730 33647 Congenital Heart Disease
33505 33660 Congenital Heart Disease
33506 33660 Congenital Heart Disease
33608 33660 Congenital Heart Disease
33610 33660 Congenital Heart Disease
33611 33660 Congenital Heart Disease
33612 33660 Congenital Heart Disease
33615 33660 Congenital Heart Disease
33617 33660 Congenital Heart Disease
33619 33660 Congenital Heart Disease
33647 33660 Congenital Heart Disease
33665 33660 Congenital Heart Disease
33670 33660 Congenital Heart Disease
33710 33660 Congenital Heart Disease
33726 33660 Congenital Heart Disease
33730 33660 Congenital Heart Disease
33505 33665 Congenital Heart Disease
33506 33665 Congenital Heart Disease
33612 33665 Congenital Heart Disease
33615 33665 Congenital Heart Disease
33617 33665 Congenital Heart Disease
33619 33665 Congenital Heart Disease
33670 33665 Congenital Heart Disease
33710 33665 Congenital Heart Disease
33726 33665 Congenital Heart Disease
33730 33665 Congenital Heart Disease
33505 33670 Congenital Heart Disease
33506 33670 Congenital Heart Disease
33612 33670 Congenital Heart Disease
33615 33670 Congenital Heart Disease
33617 33670 Congenital Heart Disease
33619 33670 Congenital Heart Disease
33710 33670 Congenital Heart Disease
33726 33670 Congenital Heart Disease
33730 33670 Congenital Heart Disease
33688 33675 Congenital Heart Disease
33786 33675 Congenital Heart Disease
33676 33675 Congenital Heart Disease
33677 33675 Congenital Heart Disease
33677 33676 Congenital Heart Disease
33786 33676 Congenital Heart Disease
33786 33677 Congenital Heart Disease
33675 33681 Congenital Heart Disease
33676 33681 Congenital Heart Disease
33677 33681 Congenital Heart Disease
33684 33681 Congenital Heart Disease
33688 33681 Congenital Heart Disease
33786 33681 Congenital Heart Disease
Page 32 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
33675 33684 Congenital Heart Disease
33676 33684 Congenital Heart Disease
33677 33684 Congenital Heart Disease
33688 33684 Congenital Heart Disease
33786 33684 Congenital Heart Disease
33676 33688 Congenital Heart Disease
33677 33688 Congenital Heart Disease
33786 33688 Congenital Heart Disease
33606 33690 Congenital Heart Disease
33645 33690 Congenital Heart Disease
33788 33690 Congenital Heart Disease
33694 33692 Congenital Heart Disease
33697 33692 Congenital Heart Disease
33692 33694 Congenital Heart Disease
33697 33694 Congenital Heart Disease
33692 33697 Congenital Heart Disease
33500 33702 Congenital Heart Disease
33505 33702 Congenital Heart Disease
33506 33702 Congenital Heart Disease
33507 33702 Congenital Heart Disease
33608 33702 Congenital Heart Disease
33610 33702 Congenital Heart Disease
33611 33702 Congenital Heart Disease
33612 33702 Congenital Heart Disease
33615 33702 Congenital Heart Disease
33617 33702 Congenital Heart Disease
33619 33702 Congenital Heart Disease
33641 33702 Congenital Heart Disease
33647 33702 Congenital Heart Disease
33660 33702 Congenital Heart Disease
33665 33702 Congenital Heart Disease
33670 33702 Congenital Heart Disease
33720 33702 Congenital Heart Disease
33726 33702 Congenital Heart Disease
33730 33702 Congenital Heart Disease
33732 33702 Congenital Heart Disease
33710 33702 Congenital Heart Disease
33505 33710 Congenital Heart Disease
33506 33710 Congenital Heart Disease
33617 33710 Congenital Heart Disease
33619 33710 Congenital Heart Disease
33500 33720 Congenital Heart Disease
33505 33720 Congenital Heart Disease
33506 33720 Congenital Heart Disease
33507 33720 Congenital Heart Disease
33608 33720 Congenital Heart Disease
33610 33720 Congenital Heart Disease
33611 33720 Congenital Heart Disease
33612 33720 Congenital Heart Disease
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
33615 33720 Congenital Heart Disease
33617 33720 Congenital Heart Disease
33619 33720 Congenital Heart Disease
33641 33720 Congenital Heart Disease
33647 33720 Congenital Heart Disease
33660 33720 Congenital Heart Disease
33665 33720 Congenital Heart Disease
33670 33720 Congenital Heart Disease
33710 33720 Congenital Heart Disease
33726 33720 Congenital Heart Disease
33730 33720 Congenital Heart Disease
33732 33720 Congenital Heart Disease
33600 33722 Congenital Heart Disease
33602 33722 Congenital Heart Disease
33675 33722 Congenital Heart Disease
33676 33722 Congenital Heart Disease
33677 33722 Congenital Heart Disease
33681 33722 Congenital Heart Disease
33684 33722 Congenital Heart Disease
33688 33722 Congenital Heart Disease
33786 33722 Congenital Heart Disease
33500 33724 Congenital Heart Disease
33505 33724 Congenital Heart Disease
33506 33724 Congenital Heart Disease
33507 33724 Congenital Heart Disease
33608 33724 Congenital Heart Disease
33610 33724 Congenital Heart Disease
33611 33724 Congenital Heart Disease
33612 33724 Congenital Heart Disease
33615 33724 Congenital Heart Disease
33617 33724 Congenital Heart Disease
33619 33724 Congenital Heart Disease
33641 33724 Congenital Heart Disease
33647 33724 Congenital Heart Disease
33660 33724 Congenital Heart Disease
33665 33724 Congenital Heart Disease
33670 33724 Congenital Heart Disease
33702 33724 Congenital Heart Disease
33710 33724 Congenital Heart Disease
33720 33724 Congenital Heart Disease
33726 33724 Congenital Heart Disease
33732 33724 Congenital Heart Disease
33730 33724 Congenital Heart Disease
33505 33726 Congenital Heart Disease
33506 33726 Congenital Heart Disease
33617 33726 Congenital Heart Disease
33619 33726 Congenital Heart Disease
33710 33726 Congenital Heart Disease
33505 33730 Congenital Heart Disease
Page 33 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
33506 33730 Congenital Heart Disease
33617 33730 Congenital Heart Disease
33619 33730 Congenital Heart Disease
33710 33730 Congenital Heart Disease
33726 33730 Congenital Heart Disease
33505 33732 Congenital Heart Disease
33506 33732 Congenital Heart Disease
33507 33732 Congenital Heart Disease
33608 33732 Congenital Heart Disease
33610 33732 Congenital Heart Disease
33611 33732 Congenital Heart Disease
33612 33732 Congenital Heart Disease
33615 33732 Congenital Heart Disease
33617 33732 Congenital Heart Disease
33619 33732 Congenital Heart Disease
33647 33732 Congenital Heart Disease
33660 33732 Congenital Heart Disease
33665 33732 Congenital Heart Disease
33670 33732 Congenital Heart Disease
33710 33732 Congenital Heart Disease
33726 33732 Congenital Heart Disease
33730 33732 Congenital Heart Disease
33736 33735 Congenital Heart Disease
33737 33735 Congenital Heart Disease
33736 33737 Congenital Heart Disease
33755 33750 Congenital Heart Disease
33762 33750 Congenital Heart Disease
33764 33750 Congenital Heart Disease
33766 33750 Congenital Heart Disease
33767 33750 Congenital Heart Disease
33766 33755 Congenital Heart Disease
33767 33755 Congenital Heart Disease
33755 33762 Congenital Heart Disease
33766 33762 Congenital Heart Disease
33767 33762 Congenital Heart Disease
33750 33764 Congenital Heart Disease
33755 33764 Congenital Heart Disease
33762 33764 Congenital Heart Disease
33766 33764 Congenital Heart Disease
33767 33764 Congenital Heart Disease
33767 33766 Congenital Heart Disease
33606 33768 Congenital Heart Disease
33645 33768 Congenital Heart Disease
33690 33768 Congenital Heart Disease
33788 33768 Congenital Heart Disease
33478 33768 Congenital Heart Disease
33617 33768 Congenital Heart Disease
33622 33768 Congenital Heart Disease
33767 33768 Congenital Heart Disease
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
33771 33770 Congenital Heart Disease
33778 33770 Congenital Heart Disease
33779 33770 Congenital Heart Disease
33780 33770 Congenital Heart Disease
33781 33770 Congenital Heart Disease
33775 33770 Congenital Heart Disease
33775 33771 Congenital Heart Disease
33778 33771 Congenital Heart Disease
33779 33771 Congenital Heart Disease
33780 33771 Congenital Heart Disease
33781 33771 Congenital Heart Disease
33770 33774 Congenital Heart Disease
33771 33774 Congenital Heart Disease
33778 33774 Congenital Heart Disease
33779 33774 Congenital Heart Disease
33780 33774 Congenital Heart Disease
33781 33774 Congenital Heart Disease
33775 33774 Congenital Heart Disease
33776 33774 Congenital Heart Disease
33777 33774 Congenital Heart Disease
33770 33775 Congenital Heart Disease
33771 33775 Congenital Heart Disease
33776 33775 Congenital Heart Disease
33778 33775 Congenital Heart Disease
33779 33775 Congenital Heart Disease
33780 33775 Congenital Heart Disease
33781 33775 Congenital Heart Disease
33770 33776 Congenital Heart Disease
33771 33776 Congenital Heart Disease
33778 33776 Congenital Heart Disease
33779 33776 Congenital Heart Disease
33780 33776 Congenital Heart Disease
33781 33776 Congenital Heart Disease
33770 33777 Congenital Heart Disease
33771 33777 Congenital Heart Disease
33775 33777 Congenital Heart Disease
33776 33777 Congenital Heart Disease
33778 33777 Congenital Heart Disease
33779 33777 Congenital Heart Disease
33780 33777 Congenital Heart Disease
33781 33777 Congenital Heart Disease
33779 33778 Congenital Heart Disease
33780 33778 Congenital Heart Disease
33781 33778 Congenital Heart Disease
33780 33779 Congenital Heart Disease
33779 33781 Congenital Heart Disease
33780 33781 Congenital Heart Disease
33606 33788 Congenital Heart Disease
33645 33788 Congenital Heart Disease
Page 34 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
33803 33802 Congenital Heart Disease
33822 33820 Congenital Heart Disease
33840 33820 Congenital Heart Disease
33845 33820 Congenital Heart Disease
33851 33820 Congenital Heart Disease
33840 33822 Congenital Heart Disease
33845 33822 Congenital Heart Disease
33851 33822 Congenital Heart Disease
33845 33840 Congenital Heart Disease
33851 33840 Congenital Heart Disease
33845 33851 Congenital Heart Disease
33853 33852 Congenital Heart Disease
33917 33852 Congenital Heart Disease
33920 33852 Congenital Heart Disease
33920 33853 Congenital Heart Disease
33853 33917 Congenital Heart Disease
33920 33917 Congenital Heart Disease
33600 33924 Congenital Heart Disease
33602 33924 Congenital Heart Disease
33675 33924 Congenital Heart Disease
33676 33924 Congenital Heart Disease
33677 33924 Congenital Heart Disease
33681 33924 Congenital Heart Disease
33684 33924 Congenital Heart Disease
33688 33924 Congenital Heart Disease
33722 33924 Congenital Heart Disease
33786 33924 Congenital Heart Disease
33470 33924 Congenital Heart Disease
33471 33924 Congenital Heart Disease
33474 33924 Congenital Heart Disease
33475 33924 Congenital Heart Disease
33476 33924 Congenital Heart Disease
33477 33924 Congenital Heart Disease
33478 33924 Congenital Heart Disease
33606 33924 Congenital Heart Disease
33608 33924 Congenital Heart Disease
33610 33924 Congenital Heart Disease
33611 33924 Congenital Heart Disease
33612 33924 Congenital Heart Disease
33615 33924 Congenital Heart Disease
33617 33924 Congenital Heart Disease
33622 33924 Congenital Heart Disease
33692 33924 Congenital Heart Disease
33694 33924 Congenital Heart Disease
33697 33924 Congenital Heart Disease
33735 33924 Congenital Heart Disease
33736 33924 Congenital Heart Disease
33737 33924 Congenital Heart Disease
33750 33924 Congenital Heart Disease
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
33755 33924 Congenital Heart Disease
33762 33924 Congenital Heart Disease
33764 33924 Congenital Heart Disease
33766 33924 Congenital Heart Disease
33767 33924 Congenital Heart Disease
33770 33924 Congenital Heart Disease
33771 33924 Congenital Heart Disease
33774 33924 Congenital Heart Disease
33775 33924 Congenital Heart Disease
33776 33924 Congenital Heart Disease
33777 33924 Congenital Heart Disease
33778 33924 Congenital Heart Disease
33779 33924 Congenital Heart Disease
33780 33924 Congenital Heart Disease
33781 33924 Congenital Heart Disease
33782 33924 Congenital Heart Disease
33783 33924 Congenital Heart Disease
33917 33924 Congenital Heart Disease
33920 33924 Congenital Heart Disease
33922 33924 Congenital Heart Disease
33925 33924 Congenital Heart Disease
33926 33924 Congenital Heart Disease
33935 33924 Congenital Heart Disease
33945 33924 Congenital Heart Disease
33945 33929 Ventricular Assist Devices
33976 33975 Ventricular Assist Devices
33979 33975 Ventricular Assist Devices
33979 33976 Ventricular Assist Devices
33982 33981 Ventricular Assist Devices
33983 33981 Ventricular Assist Devices
33983 33982 Ventricular Assist Devices
36475 36473 Vein Procedures
36478 36473 Vein Procedures
37718 36475 Vein Procedures
37722 36475 Vein Procedures
37735 36475 Vein Procedures
36475 36478 Vein Procedures
37718 36478 Vein Procedures
37722 36478 Vein Procedures
37735 36478 Vein Procedures
36475 37700 Vein Procedures
36478 37700 Vein Procedures
37718 37700 Vein Procedures
37722 37700 Vein Procedures
37735 37700 Vein Procedures
37780 37700 Vein Procedures
37785 37700 Vein Procedures
37722 37718 Vein Procedures
37735 37718 Vein Procedures
Page 35 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
37735 37722 Vein Procedures
36475 37780 Vein Procedures
36478 37780 Vein Procedures
37718 37780 Vein Procedures
37722 37780 Vein Procedures
37735 37780 Vein Procedures
37785 37780 Vein Procedures
38210 38208 Services related to Transplant
38212 38208 Services related to Transplant
38214 38208 Services related to Transplant
38215 38208 Services related to Transplant
38208 38209 Services related to Transplant
38210 38209 Services related to Transplant
38212 38209 Services related to Transplant
38213 38209 Services related to Transplant
38214 38209 Services related to Transplant
38215 38209 Services related to Transplant
38210 38212 Services related to Transplant
38208 38213 Services related to Transplant
38210 38213 Services related to Transplant
38212 38213 Services related to Transplant
38214 38213 Services related to Transplant
38215 38213 Services related to Transplant
38209 38213 Services related to Transplant
38210 38214 Services related to Transplant
38212 38214 Services related to Transplant
38215 38214 Services related to Transplant
38210 38215 Services related to Transplant
38212 38215 Services related to Transplant
38240 38241 Optum Transplant - Bone Marrow Harvest
21685 41530 Sleep Apnea Procedures & Surgeries
41512 41530 Sleep Apnea Procedures & Surgeries
42145 41530 Sleep Apnea Procedures & Surgeries
42820 41821 Site of Service (SOS) OPH to ASC
42825 41821 Site of Service (SOS) OPH to ASC
42826 41821 Site of Service (SOS) OPH to ASC
42830 41821 Site of Service (SOS) OPH to ASC
21685 42145 Sleep Apnea Procedures & Surgeries
42821 42820 Site of Service (SOS) OPH to ASC
42825 42820 Site of Service (SOS) OPH to ASC
42826 42820 Site of Service (SOS) OPH to ASC
42830 42820 Site of Service (SOS) OPH to ASC
42820 42825 Site of Service (SOS) OPH to ASC
42821 42825 Site of Service (SOS) OPH to ASC
42826 42825 Site of Service (SOS) OPH to ASC
42830 42825 Site of Service (SOS) OPH to ASC
42821 42826 Site of Service (SOS) OPH to ASC
42820 42826 Site of Service (SOS) OPH to ASC
42825 42826 Site of Service (SOS) OPH to ASC
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
42830 42826 Site of Service (SOS) OPH to ASC
42820 42830 Site of Service (SOS) OPH to ASC
42821 42830 Site of Service (SOS) OPH to ASC
42825 42830 Site of Service (SOS) OPH to ASC
42826 42830 Site of Service (SOS) OPH to ASC
43239 43235 Site of Service (SOS) OPH to ASC
43249 43235 Site of Service (SOS) OPH to ASC
45378 43235 Site of Service (SOS) OPH to ASC
45380 43235 Site of Service (SOS) OPH to ASC
45384 43235 Site of Service (SOS) OPH to ASC
45385 43235 Site of Service (SOS) OPH to ASC
43249 43239 Site of Service (SOS) OPH to ASC
43235 43239 Site of Service (SOS) OPH to ASC
45378 43239 Site of Service (SOS) OPH to ASC
45380 43239 Site of Service (SOS) OPH to ASC
45384 43239 Site of Service (SOS) OPH to ASC
45385 43239 Site of Service (SOS) OPH to ASC
43238 43245 NHP - Digestive System
43246 43245 NHP - Digestive System
43251 43245 NHP - Digestive System
43259 43245 NHP - Digestive System
43238 43246 NHP - Digestive System
43259 43246 NHP - Digestive System
43238 43248 NHP - Digestive System
43245 43248 NHP - Digestive System
43246 43248 NHP - Digestive System
43250 43248 NHP - Digestive System
43251 43248 NHP - Digestive System
43259 43248 NHP - Digestive System
43235 43249 Site of Service (SOS) OPH to ASC
43239 43249 Site of Service (SOS) OPH to ASC
45378 43249 Site of Service (SOS) OPH to ASC
45380 43249 Site of Service (SOS) OPH to ASC
45384 43249 Site of Service (SOS) OPH to ASC
45385 43249 Site of Service (SOS) OPH to ASC
43238 43250 NHP - Digestive System
43245 43250 NHP - Digestive System
43246 43250 NHP - Digestive System
43251 43250 NHP - Digestive System
43259 43250 NHP - Digestive System
43238 43251 NHP - Digestive System
43246 43251 NHP - Digestive System
43259 43251 NHP - Digestive System
43238 43259 NHP - Digestive System
43645 43644 Bariatric Surgery
43845 43644 Bariatric Surgery
43847 43644 Bariatric Surgery
43848 43644 Bariatric Surgery
43845 43645 Bariatric Surgery
Page 36 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
43648 43647 Bariatric Surgery
43881 43647 Bariatric Surgery
43882 43647 Bariatric Surgery
64590 43647 Bariatric Surgery
43647 43648 Bariatric Surgery
43881 43648 Bariatric Surgery
43882 43648 Bariatric Surgery
64590 43648 Bariatric Surgery
43644 43770 Bariatric Surgery
43645 43770 Bariatric Surgery
43771 43770 Bariatric Surgery
43773 43770 Bariatric Surgery
43842 43770 Bariatric Surgery
43773 43771 Bariatric Surgery
43770 43772 Bariatric Surgery
43771 43772 Bariatric Surgery
43773 43772 Bariatric Surgery
43774 43772 Bariatric Surgery
43842 43772 Bariatric Surgery
43770 43774 Bariatric Surgery
43771 43774 Bariatric Surgery
43773 43774 Bariatric Surgery
43842 43774 Bariatric Surgery
43644 43775 Bariatric Surgery
43645 43775 Bariatric Surgery
43770 43775 Bariatric Surgery
43843 43775 Bariatric Surgery
43845 43775 Bariatric Surgery
43846 43775 Bariatric Surgery
43847 43775 Bariatric Surgery
43848 43775 Bariatric Surgery
43860 43775 Bariatric Surgery
43865 43775 Bariatric Surgery
43771 43842 Bariatric Surgery
43773 43842 Bariatric Surgery
43633 43843 Bariatric Surgery
43644 43843 Bariatric Surgery
43645 43843 Bariatric Surgery
43845 43843 Bariatric Surgery
43846 43843 Bariatric Surgery
43847 43843 Bariatric Surgery
43848 43843 Bariatric Surgery
43860 43843 Bariatric Surgery
43865 43843 Bariatric Surgery
43633 43846 Bariatric Surgery
43644 43846 Bariatric Surgery
43645 43846 Bariatric Surgery
43845 43846 Bariatric Surgery
43847 43846 Bariatric Surgery
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
43848 43846 Bariatric Surgery
43860 43846 Bariatric Surgery
43865 43846 Bariatric Surgery
43633 43847 Bariatric Surgery
43645 43847 Bariatric Surgery
43845 43847 Bariatric Surgery
43848 43847 Bariatric Surgery
43845 43848 Bariatric Surgery
43644 43860 Bariatric Surgery w/ Diagnosis Code
43645 43860 Bariatric Surgery w/ Diagnosis Code
43845 43860 Bariatric Surgery w/ Diagnosis Code
43847 43860 Bariatric Surgery w/ Diagnosis Code
43848 43860 Bariatric Surgery w/ Diagnosis Code
43865 43860 Bariatric Surgery w/ Diagnosis Code
43644 43865 Bariatric Surgery w/ Diagnosis Code
43645 43865 Bariatric Surgery w/ Diagnosis Code
43845 43865 Bariatric Surgery w/ Diagnosis Code
43847 43865 Bariatric Surgery w/ Diagnosis Code
43848 43865 Bariatric Surgery w/ Diagnosis Code
43647 43881 Bariatric Surgery
43648 43881 Bariatric Surgery
43882 43881 Bariatric Surgery
64590 43881 Bariatric Surgery
43647 43882 Bariatric Surgery
43648 43882 Bariatric Surgery
43881 43882 Bariatric Surgery
64590 43882 Bariatric Surgery
43644 43886 Bariatric Surgery
43645 43886 Bariatric Surgery
43775 43886 Bariatric Surgery
43843 43886 Bariatric Surgery
43845 43886 Bariatric Surgery
43846 43886 Bariatric Surgery
43847 43886 Bariatric Surgery
43848 43886 Bariatric Surgery
43860 43886 Bariatric Surgery
43865 43886 Bariatric Surgery
43888 43886 Bariatric Surgery
43644 43887 Bariatric Surgery
43645 43887 Bariatric Surgery
43775 43887 Bariatric Surgery
43843 43887 Bariatric Surgery
43845 43887 Bariatric Surgery
43846 43887 Bariatric Surgery
43847 43887 Bariatric Surgery
43848 43887 Bariatric Surgery
43860 43887 Bariatric Surgery
43865 43887 Bariatric Surgery
43886 43887 Bariatric Surgery
Page 37 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
43888 43887 Bariatric Surgery
43644 43888 Bariatric Surgery
43645 43888 Bariatric Surgery
43775 43888 Bariatric Surgery
43843 43888 Bariatric Surgery
43845 43888 Bariatric Surgery
43846 43888 Bariatric Surgery
43847 43888 Bariatric Surgery
43848 43888 Bariatric Surgery
43860 43888 Bariatric Surgery
43865 43888 Bariatric Surgery
44133 44132 Optum Transplant - Intestine
44132 44133 Optum Transplant - Intestine
44207 44204 NHP - Digestive System
45330 45300 Site of Service (SOS) Office Based Programs
45378 45300 Site of Service (SOS) Office Based Programs
45300 45330 Site of Service (SOS) Office Based Programs
45378 45330 Site of Service (SOS) Office Based Programs
G0105 45378 Site of Service (SOS) OPH to ASC
G0120 45378 Site of Service (SOS) OPH to ASC
G0121 45378 Site of Service (SOS) OPH to ASC
G0122 45378 Site of Service (SOS) OPH to ASC
44388 45378 Site of Service (SOS) OPH to ASC
44389 45378 Site of Service (SOS) OPH to ASC
44392 45378 Site of Service (SOS) OPH to ASC
44394 45378 Site of Service (SOS) OPH to ASC
45380 45378 Site of Service (SOS) OPH to ASC
45381 45378 Site of Service (SOS) OPH to ASC
45384 45378 Site of Service (SOS) OPH to ASC
45385 45378 Site of Service (SOS) OPH to ASC
45388 45378 Site of Service (SOS) OPH to ASC
43235 45378 Site of Service (SOS) OPH to ASC
43239 45378 Site of Service (SOS) OPH to ASC
43249 45378 Site of Service (SOS) OPH to ASC
G0105 45380 Site of Service (SOS) OPH to ASC
G0120 45380 Site of Service (SOS) OPH to ASC
G0121 45380 Site of Service (SOS) OPH to ASC
G0122 45380 Site of Service (SOS) OPH to ASC
44388 45380 Site of Service (SOS) OPH to ASC
44389 45380 Site of Service (SOS) OPH to ASC
44392 45380 Site of Service (SOS) OPH to ASC
44394 45380 Site of Service (SOS) OPH to ASC
45378 45380 Site of Service (SOS) OPH to ASC
45381 45380 Site of Service (SOS) OPH to ASC
45384 45380 Site of Service (SOS) OPH to ASC
45385 45380 Site of Service (SOS) OPH to ASC
45388 45380 Site of Service (SOS) OPH to ASC
43235 45380 Site of Service (SOS) OPH to ASC
43239 45380 Site of Service (SOS) OPH to ASC
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
43249 45380 Site of Service (SOS) OPH to ASC
G0105 45384 Site of Service (SOS) OPH to ASC
G0120 45384 Site of Service (SOS) OPH to ASC
G0121 45384 Site of Service (SOS) OPH to ASC
G0122 45384 Site of Service (SOS) OPH to ASC
44388 45384 Site of Service (SOS) OPH to ASC
44389 45384 Site of Service (SOS) OPH to ASC
44392 45384 Site of Service (SOS) OPH to ASC
44394 45384 Site of Service (SOS) OPH to ASC
45378 45384 Site of Service (SOS) OPH to ASC
45380 45384 Site of Service (SOS) OPH to ASC
45381 45384 Site of Service (SOS) OPH to ASC
45385 45384 Site of Service (SOS) OPH to ASC
45388 45384 Site of Service (SOS) OPH to ASC
43235 45384 Site of Service (SOS) OPH to ASC
43239 45384 Site of Service (SOS) OPH to ASC
43249 45384 Site of Service (SOS) OPH to ASC
G0105 45385 Site of Service (SOS) OPH to ASC
G0120 45385 Site of Service (SOS) OPH to ASC
G0121 45385 Site of Service (SOS) OPH to ASC
G0122 45385 Site of Service (SOS) OPH to ASC
44388 45385 Site of Service (SOS) OPH to ASC
44389 45385 Site of Service (SOS) OPH to ASC
44392 45385 Site of Service (SOS) OPH to ASC
44394 45385 Site of Service (SOS) OPH to ASC
45378 45385 Site of Service (SOS) OPH to ASC
45380 45385 Site of Service (SOS) OPH to ASC
45381 45385 Site of Service (SOS) OPH to ASC
45384 45385 Site of Service (SOS) OPH to ASC
45388 45385 Site of Service (SOS) OPH to ASC
43235 45385 Site of Service (SOS) OPH to ASC
43239 45385 Site of Service (SOS) OPH to ASC
43249 45385 Site of Service (SOS) OPH to ASC
45382 45386 NHP - Digestive System
46280 46270 NHP - Digestive System
47141 47140 Services related to Transplant
47142 47140 Services related to Transplant
47142 47141 Services related to Transplant
47144 47143 Services related to Transplant
47145 47143 Services related to Transplant
47143 47144 Services related to Transplant
47145 47144 Services related to Transplant
47143 47145 Services related to Transplant
47144 47145 Services related to Transplant
47147 47146 Services related to Transplant
49507 49500 NHP - Digestive System
49650 49505 Site of Service (SOS) OPH to ASC
49585 49505 Site of Service (SOS) OPH to ASC
49587 49505 Site of Service (SOS) OPH to ASC
Page 38 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
49651 49505 Site of Service (SOS) OPH to ASC
49587 49585 Site of Service (SOS) OPH to ASC
49505 49585 Site of Service (SOS) OPH to ASC
49650 49585 Site of Service (SOS) OPH to ASC
49651 49585 Site of Service (SOS) OPH to ASC
49652 49585 Site of Service (SOS) OPH to ASC
49653 49585 Site of Service (SOS) OPH to ASC
49652 49587 Site of Service (SOS) OPH to ASC
49653 49587 Site of Service (SOS) OPH to ASC
49505 49587 Site of Service (SOS) OPH to ASC
49585 49587 Site of Service (SOS) OPH to ASC
49650 49587 Site of Service (SOS) OPH to ASC
49651 49587 Site of Service (SOS) OPH to ASC
49652 49587 Site of Service (SOS) OPH to ASC
49653 49587 Site of Service (SOS) OPH to ASC
49651 49650 Site of Service (SOS) OPH to ASC
49505 49650 Site of Service (SOS) OPH to ASC
49585 49650 Site of Service (SOS) OPH to ASC
49587 49650 Site of Service (SOS) OPH to ASC
49652 49650 Site of Service (SOS) OPH to ASC
49653 49650 Site of Service (SOS) OPH to ASC
49505 49651 Site of Service (SOS) OPH to ASC
49585 49651 Site of Service (SOS) OPH to ASC
49587 49651 Site of Service (SOS) OPH to ASC
49650 49651 Site of Service (SOS) OPH to ASC
49652 49651 Site of Service (SOS) OPH to ASC
49653 49651 Site of Service (SOS) OPH to ASC
49585 49652 Site of Service (SOS) OPH to ASC
49505 49652 Site of Service (SOS) OPH to ASC
49587 49652 Site of Service (SOS) OPH to ASC
49650 49652 Site of Service (SOS) OPH to ASC
49651 49652 Site of Service (SOS) OPH to ASC
49653 49652 Site of Service (SOS) OPH to ASC
49585 49653 Site of Service (SOS) OPH to ASC
49587 49653 Site of Service (SOS) OPH to ASC
49505 49653 Site of Service (SOS) OPH to ASC
49650 49653 Site of Service (SOS) OPH to ASC
49651 49653 Site of Service (SOS) OPH to ASC
49652 49653 Site of Service (SOS) OPH to ASC
49655 49654 Site of Service (SOS) OPH to ASC
49654 49655 Site of Service (SOS) OPH to ASC
50320 50300 Optum Transplant - Kidney
50325 50323 Optum Transplant - Kidney
50323 50325 Services related to Transplant
50365 50360 Optum Transplant - Kidney
52000 50590 Site of Service (SOS) OPH to ASC
52005 50590 Site of Service (SOS) OPH to ASC
52204 50590 Site of Service (SOS) OPH to ASC
52224 50590 Site of Service (SOS) OPH to ASC
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
52234 50590 Site of Service (SOS) OPH to ASC
52235 50590 Site of Service (SOS) OPH to ASC
52260 50590 Site of Service (SOS) OPH to ASC
52281 50590 Site of Service (SOS) OPH to ASC
52310 50590 Site of Service (SOS) OPH to ASC
52332 50590 Site of Service (SOS) OPH to ASC
52351 50590 Site of Service (SOS) OPH to ASC
52352 50590 Site of Service (SOS) OPH to ASC
52353 50590 Site of Service (SOS) OPH to ASC
52356 50590 Site of Service (SOS) OPH to ASC
52005 52000 Site of Service (SOS) OPH to ASC
52204 52000 Site of Service (SOS) OPH to ASC
52224 52000 Site of Service (SOS) OPH to ASC
52234 52000 Site of Service (SOS) OPH to ASC
52235 52000 Site of Service (SOS) OPH to ASC
52260 52000 Site of Service (SOS) OPH to ASC
52281 52000 Site of Service (SOS) OPH to ASC
52310 52000 Site of Service (SOS) OPH to ASC
52332 52000 Site of Service (SOS) OPH to ASC
50590 52000 Site of Service (SOS) OPH to ASC
52351 52000 Site of Service (SOS) OPH to ASC
52352 52000 Site of Service (SOS) OPH to ASC
52353 52000 Site of Service (SOS) OPH to ASC
52356 52000 Site of Service (SOS) OPH to ASC
52204 52005 Site of Service (SOS) OPH to ASC
52224 52005 Site of Service (SOS) OPH to ASC
52234 52005 Site of Service (SOS) OPH to ASC
52235 52005 Site of Service (SOS) OPH to ASC
52260 52005 Site of Service (SOS) OPH to ASC
52281 52005 Site of Service (SOS) OPH to ASC
52310 52005 Site of Service (SOS) OPH to ASC
52332 52005 Site of Service (SOS) OPH to ASC
52351 52005 Site of Service (SOS) OPH to ASC
52352 52005 Site of Service (SOS) OPH to ASC
52353 52005 Site of Service (SOS) OPH to ASC
52356 52005 Site of Service (SOS) OPH to ASC
50590 52005 Site of Service (SOS) OPH to ASC
52000 52005 Site of Service (SOS) OPH to ASC
52224 52204 Site of Service (SOS) OPH to ASC
52234 52204 Site of Service (SOS) OPH to ASC
52235 52204 Site of Service (SOS) OPH to ASC
52260 52204 Site of Service (SOS) OPH to ASC
52281 52204 Site of Service (SOS) OPH to ASC
52310 52204 Site of Service (SOS) OPH to ASC
52332 52204 Site of Service (SOS) OPH to ASC
52351 52204 Site of Service (SOS) OPH to ASC
52352 52204 Site of Service (SOS) OPH to ASC
52353 52204 Site of Service (SOS) OPH to ASC
52356 52204 Site of Service (SOS) OPH to ASC
Page 39 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
50590 52204 Site of Service (SOS) OPH to ASC
52000 52204 Site of Service (SOS) OPH to ASC
52005 52204 Site of Service (SOS) OPH to ASC
52234 52224 Site of Service (SOS) OPH to ASC
52235 52224 Site of Service (SOS) OPH to ASC
52260 52224 Site of Service (SOS) OPH to ASC
52281 52224 Site of Service (SOS) OPH to ASC
52310 52224 Site of Service (SOS) OPH to ASC
52332 52224 Site of Service (SOS) OPH to ASC
52351 52224 Site of Service (SOS) OPH to ASC
52352 52224 Site of Service (SOS) OPH to ASC
52353 52224 Site of Service (SOS) OPH to ASC
52356 52224 Site of Service (SOS) OPH to ASC
50590 52224 Site of Service (SOS) OPH to ASC
52000 52224 Site of Service (SOS) OPH to ASC
52005 52224 Site of Service (SOS) OPH to ASC
52204 52224 Site of Service (SOS) OPH to ASC
52235 52234 Site of Service (SOS) OPH to ASC
52351 52234 Site of Service (SOS) OPH to ASC
52352 52234 Site of Service (SOS) OPH to ASC
52353 52234 Site of Service (SOS) OPH to ASC
52356 52234 Site of Service (SOS) OPH to ASC
50590 52234 Site of Service (SOS) OPH to ASC
52000 52234 Site of Service (SOS) OPH to ASC
52005 52234 Site of Service (SOS) OPH to ASC
52204 52234 Site of Service (SOS) OPH to ASC
52224 52234 Site of Service (SOS) OPH to ASC
52260 52234 Site of Service (SOS) OPH to ASC
52281 52234 Site of Service (SOS) OPH to ASC
52310 52234 Site of Service (SOS) OPH to ASC
52332 52234 Site of Service (SOS) OPH to ASC
52351 52235 Site of Service (SOS) OPH to ASC
52352 52235 Site of Service (SOS) OPH to ASC
52353 52235 Site of Service (SOS) OPH to ASC
52356 52235 Site of Service (SOS) OPH to ASC
50590 52235 Site of Service (SOS) OPH to ASC
52000 52235 Site of Service (SOS) OPH to ASC
52005 52235 Site of Service (SOS) OPH to ASC
52204 52235 Site of Service (SOS) OPH to ASC
52224 52235 Site of Service (SOS) OPH to ASC
52234 52235 Site of Service (SOS) OPH to ASC
52260 52235 Site of Service (SOS) OPH to ASC
52281 52235 Site of Service (SOS) OPH to ASC
52310 52235 Site of Service (SOS) OPH to ASC
52332 52235 Site of Service (SOS) OPH to ASC
52234 52260 Site of Service (SOS) OPH to ASC
52235 52260 Site of Service (SOS) OPH to ASC
52351 52260 Site of Service (SOS) OPH to ASC
52352 52260 Site of Service (SOS) OPH to ASC
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
52353 52260 Site of Service (SOS) OPH to ASC
52356 52260 Site of Service (SOS) OPH to ASC
50590 52260 Site of Service (SOS) OPH to ASC
52000 52260 Site of Service (SOS) OPH to ASC
52005 52260 Site of Service (SOS) OPH to ASC
52204 52260 Site of Service (SOS) OPH to ASC
52224 52260 Site of Service (SOS) OPH to ASC
52281 52260 Site of Service (SOS) OPH to ASC
52310 52260 Site of Service (SOS) OPH to ASC
52332 52260 Site of Service (SOS) OPH to ASC
52224 52281 Site of Service (SOS) OPH to ASC
52234 52281 Site of Service (SOS) OPH to ASC
52235 52281 Site of Service (SOS) OPH to ASC
52260 52281 Site of Service (SOS) OPH to ASC
52332 52281 Site of Service (SOS) OPH to ASC
52351 52281 Site of Service (SOS) OPH to ASC
52352 52281 Site of Service (SOS) OPH to ASC
52353 52281 Site of Service (SOS) OPH to ASC
52356 52281 Site of Service (SOS) OPH to ASC
50590 52281 Site of Service (SOS) OPH to ASC
52000 52281 Site of Service (SOS) OPH to ASC
52005 52281 Site of Service (SOS) OPH to ASC
52204 52281 Site of Service (SOS) OPH to ASC
52310 52281 Site of Service (SOS) OPH to ASC
52224 52310 Site of Service (SOS) OPH to ASC
52234 52310 Site of Service (SOS) OPH to ASC
52235 52310 Site of Service (SOS) OPH to ASC
52260 52310 Site of Service (SOS) OPH to ASC
52281 52310 Site of Service (SOS) OPH to ASC
52332 52310 Site of Service (SOS) OPH to ASC
52351 52310 Site of Service (SOS) OPH to ASC
52352 52310 Site of Service (SOS) OPH to ASC
52353 52310 Site of Service (SOS) OPH to ASC
52356 52310 Site of Service (SOS) OPH to ASC
50590 52310 Site of Service (SOS) OPH to ASC
52000 52310 Site of Service (SOS) OPH to ASC
52005 52310 Site of Service (SOS) OPH to ASC
52204 52310 Site of Service (SOS) OPH to ASC
52224 52332 Site of Service (SOS) OPH to ASC
52234 52332 Site of Service (SOS) OPH to ASC
52235 52332 Site of Service (SOS) OPH to ASC
52260 52332 Site of Service (SOS) OPH to ASC
52351 52332 Site of Service (SOS) OPH to ASC
52352 52332 Site of Service (SOS) OPH to ASC
52353 52332 Site of Service (SOS) OPH to ASC
52356 52332 Site of Service (SOS) OPH to ASC
50590 52332 Site of Service (SOS) OPH to ASC
52000 52332 Site of Service (SOS) OPH to ASC
52005 52332 Site of Service (SOS) OPH to ASC
Page 40 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
52204 52332 Site of Service (SOS) OPH to ASC
52281 52332 Site of Service (SOS) OPH to ASC
52310 52332 Site of Service (SOS) OPH to ASC
52352 52351 Site of Service (SOS) OPH to ASC
52353 52351 Site of Service (SOS) OPH to ASC
52356 52351 Site of Service (SOS) OPH to ASC
50590 52351 Site of Service (SOS) OPH to ASC
52000 52351 Site of Service (SOS) OPH to ASC
52005 52351 Site of Service (SOS) OPH to ASC
52204 52351 Site of Service (SOS) OPH to ASC
52224 52351 Site of Service (SOS) OPH to ASC
52234 52351 Site of Service (SOS) OPH to ASC
52235 52351 Site of Service (SOS) OPH to ASC
52260 52351 Site of Service (SOS) OPH to ASC
52281 52351 Site of Service (SOS) OPH to ASC
52310 52351 Site of Service (SOS) OPH to ASC
52332 52351 Site of Service (SOS) OPH to ASC
52353 52352 Site of Service (SOS) OPH to ASC
50590 52352 Site of Service (SOS) OPH to ASC
52000 52352 Site of Service (SOS) OPH to ASC
52005 52352 Site of Service (SOS) OPH to ASC
52204 52352 Site of Service (SOS) OPH to ASC
52224 52352 Site of Service (SOS) OPH to ASC
52234 52352 Site of Service (SOS) OPH to ASC
52235 52352 Site of Service (SOS) OPH to ASC
52260 52352 Site of Service (SOS) OPH to ASC
52281 52352 Site of Service (SOS) OPH to ASC
52310 52352 Site of Service (SOS) OPH to ASC
52332 52352 Site of Service (SOS) OPH to ASC
52351 52352 Site of Service (SOS) OPH to ASC
52356 52352 Site of Service (SOS) OPH to ASC
50590 52353 Site of Service (SOS) OPH to ASC
52356 52353 Site of Service (SOS) OPH to ASC
52000 52353 Site of Service (SOS) OPH to ASC
52005 52353 Site of Service (SOS) OPH to ASC
52204 52353 Site of Service (SOS) OPH to ASC
52224 52353 Site of Service (SOS) OPH to ASC
52234 52353 Site of Service (SOS) OPH to ASC
52235 52353 Site of Service (SOS) OPH to ASC
52260 52353 Site of Service (SOS) OPH to ASC
52281 52353 Site of Service (SOS) OPH to ASC
52310 52353 Site of Service (SOS) OPH to ASC
52332 52353 Site of Service (SOS) OPH to ASC
52351 52353 Site of Service (SOS) OPH to ASC
52352 52353 Site of Service (SOS) OPH to ASC
50590 52356 Site of Service (SOS) OPH to ASC
52000 52356 Site of Service (SOS) OPH to ASC
52005 52356 Site of Service (SOS) OPH to ASC
52204 52356 Site of Service (SOS) OPH to ASC
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
52224 52356 Site of Service (SOS) OPH to ASC
52234 52356 Site of Service (SOS) OPH to ASC
52235 52356 Site of Service (SOS) OPH to ASC
52260 52356 Site of Service (SOS) OPH to ASC
52281 52356 Site of Service (SOS) OPH to ASC
52310 52356 Site of Service (SOS) OPH to ASC
52332 52356 Site of Service (SOS) OPH to ASC
52351 52356 Site of Service (SOS) OPH to ASC
52352 52356 Site of Service (SOS) OPH to ASC
52353 52356 Site of Service (SOS) OPH to ASC
54660 54520 Gender Dysphoria Treatment w diagnosis code
54690 54520 Gender Dysphoria Treatment w diagnosis code
55180 55175 Gender Dysphoria Treatment w diagnosis code
56805 56800 Gender Dysphoria Treatment w diagnosis code
57522 57460 Site of Service (SOS) Office Based Programs
58661 57460 Site of Service (SOS) Office Based Programs
58353 57522 Site of Service (SOS) OPH to ASC
58558 57522 Site of Service (SOS) OPH to ASC
58563 57522 Site of Service (SOS) OPH to ASC
58565 57522 Site of Service (SOS) OPH to ASC
58146 58140 Infertility w/ DX
58140 58145 Infertility w/ DX
58146 58145 Infertility w/ DX
58145 58146 Infertility w/ DX
58152 58150 Hysterectomy - IP and OP
58554 58150 Hysterectomy - IP and OP
58150 58180 Hysterectomy - IP and OP
58152 58180 Hysterectomy - IP and OP
58572 58180 Hysterectomy - IP and OP
58262 58260 Hysterectomy - IP Only
58263 58260 Hysterectomy - IP Only
58267 58260 Hysterectomy - IP Only
58270 58260 Hysterectomy - IP Only
58275 58260 Hysterectomy - IP Only
58280 58260 Hysterectomy - IP Only
58290 58260 Hysterectomy - IP Only
58291 58260 Hysterectomy - IP Only
58292 58260 Hysterectomy - IP Only
58293 58260 Hysterectomy - IP Only
58294 58260 Hysterectomy - IP Only
58263 58262 Hysterectomy - IP Only
58267 58262 Hysterectomy - IP Only
58275 58262 Hysterectomy - IP Only
58280 58262 Hysterectomy - IP Only
58290 58262 Hysterectomy - IP Only
58291 58262 Hysterectomy - IP Only
58292 58262 Hysterectomy - IP Only
58293 58262 Hysterectomy - IP Only
58294 58262 Hysterectomy - IP Only
Page 41 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
58267 58263 Hysterectomy - IP Only
58280 58263 Hysterectomy - IP Only
58290 58263 Hysterectomy - IP Only
58291 58263 Hysterectomy - IP Only
58292 58263 Hysterectomy - IP Only
58293 58263 Hysterectomy - IP Only
58294 58263 Hysterectomy - IP Only
58280 58267 Hysterectomy - IP Only
58290 58267 Hysterectomy - IP Only
58291 58267 Hysterectomy - IP Only
58292 58267 Hysterectomy - IP Only
58293 58267 Hysterectomy - IP Only
58294 58267 Hysterectomy - IP Only
58262 58270 Hysterectomy - IP Only
58263 58270 Hysterectomy - IP Only
58267 58270 Hysterectomy - IP Only
58275 58270 Hysterectomy - IP Only
58280 58270 Hysterectomy - IP Only
58290 58270 Hysterectomy - IP Only
58291 58270 Hysterectomy - IP Only
58292 58270 Hysterectomy - IP Only
58293 58270 Hysterectomy - IP Only
58294 58270 Hysterectomy - IP Only
58263 58275 Hysterectomy - IP Only
58267 58275 Hysterectomy - IP Only
58280 58275 Hysterectomy - IP Only
58290 58275 Hysterectomy - IP Only
58291 58275 Hysterectomy - IP Only
58292 58275 Hysterectomy - IP Only
58293 58275 Hysterectomy - IP Only
58294 58275 Hysterectomy - IP Only
58290 58280 Hysterectomy - IP Only
58291 58280 Hysterectomy - IP Only
58292 58280 Hysterectomy - IP Only
58293 58280 Hysterectomy - IP Only
58294 58280 Hysterectomy - IP Only
58260 58290 Hysterectomy - IP Only
58291 58290 Hysterectomy - IP Only
58292 58290 Hysterectomy - IP Only
58293 58290 Hysterectomy - IP Only
58294 58290 Hysterectomy - IP Only
58262 58291 Hysterectomy - IP Only
58292 58291 Hysterectomy - IP Only
58293 58291 Hysterectomy - IP Only
58263 58292 Hysterectomy - IP Only
58293 58292 Hysterectomy - IP Only
58267 58293 Hysterectomy - IP Only
58270 58294 Hysterectomy - IP Only
58291 58294 Hysterectomy - IP Only
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
58292 58294 Hysterectomy - IP Only
58293 58294 Hysterectomy - IP Only
58563 58353 Site of Service (SOS) OPH to ASC
57522 58353 Site of Service (SOS) OPH to ASC
58558 58353 Site of Service (SOS) OPH to ASC
58565 58353 Site of Service (SOS) OPH to ASC
58542 58541 Hysterectomy - IP and OP
58543 58541 Hysterectomy - IP and OP
58544 58541 Hysterectomy - IP and OP
58550 58541 Hysterectomy - IP and OP
58552 58541 Hysterectomy - IP and OP
58553 58541 Hysterectomy - IP and OP
58554 58541 Hysterectomy - IP and OP
58570 58541 Hysterectomy - IP and OP
58571 58541 Hysterectomy - IP and OP
58572 58541 Hysterectomy - IP and OP
58573 58541 Hysterectomy - IP and OP
58543 58542 Hysterectomy - IP and OP
58544 58542 Hysterectomy - IP and OP
58550 58542 Hysterectomy - IP and OP
58552 58542 Hysterectomy - IP and OP
58553 58542 Hysterectomy - IP and OP
58554 58542 Hysterectomy - IP and OP
58571 58542 Hysterectomy - IP and OP
58572 58542 Hysterectomy - IP and OP
58573 58542 Hysterectomy - IP and OP
58541 58543 Hysterectomy - IP and OP
58544 58543 Hysterectomy - IP and OP
58550 58543 Hysterectomy - IP and OP
58552 58543 Hysterectomy - IP and OP
58553 58543 Hysterectomy - IP and OP
58554 58543 Hysterectomy - IP and OP
58571 58543 Hysterectomy - IP and OP
58572 58543 Hysterectomy - IP and OP
58573 58543 Hysterectomy - IP and OP
58542 58544 Hysterectomy - IP and OP
58552 58544 Hysterectomy - IP and OP
58553 58544 Hysterectomy - IP and OP
58554 58544 Hysterectomy - IP and OP
58571 58544 Hysterectomy - IP and OP
58572 58544 Hysterectomy - IP and OP
58573 58544 Hysterectomy - IP and OP
58546 58545 Infertility w/ DX
58544 58550 Hysterectomy - IP and OP
58552 58550 Hysterectomy - IP and OP
58553 58550 Hysterectomy - IP and OP
58554 58550 Hysterectomy - IP and OP
58571 58550 Hysterectomy - IP and OP
58572 58550 Hysterectomy - IP and OP
Page 42 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
58573 58550 Hysterectomy - IP and OP
58553 58552 Hysterectomy - IP and OP
58554 58552 Hysterectomy - IP and OP
58572 58552 Hysterectomy - IP and OP
58573 58552 Hysterectomy - IP and OP
58550 58553 Hysterectomy - IP and OP
58554 58553 Hysterectomy - IP and OP
58573 58553 Hysterectomy - IP and OP
58552 58554 Hysterectomy - IP and OP
58563 58558 Site of Service (SOS) OPH to ASC
57522 58558 Site of Service (SOS) OPH to ASC
58353 58558 Site of Service (SOS) OPH to ASC
58565 58558 Site of Service (SOS) OPH to ASC
58353 58563 Site of Service (SOS) OPH to ASC
58558 58563 Site of Service (SOS) OPH to ASC
57522 58563 Site of Service (SOS) OPH to ASC
58565 58563 Site of Service (SOS) OPH to ASC
58353 58565 Site of Service (SOS) OPH to ASC
58558 58565 Site of Service (SOS) OPH to ASC
57522 58565 Site of Service (SOS) OPH to ASC
58563 58565 Site of Service (SOS) OPH to ASC
58267 58570 Hysterectomy - IP and OP
58542 58570 Hysterectomy - IP and OP
58543 58570 Hysterectomy - IP and OP
58544 58570 Hysterectomy - IP and OP
58550 58570 Hysterectomy - IP and OP
58552 58570 Hysterectomy - IP and OP
58553 58570 Hysterectomy - IP and OP
58554 58570 Hysterectomy - IP and OP
58571 58570 Hysterectomy - IP and OP
58572 58570 Hysterectomy - IP and OP
58573 58570 Hysterectomy - IP and OP
58552 58571 Hysterectomy - IP and OP
58553 58571 Hysterectomy - IP and OP
58554 58571 Hysterectomy - IP and OP
58572 58571 Hysterectomy - IP and OP
58573 58571 Hysterectomy - IP and OP
58553 58572 Hysterectomy - IP and OP
58554 58572 Hysterectomy - IP and OP
58570 58572 Hysterectomy - IP and OP
58573 58572 Hysterectomy - IP and OP
58554 58573 Hysterectomy - IP and OP
58571 58573 Hysterectomy - IP and OP
58720 58661 Gender Dysphoria Treatment w diagnosis code
58661 58940 Gender Dysphoria Treatment w diagnosis code
58720 58940 Gender Dysphoria Treatment w diagnosis code
61867 61863 Potentially Unproven Services
61863 61864 Potentially Unproven Services
61867 61868 Potentially Unproven Services
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
64568 61885 Vagus Nerve Stimulation
62320 62270 Site of Service (SOS) Office Based Programs
62321 62320 Site of Service (SOS) Office Based Programs
62320 62321 Site of Service (SOS) Office Based Programs
64479 62321 Site of Service (SOS) Office Based Programs
64483 62321 Site of Service (SOS) Office Based Programs
62320 62322 Site of Service (SOS) Office Based Programs
62321 62322 Site of Service (SOS) Office Based Programs
62323 62322 Site of Service (SOS) Office Based Programs
62320 62323 Site of Service (SOS) Office Based Programs
62321 62323 Site of Service (SOS) Office Based Programs
62322 62323 Site of Service (SOS) Office Based Programs
64483 62323 Site of Service (SOS) Office Based Programs
64493 62323 Site of Service (SOS) Office Based Programs
64494 62323 Site of Service (SOS) Office Based Programs
64495 62323 Site of Service (SOS) Office Based Programs
62263 62323 Site of Service (SOS) Office Based Programs
63015 63001 Spine Surgery
63040 63001 Spine Surgery
63045 63001 Spine Surgery
63016 63003 Spine Surgery
63012 63005 Spine Surgery
63017 63005 Spine Surgery
63042 63005 Spine Surgery
63005 63011 Spine Surgery
63012 63011 Spine Surgery
63017 63011 Spine Surgery
63042 63011 Spine Surgery
63047 63011 Spine Surgery
63017 63012 Spine Surgery
63042 63012 Spine Surgery
63042 63017 Spine Surgery
63001 63020 Spine Surgery
63015 63020 Spine Surgery
63040 63020 Spine Surgery
63045 63020 Spine Surgery
63005 63030 Spine Surgery
63011 63030 Spine Surgery
63012 63030 Spine Surgery
63017 63030 Spine Surgery
63042 63030 Spine Surgery
63047 63030 Spine Surgery
63020 63035 Spine Surgery
63030 63035 Spine Surgery
63015 63040 Spine Surgery
63040 63043 Spine Surgery
63042 63044 Spine Surgery
63051 63045 Spine Surgery
63015 63045 Spine Surgery
Page 43 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
63040 63045 Spine Surgery
63003 63046 Spine Surgery
63016 63046 Spine Surgery
63005 63047 Spine Surgery
63012 63047 Spine Surgery
63017 63047 Spine Surgery
63042 63047 Spine Surgery
63045 63048 Spine Surgery
63046 63048 Spine Surgery
63047 63048 Spine Surgery
63051 63050 Spine Surgery
63064 63055 Spine Surgery
63055 63057 Spine Surgery
63056 63057 Spine Surgery
63064 63066 Spine Surgery
63081 63075 Spine Surgery
63075 63076 Spine Surgery
63085 63077 Spine Surgery
63087 63077 Spine Surgery
63090 63077 Spine Surgery
63101 63077 Spine Surgery
63077 63078 Spine Surgery
63081 63082 Spine Surgery
63087 63085 Spine Surgery
63090 63085 Spine Surgery
63101 63085 Spine Surgery
63085 63086 Spine Surgery
63087 63088 Spine Surgery
63087 63090 Spine Surgery
63101 63090 Spine Surgery
63102 63090 Spine Surgery
63090 63091 Spine Surgery
63087 63101 Spine Surgery
63087 63102 Spine Surgery
63101 63103 Spine Surgery
63102 63103 Spine Surgery
63173 63170 Spine Surgery
63182 63170 Spine Surgery
63197 63170 Spine Surgery
63198 63170 Spine Surgery
63199 63170 Spine Surgery
63170 63172 Spine Surgery
63180 63172 Spine Surgery
63182 63172 Spine Surgery
63198 63172 Spine Surgery
63199 63172 Spine Surgery
63199 63173 Spine Surgery
63170 63180 Spine Surgery
63182 63180 Spine Surgery
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
63194 63180 Spine Surgery
63198 63180 Spine Surgery
63198 63182 Spine Surgery
63170 63185 Spine Surgery
63172 63185 Spine Surgery
63173 63185 Spine Surgery
63182 63185 Spine Surgery
63190 63185 Spine Surgery
63191 63185 Spine Surgery
63194 63185 Spine Surgery
63195 63185 Spine Surgery
63196 63185 Spine Surgery
63197 63185 Spine Surgery
63198 63185 Spine Surgery
63199 63185 Spine Surgery
63200 63185 Spine Surgery
63170 63190 Spine Surgery
63172 63190 Spine Surgery
63173 63190 Spine Surgery
63182 63190 Spine Surgery
63191 63190 Spine Surgery
63195 63190 Spine Surgery
63194 63190 Spine Surgery
63196 63190 Spine Surgery
63197 63190 Spine Surgery
63198 63190 Spine Surgery
63199 63190 Spine Surgery
63200 63190 Spine Surgery
63170 63191 Spine Surgery
63172 63191 Spine Surgery
63173 63191 Spine Surgery
63182 63191 Spine Surgery
63190 63191 Spine Surgery
63194 63191 Spine Surgery
63195 63191 Spine Surgery
63196 63191 Spine Surgery
63197 63191 Spine Surgery
63198 63191 Spine Surgery
63199 63191 Spine Surgery
63200 63191 Spine Surgery
63170 63194 Spine Surgery
63172 63194 Spine Surgery
63182 63194 Spine Surgery
63196 63194 Spine Surgery
63198 63194 Spine Surgery
63170 63195 Spine Surgery
63173 63195 Spine Surgery
63197 63195 Spine Surgery
63199 63195 Spine Surgery
Page 44 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
63170 63196 Spine Surgery
63172 63196 Spine Surgery
63182 63196 Spine Surgery
63198 63196 Spine Surgery
63173 63197 Spine Surgery
63199 63197 Spine Surgery
63170 63200 Spine Surgery
63250 63265 Spine Surgery
63270 63265 Spine Surgery
63275 63265 Spine Surgery
63280 63265 Spine Surgery
63285 63265 Spine Surgery
63290 63265 Spine Surgery
63251 63266 Spine Surgery
63271 63266 Spine Surgery
63276 63266 Spine Surgery
63281 63266 Spine Surgery
63286 63266 Spine Surgery
63290 63266 Spine Surgery
63272 63267 Spine Surgery
63277 63267 Spine Surgery
63282 63267 Spine Surgery
63290 63267 Spine Surgery
63273 63268 Spine Surgery
63278 63268 Spine Surgery
63283 63268 Spine Surgery
63290 63268 Spine Surgery
63250 63270 Spine Surgery
63280 63270 Spine Surgery
63285 63270 Spine Surgery
63290 63270 Spine Surgery
63251 63271 Spine Surgery
63281 63271 Spine Surgery
63286 63271 Spine Surgery
63290 63271 Spine Surgery
63282 63272 Spine Surgery
63290 63272 Spine Surgery
63283 63273 Spine Surgery
63290 63273 Spine Surgery
63250 63275 Spine Surgery
63270 63275 Spine Surgery
63280 63275 Spine Surgery
63285 63275 Spine Surgery
63290 63275 Spine Surgery
63251 63276 Spine Surgery
63271 63276 Spine Surgery
63281 63276 Spine Surgery
63286 63276 Spine Surgery
63290 63276 Spine Surgery
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
63272 63277 Spine Surgery
63282 63277 Spine Surgery
63290 63277 Spine Surgery
63273 63278 Spine Surgery
63283 63278 Spine Surgery
63290 63278 Spine Surgery
63250 63280 Spine Surgery
63285 63280 Spine Surgery
63290 63280 Spine Surgery
63251 63281 Spine Surgery
63286 63281 Spine Surgery
63290 63281 Spine Surgery
63290 63282 Spine Surgery
63290 63283 Spine Surgery
63250 63285 Spine Surgery
63290 63285 Spine Surgery
63251 63286 Spine Surgery
63290 63286 Spine Surgery
63252 63287 Spine Surgery
63290 63287 Spine Surgery
63250 63290 Spine Surgery
63251 63290 Spine Surgery
63252 63290 Spine Surgery
63172 63295 Spine Surgery
63173 63295 Spine Surgery
63185 63295 Spine Surgery
63190 63295 Spine Surgery
63200 63295 Spine Surgery
63250 63295 Spine Surgery
63251 63295 Spine Surgery
63252 63295 Spine Surgery
63265 63295 Spine Surgery
63266 63295 Spine Surgery
63267 63295 Spine Surgery
63268 63295 Spine Surgery
63270 63295 Spine Surgery
63271 63295 Spine Surgery
63272 63295 Spine Surgery
63273 63295 Spine Surgery
63275 63295 Spine Surgery
63276 63295 Spine Surgery
63277 63295 Spine Surgery
63278 63295 Spine Surgery
63280 63295 Spine Surgery
63281 63295 Spine Surgery
63282 63295 Spine Surgery
63283 63295 Spine Surgery
63285 63295 Spine Surgery
63286 63295 Spine Surgery
Page 45 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
63287 63295 Spine Surgery
63290 63295 Spine Surgery
63304 63300 Spine Surgery
63302 63301 Spine Surgery
63305 63301 Spine Surgery
63305 63302 Spine Surgery
63301 63306 Spine Surgery
63302 63306 Spine Surgery
63305 63306 Spine Surgery
63303 63307 Spine Surgery
63300 63308 Spine Surgery
63301 63308 Spine Surgery
63302 63308 Spine Surgery
63303 63308 Spine Surgery
63304 63308 Spine Surgery
63305 63308 Spine Surgery
63306 63308 Spine Surgery
63307 63308 Spine Surgery
63655 63650 Spinal Cord Stimulators
63662 63661 Spinal Cord Stimulators
63664 63662 Spinal Cord Stimulators
63664 63663 Spinal Cord Stimulators
63650 63685 Spinal Cord Stimulators
63655 63685 Spinal Cord Stimulators
63663 63688 Spinal Cord Stimulators
64483 64479 Site of Service (SOS) Office Based Programs
62320 64479 Site of Service (SOS) Office Based Programs
62323 64483 Site of Service (SOS) Office Based Programs
64479 64483 Site of Service (SOS) Office Based Programs
64493 64483 Site of Service (SOS) Office Based Programs
64479 64490 Site of Service (SOS) Office Based Programs
64483 64490 Site of Service (SOS) Office Based Programs
64633 64490 Site of Service (SOS) Office Based Programs
64634 64490 Site of Service (SOS) Office Based Programs
64479 64493 Site of Service (SOS) Office Based Programs
64483 64493 Site of Service (SOS) Office Based Programs
64490 64493 Site of Service (SOS) Office Based Programs
64633 64635 Site of Service (SOS) Office Based Programs
62323 64635 Site of Service (SOS) Office Based Programs
64493 64635 Site of Service (SOS) Office Based Programs
64494 64635 Site of Service (SOS) Office Based Programs
29848 64721 Site of Service (SOS) OPH to ASC
64892 64856 Gender Dysphoria Treatment w diagnosis code
64896 64856 Gender Dysphoria Treatment w diagnosis code
64896 64892 Gender Dysphoria Treatment w diagnosis code
66761 65855 Site of Service (SOS) OPH to ASC
65855 66761 Site of Service (SOS) OPH to ASC
66984 66982 Site of Service (SOS) OPH to ASC
66982 66984 Site of Service (SOS) OPH to ASC
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
67040 67036 Site of Service (SOS) OPH to ASC
67036 67040 Site of Service (SOS) OPH to ASC
67312 67311 Cosmetic & Reconstructive
67311 67312 Site of Service (SOS) OPH to ASC
67901 67900 Cosmetic & Reconstructive
67902 67900 Cosmetic & Reconstructive
67904 67900 Cosmetic & Reconstructive
67911 67900 Cosmetic & Reconstructive
67902 67901 Cosmetic & Reconstructive
67904 67901 Cosmetic & Reconstructive
67900 67903 Cosmetic & Reconstructive
67901 67903 Cosmetic & Reconstructive
67902 67903 Cosmetic & Reconstructive
67904 67903 Cosmetic & Reconstructive
67906 67903 Cosmetic & Reconstructive
67911 67903 Cosmetic & Reconstructive
67902 67904 Cosmetic & Reconstructive
67900 67906 Cosmetic & Reconstructive
67901 67906 Cosmetic & Reconstructive
67902 67906 Cosmetic & Reconstructive
67904 67906 Cosmetic & Reconstructive
67911 67906 Cosmetic & Reconstructive
67900 67908 Cosmetic & Reconstructive
67901 67908 Cosmetic & Reconstructive
67902 67908 Cosmetic & Reconstructive
67903 67908 Cosmetic & Reconstructive
67904 67908 Cosmetic & Reconstructive
67906 67908 Cosmetic & Reconstructive
67909 67908 Cosmetic & Reconstructive
67911 67908 Cosmetic & Reconstructive
67912 67908 Cosmetic & Reconstructive
67961 67908 Cosmetic & Reconstructive
67900 67909 Cosmetic & Reconstructive
67901 67909 Cosmetic & Reconstructive
67902 67909 Cosmetic & Reconstructive
67903 67909 Cosmetic & Reconstructive
67904 67909 Cosmetic & Reconstructive
67906 67909 Cosmetic & Reconstructive
67911 67909 Cosmetic & Reconstructive
67912 67909 Cosmetic & Reconstructive
67961 67909 Cosmetic & Reconstructive
67901 67911 Cosmetic & Reconstructive
67902 67911 Cosmetic & Reconstructive
67904 67911 Cosmetic & Reconstructive
67900 67912 Cosmetic & Reconstructive
67901 67912 Cosmetic & Reconstructive
67902 67912 Cosmetic & Reconstructive
67904 67912 Cosmetic & Reconstructive
67906 67912 Cosmetic & Reconstructive
Page 46 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
67911 67912 Cosmetic & Reconstructive
67916 67914 Cosmetic & Reconstructive
67917 67914 Cosmetic & Reconstructive
67923 67914 Cosmetic & Reconstructive
67924 67914 Cosmetic & Reconstructive
67914 67915 Cosmetic & Reconstructive
67916 67915 Cosmetic & Reconstructive
67917 67915 Cosmetic & Reconstructive
67921 67915 Cosmetic & Reconstructive
67923 67915 Cosmetic & Reconstructive
67924 67915 Cosmetic & Reconstructive
67917 67916 Cosmetic & Reconstructive
67924 67916 Cosmetic & Reconstructive
67924 67917 Cosmetic & Reconstructive
67914 67921 Cosmetic & Reconstructive
67916 67921 Cosmetic & Reconstructive
67923 67921 Cosmetic & Reconstructive
67924 67921 Cosmetic & Reconstructive
67914 67922 Cosmetic & Reconstructive
67915 67922 Cosmetic & Reconstructive
67916 67922 Cosmetic & Reconstructive
67921 67922 Cosmetic & Reconstructive
67923 67922 Cosmetic & Reconstructive
67924 67922 Cosmetic & Reconstructive
67916 67923 Cosmetic & Reconstructive
67924 67923 Cosmetic & Reconstructive
67900 67961 Cosmetic & Reconstructive
67901 67961 Cosmetic & Reconstructive
67902 67961 Cosmetic & Reconstructive
67903 67961 Cosmetic & Reconstructive
67904 67961 Cosmetic & Reconstructive
67906 67961 Cosmetic & Reconstructive
67911 67961 Cosmetic & Reconstructive
67912 67961 Cosmetic & Reconstructive
67966 67961 Cosmetic & Reconstructive
69631 69436 Site of Service (SOS) OPH to ASC
69436 69631 Site of Service (SOS) OPH to ASC
69714 69710 Cochlear Implants and Other Auditory Implants
69715 69710 Cochlear Implants and Other Auditory Implants
69715 69714 Cochlear Implants and Other Auditory Implants
69717 69714 Cochlear Implants and Other Auditory Implants
69718 69714 Cochlear Implants and Other Auditory Implants
69930 69714 Cochlear Implants and Other Auditory Implants
69718 69715 Cochlear Implants and Other Auditory Implants
69715 69930 Cochlear Implants and Other Auditory Implants
69718 69930 Cochlear Implants and Other Auditory Implants
77386 77385 IMRT
77522 77520 Proton Beam Therapy
77523 77520 Proton Beam Therapy
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
77525 77520 Proton Beam Therapy
77523 77522 Proton Beam Therapy
77525 77522 Proton Beam Therapy
77525 77523 Proton Beam Therapy
90937 90935 End Stage Renal Disease (ESRD)
90999 90935 End Stage Renal Disease (ESRD)
90999 90937 End Stage Renal Disease (ESRD)
90947 90945 End Stage Renal Disease (ESRD)
90999 90945 End Stage Renal Disease (ESRD)
90999 90947 End Stage Renal Disease (ESRD)
93531 93530 Congenital Heart Disease
93532 93530 Congenital Heart Disease
93533 93530 Congenital Heart Disease
93532 93531 Congenital Heart Disease
93533 93531 Congenital Heart Disease
93533 93532 Congenital Heart Disease
93531 93533 Congenital Heart Disease
93532 93533 Congenital Heart Disease
93562 93561 Congenital Heart Disease
93561 93562 Congenital Heart Disease
93581 93580 Congenital Heart Disease
95807 95805 Sleep Studies
95808 95805 Sleep Studies
95810 95805 Sleep Studies
95811 95805 Sleep Studies
95808 95807 Sleep Studies
95810 95807 Sleep Studies
95811 95807 Sleep Studies
95811 95808 Sleep Studies
95808 95810 Sleep Studies
95811 95810 Sleep Studies
95980 95981 Bariatric Surgery
95982 95981 Bariatric Surgery
95980 95982 Bariatric Surgery
0072T 0071T MR-Guided Focused Ultrasound to treat Uterine Fibroids
0269T 0270T Potentially Unproven Services
0269T 0271T Potentially Unproven Services
0313T 0312T Bariatric Surgery
0314T 0312T Bariatric Surgery
0315T 0312T Bariatric Surgery
0316T 0312T Bariatric Surgery
0312T 0313T Bariatric Surgery
0314T 0313T Bariatric Surgery
0315T 0313T Bariatric Surgery
0316T 0313T Bariatric Surgery
0312T 0314T Bariatric Surgery
0313T 0314T Bariatric Surgery
0315T 0314T Bariatric Surgery
0316T 0314T Bariatric Surgery
Page 47 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
0312T 0315T Bariatric Surgery
0313T 0315T Bariatric Surgery
0314T 0315T Bariatric Surgery
0316T 0315T Bariatric Surgery
0312T 0316T Bariatric Surgery
0313T 0316T Bariatric Surgery
0314T 0316T Bariatric Surgery
0315T 0316T Bariatric Surgery
A0431 A0430 Non Emergency Transport - Air
A0435 A0430 Non Emergency Transport - Air
A0436 A0430 Non Emergency Transport - Air
A0430 A0431 Non Emergency Transport - Air
A0435 A0431 Non Emergency Transport - Air
A0436 A0431 Non Emergency Transport - Air
A0430 A0435 Non Emergency Transport - Air
A0431 A0435 Non Emergency Transport - Air
A0430 A0436 Non Emergency Transport - Air
A0431 A0436 Non Emergency Transport - Air
A0435 A0436 Non Emergency Transport - Air
E0265 E0266 DME greater than $1,000
E0296 E0297 DME greater than $1,000
E0304 E0302 DME greater than $1,000
E0329 E0328 DME greater than $1,000
E0747 E0760 Bone Growth Stimulator
E0748 E0760 Bone Growth Stimulator
E1004 E1003 DME greater than $1,000
E1005 E1003 DME greater than $1,000
E1007 E1006 DME greater than $1,000
E1008 E1006 DME greater than $1,000
E1236 E1238 DME greater than $1,000
E2311 E2310 DME greater than $1,000
E2504 E2502 DME greater than $1,000
E2506 E2502 DME greater than $1,000
E2506 E2504 DME greater than $1,000
77385 G6015 IMRT
77386 G6016 IMRT
J0257 J0256 Injectable Medications - Alpha1 - Proteinase
J0256 J0257 Injectable Medications - Alpha1 - Proteinase
J1556 J1459 Injectable Medications - Immune Globulin
J1557 J1459 Injectable Medications - Immune Globulin
J1561 J1459 Injectable Medications - Immune Globulin
J1562 J1459 Injectable Medications - Immune Globulin
J1566 J1459 Injectable Medications - Immune Globulin
J1568 J1459 Injectable Medications - Immune Globulin
J1569 J1459 Injectable Medications - Immune Globulin
J1572 J1459 Injectable Medications - Immune Globulin
J1575 J1459 Injectable Medications - Immune Globulin
J1599 J1459 Injectable Medications - Immune Globulin
J1459 J1556 Injectable Medications - Immune Globulin
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
J1557 J1556 Injectable Medications - Immune Globulin
J1561 J1556 Injectable Medications - Immune Globulin
J1562 J1556 Injectable Medications - Immune Globulin
J1566 J1556 Injectable Medications - Immune Globulin
J1568 J1556 Injectable Medications - Immune Globulin
J1569 J1556 Injectable Medications - Immune Globulin
J1572 J1556 Injectable Medications - Immune Globulin
J1575 J1556 Injectable Medications - Immune Globulin
J1599 J1556 Injectable Medications - Immune Globulin
J1459 J1557 Injectable Medications - Immune Globulin
J1556 J1557 Injectable Medications - Immune Globulin
J1561 J1557 Injectable Medications - Immune Globulin
J1562 J1557 Injectable Medications - Immune Globulin
J1566 J1557 Injectable Medications - Immune Globulin
J1568 J1557 Injectable Medications - Immune Globulin
J1569 J1557 Injectable Medications - Immune Globulin
J1572 J1557 Injectable Medications - Immune Globulin
J1575 J1557 Injectable Medications - Immune Globulin
J1599 J1557 Injectable Medications - Immune Globulin
J1459 J1561 Injectable Medications - Immune Globulin
J1556 J1561 Injectable Medications - Immune Globulin
J1557 J1561 Injectable Medications - Immune Globulin
J1562 J1561 Injectable Medications - Immune Globulin
J1566 J1561 Injectable Medications - Immune Globulin
J1568 J1561 Injectable Medications - Immune Globulin
J1569 J1561 Injectable Medications - Immune Globulin
J1572 J1561 Injectable Medications - Immune Globulin
J1575 J1561 Injectable Medications - Immune Globulin
J1599 J1561 Injectable Medications - Immune Globulin
J1459 J1562 Injectable Medications - Immune Globulin
J1556 J1562 Injectable Medications - Immune Globulin
J1557 J1562 Injectable Medications - Immune Globulin
J1561 J1562 Injectable Medications - Immune Globulin
J1566 J1562 Injectable Medications - Immune Globulin
J1568 J1562 Injectable Medications - Immune Globulin
J1569 J1562 Injectable Medications - Immune Globulin
J1572 J1562 Injectable Medications - Immune Globulin
J1575 J1562 Injectable Medications - Immune Globulin
J1599 J1562 Injectable Medications - Immune Globulin
J1459 J1566 Injectable Medications - Immune Globulin
J1556 J1566 Injectable Medications - Immune Globulin
J1557 J1566 Injectable Medications - Immune Globulin
J1561 J1566 Injectable Medications - Immune Globulin
J1562 J1566 Injectable Medications - Immune Globulin
J1568 J1566 Injectable Medications - Immune Globulin
J1569 J1566 Injectable Medications - Immune Globulin
J1572 J1566 Injectable Medications - Immune Globulin
J1575 J1566 Injectable Medications - Immune Globulin
J1599 J1566 Injectable Medications - Immune Globulin
Page 48 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
J1459 J1568 Injectable Medications - Immune Globulin
J1556 J1568 Injectable Medications - Immune Globulin
J1557 J1568 Injectable Medications - Immune Globulin
J1561 J1568 Injectable Medications - Immune Globulin
J1562 J1568 Injectable Medications - Immune Globulin
J1566 J1568 Injectable Medications - Immune Globulin
J1569 J1568 Injectable Medications - Immune Globulin
J1572 J1568 Injectable Medications - Immune Globulin
J1575 J1568 Injectable Medications - Immune Globulin
J1599 J1568 Injectable Medications - Immune Globulin
J1459 J1569 Injectable Medications - Immune Globulin
J1556 J1569 Injectable Medications - Immune Globulin
J1557 J1569 Injectable Medications - Immune Globulin
J1561 J1569 Injectable Medications - Immune Globulin
J1562 J1569 Injectable Medications - Immune Globulin
J1566 J1569 Injectable Medications - Immune Globulin
J1568 J1569 Injectable Medications - Immune Globulin
J1572 J1569 Injectable Medications - Immune Globulin
J1575 J1569 Injectable Medications - Immune Globulin
J1599 J1569 Injectable Medications - Immune Globulin
J1459 J1572 Injectable Medications - Immune Globulin
J1556 J1572 Injectable Medications - Immune Globulin
J1557 J1572 Injectable Medications - Immune Globulin
J1561 J1572 Injectable Medications - Immune Globulin
J1562 J1572 Injectable Medications - Immune Globulin
J1566 J1572 Injectable Medications - Immune Globulin
J1568 J1572 Injectable Medications - Immune Globulin
J1569 J1572 Injectable Medications - Immune Globulin
J1575 J1572 Injectable Medications - Immune Globulin
J1599 J1572 Injectable Medications - Immune Globulin
J1459 J1575 Injectable Medications - Immune Globulin
J1556 J1575 Injectable Medications - Immune Globulin
J1557 J1575 Injectable Medications - Immune Globulin
J1561 J1575 Injectable Medications - Immune Globulin
J1562 J1575 Injectable Medications - Immune Globulin
J1566 J1575 Injectable Medications - Immune Globulin
J1568 J1575 Injectable Medications - Immune Globulin
J1569 J1575 Injectable Medications - Immune Globulin
J1572 J1575 Injectable Medications - Immune Globulin
J1599 J1575 Injectable Medications - Immune Globulin
J1459 J1599 Injectable Medications - Immune Globulin
J1556 J1599 Injectable Medications - Immune Globulin
J1557 J1599 Injectable Medications - Immune Globulin
J1561 J1599 Injectable Medications - Immune Globulin
J1562 J1599 Injectable Medications - Immune Globulin
J1566 J1599 Injectable Medications - Immune Globulin
J1568 J1599 Injectable Medications - Immune Globulin
J1569 J1599 Injectable Medications - Immune Globulin
J1572 J1599 Injectable Medications - Immune Globulin
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
J1575 J1599 Injectable Medications - Immune Globulin
Q5103 J1745 Injectable Medications - Inflammatory
Q5104 J1745 Injectable Medications - Inflammatory
J3060 J3385 Injectable Medications - Gaucher's Disease
J1786 J3385 Injectable Medications - Gaucher's Disease
L0430 L0220 Orthotics greater than $1,000
L0462 L0220 Orthotics greater than $1,000
L0464 L0220 Orthotics greater than $1,000
L0466 L0220 Orthotics greater than $1,000
L0468 L0220 Orthotics greater than $1,000
L0480 L0220 Orthotics greater than $1,000
L0482 L0220 Orthotics greater than $1,000
L0484 L0220 Orthotics greater than $1,000
L0486 L0220 Orthotics greater than $1,000
L0490 L0220 Orthotics greater than $1,000
L0491 L0220 Orthotics greater than $1,000
L0492 L0220 Orthotics greater than $1,000
L0482 L0480 Orthotics greater than $1,000
L0484 L0480 Orthotics greater than $1,000
L0486 L0480 Orthotics greater than $1,000
L0484 L0482 Orthotics greater than $1,000
L0486 L0482 Orthotics greater than $1,000
L0486 L0484 Orthotics greater than $1,000
L0636 L0638 Orthotics greater than $1,000
L1680 L1640 Orthotics greater than $1,000
L1685 L1640 Orthotics greater than $1,000
L1690 L1640 Orthotics greater than $1,000
L1690 L1680 Orthotics greater than $1,000
L1680 L1685 Orthotics greater than $1,000
L1690 L1685 Orthotics greater than $1,000
L1710 L1700 Orthotics greater than $1,000
L1755 L1700 Orthotics greater than $1,000
L1710 L1720 Orthotics greater than $1,000
L1755 L1720 Orthotics greater than $1,000
L1700 L1720 Orthotics greater than $1,000
L1710 L1755 Orthotics greater than $1,000
L2005 L2020 Orthotics greater than $1,000
L2034 L2020 Orthotics greater than $1,000
L2036 L2020 Orthotics greater than $1,000
L2037 L2020 Orthotics greater than $1,000
L2038 L2020 Orthotics greater than $1,000
L2005 L2034 Orthotics greater than $1,000
L2005 L2036 Orthotics greater than $1,000
L2034 L2036 Orthotics greater than $1,000
L2005 L2037 Orthotics greater than $1,000
L2034 L2037 Orthotics greater than $1,000
L2036 L2037 Orthotics greater than $1,000
L2005 L2038 Orthotics greater than $1,000
L2034 L2038 Orthotics greater than $1,000
Page 49 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
L2036 L2038 Orthotics greater than $1,000
L2037 L2038 Orthotics greater than $1,000
L3901 L3900 Orthotics greater than $1,000
L3904 L3900 Orthotics greater than $1,000
L3904 L3901 Orthotics greater than $1,000
L3967 L3961 Orthotics greater than $1,000
L3973 L3971 Orthotics greater than $1,000
L3977 L3971 Orthotics greater than $1,000
L3978 L3971 Orthotics greater than $1,000
L3978 L3973 Orthotics greater than $1,000
L3973 L3975 Orthotics greater than $1,000
L3977 L3975 Orthotics greater than $1,000
L3978 L3975 Orthotics greater than $1,000
L3971 L3975 Orthotics greater than $1,000
L3976 L3975 Orthotics greater than $1,000
L3971 L3976 Orthotics greater than $1,000
L3973 L3976 Orthotics greater than $1,000
L3977 L3976 Orthotics greater than $1,000
L3978 L3976 Orthotics greater than $1,000
L3975 L3976 Orthotics greater than $1,000
L3971 L3977 Orthotics greater than $1,000
L3973 L3977 Orthotics greater than $1,000
L3978 L3977 Orthotics greater than $1,000
L3973 L3978 Orthotics greater than $1,000
L5020 L5010 Prosthetics greater than $1,000
L5060 L5050 Prosthetics greater than $1,000
L5105 L5100 Prosthetics greater than $1,000
L5160 L5150 Prosthetics greater than $1,000
L5230 L5200 Prosthetics greater than $1,000
L5230 L5210 Prosthetics greater than $1,000
L5200 L5210 Prosthetics greater than $1,000
L5220 L5210 Prosthetics greater than $1,000
L5250 L5270 Prosthetics greater than $1,000
L5280 L5301 Prosthetics greater than $1,000
L5312 L5301 Prosthetics greater than $1,000
L5321 L5301 Prosthetics greater than $1,000
L5331 L5301 Prosthetics greater than $1,000
L5341 L5301 Prosthetics greater than $1,000
L5280 L5321 Prosthetics greater than $1,000
L5312 L5321 Prosthetics greater than $1,000
L5331 L5321 Prosthetics greater than $1,000
L5341 L5321 Prosthetics greater than $1,000
L5280 L5331 Prosthetics greater than $1,000
L5341 L5331 Prosthetics greater than $1,000
L5420 L5400 Prosthetics greater than $1,000
L5540 L5530 Prosthetics greater than $1,000
L5530 L5535 Prosthetics greater than $1,000
L5540 L5535 Prosthetics greater than $1,000
L5585 L5590 Prosthetics greater than $1,000
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
L5610 L5616 Prosthetics greater than $1,000
L5611 L5616 Prosthetics greater than $1,000
L5613 L5616 Prosthetics greater than $1,000
L5614 L5616 Prosthetics greater than $1,000
L5643 L5639 Prosthetics greater than $1,000
L5649 L5639 Prosthetics greater than $1,000
L5651 L5639 Prosthetics greater than $1,000
L5649 L5643 Prosthetics greater than $1,000
L5643 L5651 Prosthetics greater than $1,000
L5649 L5651 Prosthetics greater than $1,000
L5683 L5681 Prosthetics greater than $1,000
L5681 L5683 Prosthetics greater than $1,000
L5726 L5724 Prosthetics greater than $1,000
L5728 L5724 Prosthetics greater than $1,000
L5728 L5726 Prosthetics greater than $1,000
L5724 L5780 Prosthetics greater than $1,000
L5726 L5780 Prosthetics greater than $1,000
L5728 L5780 Prosthetics greater than $1,000
L5782 L5781 Prosthetics greater than $1,000
L5840 L5814 Prosthetics greater than $1,000
L5814 L5818 Prosthetics greater than $1,000
L5822 L5818 Prosthetics greater than $1,000
L5824 L5818 Prosthetics greater than $1,000
L5826 L5818 Prosthetics greater than $1,000
L5828 L5818 Prosthetics greater than $1,000
L5830 L5818 Prosthetics greater than $1,000
L5840 L5818 Prosthetics greater than $1,000
L5845 L5818 Prosthetics greater than $1,000
L5848 L5818 Prosthetics greater than $1,000
L5814 L5822 Prosthetics greater than $1,000
L5826 L5822 Prosthetics greater than $1,000
L5828 L5822 Prosthetics greater than $1,000
L5830 L5822 Prosthetics greater than $1,000
L5840 L5822 Prosthetics greater than $1,000
L5814 L5824 Prosthetics greater than $1,000
L5822 L5824 Prosthetics greater than $1,000
L5826 L5824 Prosthetics greater than $1,000
L5828 L5824 Prosthetics greater than $1,000
L5830 L5824 Prosthetics greater than $1,000
L5840 L5824 Prosthetics greater than $1,000
L5845 L5824 Prosthetics greater than $1,000
L5814 L5826 Prosthetics greater than $1,000
L5828 L5826 Prosthetics greater than $1,000
L5840 L5826 Prosthetics greater than $1,000
L5814 L5828 Prosthetics greater than $1,000
L5840 L5828 Prosthetics greater than $1,000
L5814 L5830 Prosthetics greater than $1,000
L5826 L5830 Prosthetics greater than $1,000
L5828 L5830 Prosthetics greater than $1,000
Page 50 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
L5840 L5830 Prosthetics greater than $1,000
L5814 L5845 Prosthetics greater than $1,000
L5822 L5845 Prosthetics greater than $1,000
L5826 L5845 Prosthetics greater than $1,000
L5828 L5845 Prosthetics greater than $1,000
L5830 L5845 Prosthetics greater than $1,000
L5840 L5845 Prosthetics greater than $1,000
L5814 L5848 Prosthetics greater than $1,000
L5822 L5848 Prosthetics greater than $1,000
L5824 L5848 Prosthetics greater than $1,000
L5826 L5848 Prosthetics greater than $1,000
L5828 L5848 Prosthetics greater than $1,000
L5830 L5848 Prosthetics greater than $1,000
L5840 L5848 Prosthetics greater than $1,000
L5845 L5848 Prosthetics greater than $1,000
L5856 L5858 Prosthetics greater than $1,000
L5961 L5930 Prosthetics greater than $1,000
L5930 L5960 Prosthetics greater than $1,000
L5961 L5960 Prosthetics greater than $1,000
L5966 L5960 Prosthetics greater than $1,000
L5930 L5966 Prosthetics greater than $1,000
L5961 L5966 Prosthetics greater than $1,000
L5980 L5968 Prosthetics greater than $1,000
L5987 L5968 Prosthetics greater than $1,000
L5968 L5979 Prosthetics greater than $1,000
L5980 L5979 Prosthetics greater than $1,000
L5981 L5979 Prosthetics greater than $1,000
L5987 L5979 Prosthetics greater than $1,000
L5987 L5980 Prosthetics greater than $1,000
L5968 L5981 Prosthetics greater than $1,000
L5980 L5981 Prosthetics greater than $1,000
L5987 L5981 Prosthetics greater than $1,000
L5968 L5988 Prosthetics greater than $1,000
L5979 L5988 Prosthetics greater than $1,000
L5980 L5988 Prosthetics greater than $1,000
L5981 L5988 Prosthetics greater than $1,000
L5987 L5988 Prosthetics greater than $1,000
L5968 L5990 Prosthetics greater than $1,000
L5979 L5990 Prosthetics greater than $1,000
L5980 L5990 Prosthetics greater than $1,000
L5981 L5990 Prosthetics greater than $1,000
L5987 L5990 Prosthetics greater than $1,000
L5988 L5990 Prosthetics greater than $1,000
L6010 L6000 Prosthetics greater than $1,000
L6020 L6000 Prosthetics greater than $1,000
L6025 L6000 Prosthetics greater than $1,000
L6025 L6010 Prosthetics greater than $1,000
L6010 L6020 Prosthetics greater than $1,000
L6025 L6020 Prosthetics greater than $1,000
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
L6055 L6050 Prosthetics greater than $1,000
L6130 L6120 Prosthetics greater than $1,000
L6205 L6200 Prosthetics greater than $1,000
L6300 L6310 Prosthetics greater than $1,000
L6300 L6320 Prosthetics greater than $1,000
L6310 L6320 Prosthetics greater than $1,000
L6350 L6360 Prosthetics greater than $1,000
L6350 L6370 Prosthetics greater than $1,000
L6360 L6370 Prosthetics greater than $1,000
L6580 L6582 Prosthetics greater than $1,000
L6584 L6586 Prosthetics greater than $1,000
L6588 L6590 Prosthetics greater than $1,000
L6624 L6621 Prosthetics greater than $1,000
L6693 L6696 Prosthetics greater than $1,000
L6697 L6696 Prosthetics greater than $1,000
L6693 L6697 Prosthetics greater than $1,000
L6696 L6697 Prosthetics greater than $1,000
L6713 L6707 Prosthetics greater than $1,000
L6715 L6707 Prosthetics greater than $1,000
L6721 L6707 Prosthetics greater than $1,000
L6722 L6707 Prosthetics greater than $1,000
L6900 L6905 Prosthetics greater than $1,000
L6900 L6910 Prosthetics greater than $1,000
L6905 L6910 Prosthetics greater than $1,000
L6925 L6920 Prosthetics greater than $1,000
L6935 L6930 Prosthetics greater than $1,000
L6945 L6940 Prosthetics greater than $1,000
L6955 L6950 Prosthetics greater than $1,000
L6965 L6960 Prosthetics greater than $1,000
L6975 L6970 Prosthetics greater than $1,000
L7009 L7007 Prosthetics greater than $1,000
L7009 L7040 Prosthetics greater than $1,000
L7007 L7040 Prosthetics greater than $1,000
L7008 L7040 Prosthetics greater than $1,000
L7008 L7045 Prosthetics greater than $1,000
L7180 L7170 Prosthetics greater than $1,000
L7181 L7170 Prosthetics greater than $1,000
L7185 L7170 Prosthetics greater than $1,000
L7186 L7170 Prosthetics greater than $1,000
L7190 L7170 Prosthetics greater than $1,000
L7191 L7170 Prosthetics greater than $1,000
L7181 L7180 Prosthetics greater than $1,000
L7180 L7185 Prosthetics greater than $1,000
L7186 L7185 Prosthetics greater than $1,000
L7190 L7185 Prosthetics greater than $1,000
L7191 L7185 Prosthetics greater than $1,000
L7181 L7185 Prosthetics greater than $1,000
L7180 L7186 Prosthetics greater than $1,000
L7181 L7186 Prosthetics greater than $1,000
Page 51 of 51
Prior Authorization given with this CPT Code
Claim submitted with this CPT Code
Code Category
L7191 L7186 Prosthetics greater than $1,000
L7180 L7190 Prosthetics greater than $1,000
L7181 L7190 Prosthetics greater than $1,000
L7186 L7190 Prosthetics greater than $1,000
L7191 L7190 Prosthetics greater than $1,000
L7180 L7191 Prosthetics greater than $1,000
L7181 L7191 Prosthetics greater than $1,000
L8042 L8041 Prosthetics greater than $1,000
L8043 L8041 Prosthetics greater than $1,000
L8044 L8041 Prosthetics greater than $1,000
L8043 L8042 Prosthetics greater than $1,000
L8044 L8042 Prosthetics greater than $1,000
L8044 L8043 Prosthetics greater than $1,000
L8614 L8619 Cochlear Implants and Other Auditory Implants
L8686 L8685 Spinal Cord Stimulators
L8685 L8686 Spinal Cord Stimulators
L8688 L8687 Spinal Cord Stimulators
L8687 L8688 Spinal Cord Stimulators
L8690 L8691 Cochlear Implants and Other Auditory Implants
L8692 L8691 Cochlear Implants and Other Auditory Implants
Q9992 Q9991 Injectable Medications - Opioid Addiction
Q9991 Q9992 Injectable Medications - Opioid Addiction
S9124 S9123 Home Health Care - Skilled Nursing
G0154 S9123 Home Health Care - Skilled Nursing
S9123 S9124 Home Health Care - Skilled Nursing
G0154 S9124 Home Health Care - Skilled Nursing
S9961 S9960 Non Emergency Transport - Air
S9960 S9961 Non Emergency Transport - Air
T1002 T1000 Home Health Care - Private Duty Nursing
T1003 T1000 Home Health Care - Private Duty Nursing
T1000 T1002 Home Health Care - Private Duty Nursing
T1000 T1003 Home Health Care - Private Duty Nursing
T1002 T1003 Home Health Care - Private Duty Nursing
M57277 5/19 ©2019 United HealthCare Services, Inc.
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