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经纪人专区

为员工人数达 51 人及以上的德州团体提供完全保险计划。这将是您推介起来最轻松的福利方案。

经纪人概览

探索

我们的服务对象准备好尝试更优方案的德州团体。计划设计高保障型、HSA 适用型或分级型，均为完全保险。保障范围线下就诊，另含 $0 远程医疗和奖励。成效积极参与的会员能更早获得医疗护理。

与我们合作

实时仪表板您的业务组合，实时更新。客户与经纪人门户团体、账单与续保。实用链接报价与客户支持所需的一切资源。
为您的客户提供一站式服务每个团体都配有专属客户经理，每位会员都有一位护理向导。了解运作方式
联系销售855-579-3879

雇主专区

既省预算，也惠员工。专为员工人数达 51 人及以上的德州雇主打造的健康计划。

雇主概览

探索

适用对象愿意携手探索更优方案的雇主。计划设计更明智的计划，提供 $0 免赔额选项。保障范围员工真正会用的福利。会员参与从第一天起，全年持续与会员互动。

管理您的计划

实时仪表板理赔、参与度与计划表现，实时掌握。客户门户团体、账单与续保。客户故事听听客户怎么说。
转投我们的雇主，都选择留下成本更低，员工更满意，护理更早开始。查看数据
联系销售855-579-3879

会员专区

真正靠得住的保险。切实的保障、专属护士，以及内置的 $0 医疗服务。

会员概览

获取医疗服务

查找医疗服务提供者与本地医生建立良好的长期关系。远程医疗经委员会认证的医生全天候服务，费用 $0。您的护理向导专属注册护士（RN），始终为您提供支持。查找药房查找您附近的药房。查询处方药轻松查找承保药物。

您的计划

会员门户福利、理赔、ID 卡和奖励。奖励每年最高可赚取 $1,000 真金白银的现金。Evry 应用所有福利，尽在掌中。表格与通知下载您需要的各类表格。申请添加医疗服务提供者申请将某位医生加入我们的网络。
认识您的护理向导一位了解您、您的计划和您的目标的注册护士。了解更多
会员支持 855-579-3879登录会员门户

医疗服务提供者专区

我们是合作伙伴，而非障碍。资格核实、理赔和事先授权一站搞定，无需层层转接电话。

医疗服务提供者概览

核实

资格核实实时查询资格和网络状态。理赔核实理赔状态和付款说明。事先授权状态您的 NPI 名下已存档的授权。

事先授权

查询是否需要查看哪些医疗程序需要事先授权。提交申请在线提交，即可获取案例参考编号。清单更新事先授权清单的近期变更。

政策与资源

通知与入院确保住院理赔准确、按时支付。回溯审查治疗后的承保决定。临床指南循证实践指南。表格与通知医疗服务提供者手册、表格和通知。
加入 Evry Health 网络医疗服务提供者专线 855-579-3879医疗服务提供者名录

Evry Health

敢于挑战现有体制的健康保险。总部位于 DFW，服务德克萨斯州全境。

关于我们概览

公司

我们的故事我们为何立志打造更好的健康计划。招贤纳士我们正在让健康保险重回正轨。新闻Evry Health 最新动态。联系我们我们随时为您解答所有问题。
这是切身之事一支达拉斯团队为何立志打造一个真正为参保者着想的健康计划。阅读这封信加入我们与志同道合的伙伴并肩，为值得奋斗的使命努力。招聘职位
在 LinkedIn 上关注我们contact@evryhealth.com

事先授权清单更新

医疗服务事先授权要求的更新。可按医疗程序代码或描述搜索。

不确定某个代码？

查询是否需要事先授权

有疑问？

请致电 855-579-3879

医疗服务事先授权清单更新

已显示 887 条更新，共 887 条
医疗服务事先授权清单更新
通知日期医疗程序代码代码描述更新内容生效日期
10/07/202697168OT RE-EVAL EST PLAN CARENo Prior Authorization Required11/01/2026
10/07/202697167OT EVAL HIGH COMPLEX 60 MINNo Prior Authorization Required11/01/2026
10/07/202697166OT EVAL MOD COMPLEX 45 MINNo Prior Authorization Required11/01/2026
10/07/202697165OT EVAL LOW COMPLEX 30 MINNo Prior Authorization Required11/01/2026
10/07/202697535SELF CARE MNGMENT TRAININGNo Prior Authorization Required11/01/2026
10/07/202621249RECONSTRUCTION OF JAWPrior Authorization Required12/01/2026
10/07/202664445NJX AA&/STRD SCIATIC NRV IMGNo Prior Authorization Required11/01/2026
10/07/202631579LARYNGOSCOPY TELESCOPICNo Prior Authorization Required11/01/2026
10/07/202678226HEPATOBILIARY SYSTEM IMAGINGNo Prior Authorization Required11/01/2026
10/07/202645330DIAGNOSTIC SIGMOIDOSCOPYNo Prior Authorization Required11/01/2026
10/07/202674270X-RAY XM COLON 1CNTRST STDNo Prior Authorization Required11/01/2026
10/07/202645990SURG DX EXAM ANORECTALNo Prior Authorization Required11/01/2026
10/07/202623515OPTX CLAVICULAR FX W/INT FIXNo Prior Authorization Required11/01/2026
10/07/202636593DECLOT VASCULAR DEVICENo Prior Authorization Required11/01/2026
10/07/202631573LARGSC W/THER INJECTIONNo Prior Authorization Required11/01/2026
10/07/202667028Injection Eye DrugNo Prior Authorization Required11/01/2026
10/07/2026G2012BRIEF COM TBS; 5-10 MIN MED DISCUSSNot reimbursable/not covered11/01/2026
10/07/202699220INITIAL OBSERVATION CARENot reimbursable/not covered11/01/2026
10/07/202699219INITIAL OBSERVATION CARENot reimbursable/not covered11/01/2026
10/07/202699218INITIAL OBSERVATIONNot reimbursable/not covered11/01/2026
10/07/202699217OBSERVATION CARE DISCHARGENot reimbursable/not covered11/01/2026
10/07/202696548NTRAOP HIPEC PX EA ADD 30MINNot reimbursable/not covered12/01/2026
10/07/202696547INTRAOP HIPEC PX 1ST 60 MINNot reimbursable/not covered12/01/2026
10/07/202693890TCD VASOREACTIVITY STUDYNot reimbursable/not covered11/01/2026
10/07/202693153INTERROG W/O PRGRMG IPNSSPrior Authorization Required12/01/2026
10/07/202693152INTERROG&PRGRMG IPNSS POLYSMPrior Authorization Required12/01/2026
10/07/202693151INTERROG&PRGRMG IPNSSPrior Authorization Required12/01/2026
10/07/202693150THERAPY ACTIVATION IPNSSPrior Authorization Required12/01/2026
10/07/202692623DX ALY AUD OI SND PRCSR EACHPrior Authorization Required12/01/2026
10/07/202692622DX ALY AUD OI SND PRCSR 1STPrior Authorization Required12/01/2026
10/07/202675756ARTERY X-RAYS CHESTNot reimbursable/not covered11/01/2026
10/07/202675736ARTERY X-RAYS PELVISNot reimbursable/not covered11/01/2026
10/07/202675733ARTERY X-RAYS ADRENALSNot reimbursable/not covered11/01/2026
10/07/202675731ARTERY X-RAYS ADRENAL GLANDNot reimbursable/not covered11/01/2026
10/07/202675705ARTERY X-RAYS SPINENot reimbursable/not covered11/01/2026
10/07/202675605CONTRAST EXAM THORACIC AORTANot reimbursable/not covered11/01/2026
10/07/202675600CONTRAST EXAM THORACIC AORTANot reimbursable/not covered11/01/2026
10/07/202667516SPRCHOROIDAL SPC NJX RX AGTPrior Authorization Required12/01/2026
10/07/202666683IMPLANTATION IRIS PROSTHESISPrior Authorization Required12/01/2026
10/07/202661892RMV SK-MNT CRNL NSTM PG/RCVRPrior Authorization Required12/01/2026
10/07/202661891REV/RPLCMT SK-MNT CRNL NSTMPrior Authorization Required12/01/2026
10/07/202660661ABLTJ 1/+THYR NDUL ADDL PRQPrior Authorization Required12/01/2026
10/07/202660660ABLTJ 1/+THYR NDUL 1LOBE PRQPrior Authorization Required12/01/2026
10/07/202658580TRANSCRV ABLTJ UTRN FIBRD RFPrior Authorization Required12/01/2026
10/07/202655882ABLT TRURL PRST8 TIS TRNSDCRPrior Authorization Required12/01/2026
10/07/202655881ABLT TRURL PRST8 TIS THRM USPrior Authorization Required12/01/2026
10/07/202653866CATHJ RMVL DEV ISCHMC RMDLGPrior Authorization Required12/01/2026
10/07/202653865CYSTO INSJ DEV ISCHMC RMDLGPrior Authorization Required12/01/2026
10/07/202652284CYSTO RX BALO CATH URTL STRXPrior Authorization Required12/01/2026
10/07/202651721INS TRURL ABLT TRNSDC THR USPrior Authorization Required12/01/2026
10/07/202649190OPN EXC/DSTR NTRA-ABD >30 CMPrior Authorization Required12/01/2026
10/07/202649189OPN EXC/DST NTRA-ABD 20.1-30Prior Authorization Required12/01/2026
10/07/202649188OPN EXC/DST NTRA-ABD 10.1-20Prior Authorization Required12/01/2026
10/07/202649187OPN EXC/DSTR NTRA-ABD 5.1-10Prior Authorization Required12/01/2026
10/07/202649186OPN EXC/DSTR NTRA-ABD 5 CM/<Prior Authorization Required12/01/2026
10/07/202638228CAR-T ADMN AUTOLOGOUSPrior Authorization Required12/01/2026
10/07/202638227CAR-T RECEIPT&PREPJ ADMNPrior Authorization Required12/01/2026
10/07/202638226CAR-T PREP T LYMPHCYT F/TRNSPrior Authorization Required12/01/2026
10/07/202638225CAR-T HRV BLD-DRV T LYMPHCYTPrior Authorization Required12/01/2026
10/07/202633288RMV&RPLCMT PHRNC NRV STIM LDPrior Authorization Required12/01/2026
10/07/202633287RMV&RPLCMT PHRNC NRV STIM PGPrior Authorization Required12/01/2026
10/07/202633281REPOSG PHRNC NRV STIM TRNSVNPrior Authorization Required12/01/2026
10/07/202633280RMVL PHRNC NRV STIM PG ONLYPrior Authorization Required12/01/2026
10/07/202633279RMVL PHRNC NRV STIM TRANSVNSPrior Authorization Required12/01/2026
10/07/202633278RMVL PHRNC NRV STIM SYSPrior Authorization Required12/01/2026
10/07/202633277INSJ PHRNC NRV STIM TRANSVNSPrior Authorization Required12/01/2026
10/07/202633276INSJ PHRNC NRV STIM SYSPrior Authorization Required12/01/2026
10/07/202631243NSL/SINUS NDSC CRYOABLTJ PNNPrior Authorization Required12/01/2026
10/07/202631242NSL/SINUS NDSC RF ABLTJ PNNPrior Authorization Required12/01/2026
10/07/202622838REV RPLC/RMV THRC VRT TETHRGPrior Authorization Required12/01/2026
10/07/202622837ANT THRC VRT BODY TETHRG 8+Prior Authorization Required12/01/2026
10/07/202622836ANT THRC VRT BODY TETHRG <7Prior Authorization Required12/01/2026
10/07/202615018APP SKN CLL SSP F/N/G/HF EAPrior Authorization Required12/01/2026
10/07/202615017APP SKN CLL SSP F/N/G/HF 1STPrior Authorization Required12/01/2026
10/07/202615016APP SKN CL SSP AGRF T/A/L EAPrior Authorization Required12/01/2026
10/07/202615015APP SKN CL SSP AGRFT T/A/L 1Prior Authorization Required12/01/2026
10/07/202615014PREPJ SKN CLL SSP AGRFT EAPrior Authorization Required12/01/2026
10/07/202615013PREPJ SKN CLL SSP AGRFT 1STPrior Authorization Required12/01/2026
10/07/202615012HRV SKN CLL SSP AGRFT EA ADDPrior Authorization Required12/01/2026
10/07/202615011HRV SKN CLL SSP AGRFT 1ST 25Prior Authorization Required12/01/2026
10/07/20260932TN-INVS DET HRT FAIL AUG ECHOPrior Authorization Required12/01/2026
10/07/20260914TPRQ TCAT THR RX NTRC BAL SEPPrior Authorization Required12/01/2026
10/07/20260913TPRQ TCAT THER RX NTRAC BALO1Prior Authorization Required12/01/2026
10/07/20260902TQTC NTRVL AUGMNT ALG ALY ECGPrior Authorization Required12/01/2026
10/07/20260898TN-INVAS PRST8 CANCER EST MAPPrior Authorization Required12/01/2026
10/07/20260881TCRYOTHERAPY ORAL CAVITYPrior Authorization Required12/01/2026
10/07/20260880TAUGMNT ALYS CH CT ILD I&RPrior Authorization Required12/01/2026
10/07/20260879TAUGMNT ALYS CH CT ILD PREPPrior Authorization Required12/01/2026
10/07/20260878TAUGMNT ALYS CH CT ILD W/CTPrior Authorization Required12/01/2026
10/07/20260877TAUGMNT ALYS CH CT ILD W/O CTPrior Authorization Required12/01/2026
10/07/20260875TPRGRM SUBQ PRTL ASCT PMP SYSPrior Authorization Required12/01/2026
10/07/20260874TRMVL PERTL ASCITES PMP SYSPrior Authorization Required12/01/2026
10/07/20260873TREVJ SUBQ PRTL ASCT PMP SYSPrior Authorization Required12/01/2026
10/07/20260872TRPLCMT NDWLLG BLDR&PRTL CATHPrior Authorization Required12/01/2026
10/07/20260871TRPLCMT SUBQ PRTL ASCITES PMPPrior Authorization Required12/01/2026
10/07/20260870TIMP SUBQ PRTL ASCTS PMP SYSPrior Authorization Required12/01/2026
10/07/20260860TNCNTC IFR SPCTRSC SCR PADPrior Authorization Required12/01/2026
10/07/20260859TNCNTC IFR SPCTRSC O/T PAD EAPrior Authorization Required12/01/2026
10/07/20260826TPRGRMG EVL LDLS PM 1CHMBR IPPrior Authorization Required12/01/2026
10/07/20260825TTCAT RMV 1CHMBR LDLS PM RAPrior Authorization Required12/01/2026
10/07/20260824TTCAT RMV 1CHMBR LDLS PM RAPrior Authorization Required12/01/2026
10/07/20260823TTCAT INS 1CHMBR LDLS PM RAPrior Authorization Required12/01/2026
10/07/20260822TMNTR PSYCHDLC MED CLN STAFFPrior Authorization Required12/01/2026
10/07/20260821TMNTR PSYCHDLC MED 2NDPHY/QHPPrior Authorization Required12/01/2026
10/07/20260820TMNTR PSYCHDLC MED 1STPHY/QHPPrior Authorization Required12/01/2026
10/07/20260819TREVJ/RMVL INS PTN SUBFPrior Authorization Required12/01/2026
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10/07/20260817TOPN INSJ/RPLCMT INS PTN SUBFPrior Authorization Required12/01/2026
10/07/20260816TOPN INSJ/RPLCMT INS PTN SUBQPrior Authorization Required12/01/2026
10/07/20260810TSUBRTA NJX RX AGT W/VTRCPrior Authorization Required12/01/2026
10/07/20260787TREVJ/RMVL NEA SAC W/NSTIMPrior Authorization Required12/01/2026
10/07/20260786TINSJ/RPLCMT PRQ RA SAC NSTIMPrior Authorization Required12/01/2026
10/07/20260785TREVJ/RMVL NEA SPI W/NSTIMPrior Authorization Required12/01/2026
10/07/20260784TINS/RPLMT ELTRD RA SPI NSTIMPrior Authorization Required12/01/2026
10/07/20260777TR-T PRS SENSING EDRL GDN SYSPrior Authorization Required12/01/2026
10/07/20260776TTHER INDCTJ NTRABRN HYPTHRMPrior Authorization Required12/01/2026
10/07/20260775TARTHRD SI JT PRQ IARTIC IMPLPrior Authorization Required12/01/2026
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10/07/20260771TVR PX DISSOC SVC SM PHY 1STPrior Authorization Required12/01/2026
10/07/20260770TVR TECHNOLOGY ASSIST THERAPYPrior Authorization Required12/01/2026
10/07/20260516URX METAB RXGENOMIC GNOTYP 40Prior Authorization Required12/01/2026
10/07/20260513UONC PRST8 ALG ALYS MSI&HRDPrior Authorization Required12/01/2026
10/07/20260512UONC PRST8 ALYS DGTZ IMG MSIPrior Authorization Required12/01/2026
10/07/20260511UONC SOL TUM 3DMICROENVIR 36+Prior Authorization Required12/01/2026
10/07/20260510UONC PNCRTC CA ALG ALYS 16GENPrior Authorization Required12/01/2026
10/07/20260509UTRNSPLJ MED DD-CFDNA<12 SNPSPrior Authorization Required12/01/2026
10/07/20260508UTRNSPLJ MED DD-CFDNA 40 SNPSPrior Authorization Required12/01/2026
10/07/20260507UONC OVR DNA WHOLE GEN W/5HMCPrior Authorization Required12/01/2026
10/07/20260506UGI BARRETTS ESOPHGL CELL 89Prior Authorization Required12/01/2026
10/07/20260505UNFCT DS VAG INFCTJ ID 32ORGSPrior Authorization Required12/01/2026
10/07/20260504UNFCT DS UTI ID 17 PATH ORGSPrior Authorization Required12/01/2026
10/07/20260503UNEURO ALZ DS BAMYL&TAU PRTNPrior Authorization Required12/01/2026
10/07/20260502UHPV E6/E7 MRK HI-RSK TYP CRVPrior Authorization Required12/01/2026
10/07/20260501UONC CLRC BLD QUAN MEAS CFDNAPrior Authorization Required12/01/2026
10/07/20260500UAUTOINFLAM DS VEXAS SYND DNAPrior Authorization Required12/01/2026
10/07/20260498UONC CLRCT NGS MUT DETC 43GENPrior Authorization Required12/01/2026
10/07/20260497UONC PRST8 MRNA RT-PCR 6GENESPrior Authorization Required12/01/2026
10/07/20260496UONC CLRCT CFDNA 8/7 GENESPrior Authorization Required12/01/2026
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10/07/20260494URBC AG FTL RHD GENE ALYS NGSPrior Authorization Required12/01/2026
10/07/20260493UTRNSPL MED QUAN DD-CFDNA NGSPrior Authorization Required12/01/2026
10/07/20260492UONC SOL TUM CTC SLCTN PD-L1Prior Authorization Required12/01/2026
10/07/20260491UONC SOL TUM CTC SLCT ER PRTNPrior Authorization Required12/01/2026
10/07/20260490UONC CUTAN/UVEAL MLNMA CD146Prior Authorization Required12/01/2026
10/07/20260489UOB SGNIPT CFDNA SEQ ALYS 1+Prior Authorization Required12/01/2026
10/07/20260488UOB FETAL AG NIPT CFDNA ALYSPrior Authorization Required12/01/2026
10/07/20260487UONC SOL TUM CFCDNA TGSAP 84Prior Authorization Required12/01/2026
10/07/20260486UONC PAN SOL TUM NGS CFCTDNAPrior Authorization Required12/01/2026
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10/07/20260484UNFCT DS MGEN 23S RRNA PT MUTPrior Authorization Required12/01/2026
10/07/20260483UNFCT DS NG GYRA S91F PT MUTPrior Authorization Required12/01/2026
10/07/20260482UOB PE BIOCHEM ASY SFLT1&PLGFPrior Authorization Required12/01/2026
10/07/20260481UIDH1 IDH2&TERT PROMOTER NGSPrior Authorization Required12/01/2026
10/07/20260480UNFCT DS CSF METAG NGS ALYSPrior Authorization Required12/01/2026
10/07/20260479UTAU PHOSPHORYLATED PTAU217Prior Authorization Required12/01/2026
10/07/20260478UONC NSCLC DNA&RNA DPCR 9GENSPrior Authorization Required12/01/2026
10/07/20260477URX METAB PSY 14&CYP2D6 GN-RXPrior Authorization Required12/01/2026
10/07/20260476URX METAB PSYC 14GEN&CYP2D6Prior Authorization Required12/01/2026
10/07/20260475UHERED PRST8 CA GSAP 23 GENESPrior Authorization Required12/01/2026
10/07/20260474UHERED PAN CA GSAP 88GENE NGSPrior Authorization Required12/01/2026
10/07/20260472UCA VI PSP&SP1 ANTB SJOGRENPrior Authorization Required12/01/2026
10/07/20260471UONC CLRC CA 35 VRN KRAS&NRASPrior Authorization Required12/01/2026
10/07/20260470UONC OROP DETCJ MRD 8 DNA HPVPrior Authorization Required12/01/2026
10/07/20260469URARE DS WHL GEN SEQ FTL SAMPPrior Authorization Required12/01/2026
10/07/20260468UHEP NASH MIR-34A5P A2M YKL40Prior Authorization Required12/01/2026
10/07/20260467UONC BLDR DNA NGS 60GEN&ANEUPPrior Authorization Required12/01/2026
10/07/20260466UCRD CAD DNA GWAS 564856 SNPPrior Authorization Required12/01/2026
10/07/20260465UONC URTHL CARC DNA QMSP 2GENPrior Authorization Required12/01/2026
10/07/20260464UONC CLRCT SCR QRTSA DNA MRKPrior Authorization Required12/01/2026
10/07/20260463UONC CRVX MRNA GENXPRSN 14BMKPrior Authorization Required12/01/2026
10/07/20260462UMELATONIN LVL TST SLP STD7/9Prior Authorization Required12/01/2026
10/07/20260461UONC RXGENOM ALYS RTPCR 24GENPrior Authorization Required12/01/2026
10/07/20260460UONC WHL BLD/BUCC RTPCR 24GENPrior Authorization Required12/01/2026
10/07/20260459UABETA42 & TTAU ECLIA CSF I CodePrior Authorization Required12/01/2026
10/07/20260458UONC BRST CA S100 A8&A9 ELISAPrior Authorization Required12/01/2026
10/07/20260457UPFAS 9 CMPND LC-MS/MS PLS/SRPrior Authorization Required12/01/2026
10/07/20260456UAI RA NGS 19 GENES ANTI-CCPPrior Authorization Required12/01/2026
10/07/20260454URARE DS ID OPT GENOME MAPGPrior Authorization Required12/01/2026
10/07/20260453UONC CLRCT CA CFDNA QPCR ASYPrior Authorization Required12/01/2026
10/07/20260452UONC BLDR MTHYL PENK LTE-QMSPPrior Authorization Required12/01/2026
10/07/20260451UONC MM LC-MS/MS MONOC P-PRTNPrior Authorization Required12/01/2026
10/07/20260450UONC MM LC-MS/MS MONOC P-PRTNPrior Authorization Required12/01/2026
10/07/20260449UCAR SCR SEV INH COND 5 GENESPrior Authorization Required12/01/2026
10/07/20260448UONC LNG&CLN CA DNA QUAL NGSPrior Authorization Required12/01/2026
10/07/20260447UAI DS SLE ALYS 11 CYTOKINEPrior Authorization Required12/01/2026
10/07/20260446UAI DS SLE ALYS 10 CYTOKINEPrior Authorization Required12/01/2026
10/07/20260445UABETATA42 & PTAU181 ECLIA CSFPrior Authorization Required12/01/2026
10/07/20260444UONC SLD ORGN NEO TGSAP 361Prior Authorization Required12/01/2026
10/07/20260443UNEURFLMNT LT CHN ULTRSENS IAPrior Authorization Required12/01/2026
10/07/20260440UCRD CHD DNA ALYS 10 SNP 6DNAPrior Authorization Required12/01/2026
10/07/20260439UCRD CHD DNA ALYS 5 SNP 3 DNAPrior Authorization Required12/01/2026
10/07/20260438URX METAB ADVRS VRNT ALYS 33Prior Authorization Required12/01/2026
10/07/20260437UPSYC ANXIETY DO MRNA 15 BMRKPrior Authorization Required12/01/2026
10/07/20260436UONC LNG PLSM ALYS 388 PRTNPrior Authorization Required12/01/2026
10/07/20260435UONC CHEMO RX CYTOX CSC 14 RXPrior Authorization Required12/01/2026
10/07/20260434URX METAB ADVRS VRNT ALYS 25Prior Authorization Required12/01/2026
10/07/20260433UONC PRST8 5 DNA REG MRK PCRPrior Authorization Required12/01/2026
10/07/20260432UKLHL11 ANTB SR/CSF ASY QUALPrior Authorization Required12/01/2026
10/07/20260431UGLY RCPTR ALPHA1 IGG SRM/CSFPrior Authorization Required12/01/2026
10/07/20260430UGI MALABS AAT CALPRO PNCRTCPrior Authorization Required12/01/2026
10/07/20260429UHPV OROP SWAB 14 HI-RISK TYPPrior Authorization Required12/01/2026
10/07/20260428UONC BRST CTDNA ALYS 56/> GENPrior Authorization Required12/01/2026
10/07/20260427UMONOCYTE DSTRBJ WDTH WHL BLDPrior Authorization Required12/01/2026
10/07/20260426UGENOME ULTRA-RAPID SEQ ALYSPrior Authorization Required12/01/2026
10/07/20260425UGENOM RPD SEQ ALYS EA CMPRTRPrior Authorization Required12/01/2026
10/07/20260424UONC PRST8 XOM ALYS 53 SNCRNAPrior Authorization Required12/01/2026
10/07/20260423UPSYC GENOMIC ALYS PNL 26 GENPrior Authorization Required12/01/2026
10/07/20260422UONC PAN SOLID TUM ALYS DNAPrior Authorization Required12/01/2026
10/07/20260421UONC CLRCT SCR SGL AMP 8 RNAPrior Authorization Required12/01/2026
10/07/20260420UONC URTHL MRNA XPRSN 6 SNPPrior Authorization Required12/01/2026
10/07/20260308UCRD CAD ALYS 3 PRTN PLSM ALGPrior Authorization Required12/01/2026
10/07/20260307UONC MRD NXT-GNRJ ALYS SBSQPrior Authorization Required12/01/2026
10/07/20260306UONC MRD NXT-GNRJ ALYS 1STPrior Authorization Required12/01/2026
10/07/20260305UHEM RBC FNCLTY&DFRM SHR STRSPrior Authorization Required12/01/2026
10/07/20260304UHEM RBC ADS WHL BLD NORMOXICPrior Authorization Required12/01/2026
10/07/20260303UHEM RBC ADS WHL BLD HYPOXICPrior Authorization Required12/01/2026
10/07/20260302UIADNA BRTNLA DDPCR FLWG LIQPrior Authorization Required12/01/2026
10/07/20260301UIADNA BARTONELLA DDPCRPrior Authorization Required12/01/2026
10/07/20260296UONC ORL&/OROP CA 20 MLC FEATPrior Authorization Required12/01/2026
10/07/20260295UONC BRST DUX CARC 7 PROTEINSPrior Authorization Required12/01/2026
10/07/20260294ULNGVTY&MRTLTY RSK MRNA 18GENPrior Authorization Required12/01/2026
10/07/20260293UPSYC SUICIDAL IDEA MRNA 54Prior Authorization Required12/01/2026
10/07/20260292UPSYC STRS DO MRNA 72 GENESPrior Authorization Required12/01/2026
10/07/20260291UPSYC MOOD DO MRNA 144 GENESPrior Authorization Required12/01/2026
10/07/20260290UPAIN MGMT MRNA GEN XPRSN 36Prior Authorization Required12/01/2026
10/07/20260289UNEURO ALZHEIMER MRNA 24 GENPrior Authorization Required12/01/2026
10/07/20260288UONC LUNG MRNA QUAN PCR 11&3Prior Authorization Required12/01/2026
10/07/20260287UONC THYR DNA&MRNA 112 GENESPrior Authorization Required12/01/2026
10/07/20260286UCEP72 NUDT15&TPMT GENE ALYSPrior Authorization Required12/01/2026
10/07/20260285UONC DS PROG&RSPSE MNTR RADJPrior Authorization Required12/01/2026
10/07/20260284UVW FACOR TYPE 2N EVAL PLSMPrior Authorization Required12/01/2026
10/07/20260283URBC DNA GNTYP 12 BLD GRP GENPrior Authorization Required12/01/2026
10/07/20260282URBC DNA GNTYP 12 BLD GRP GENPrior Authorization Required12/01/2026
10/07/20260281UHEM VWD PROPEPTIDE AG LVLPrior Authorization Required12/01/2026
10/07/20260280UHEM VW FACTOR&CLGN IV BNDGPrior Authorization Required12/01/2026
10/07/20260279UHEM VW FACTOR&CLGN III BNDGPrior Authorization Required12/01/2026
10/07/20260278UHEM GEN PLTLT FUNCJ DO 31Prior Authorization Required12/01/2026
10/07/20260277UHEM GEN PLTLT FUNCJ DO 31Prior Authorization Required12/01/2026
10/07/20260274UHEM GEN PLTLT DO 43 GENESPrior Authorization Required12/01/2026
10/07/20260276UHEM INH THROMBOCYTOPENIA 42Prior Authorization Required12/01/2026
10/07/20260273UHEM GEN HYPRFIBRNLYSIS 9 GENPrior Authorization Required12/01/2026
10/07/20260272UHEM GENETIC BLD DO 51 GENESPrior Authorization Required12/01/2026
10/07/20260271UHEM CGEN NEUTROPENIA 23 GENPrior Authorization Required12/01/2026
10/07/20260270UHEM CGEN COAGJ DO 20 GENESPrior Authorization Required12/01/2027
10/07/20260269UHEM AUT DM CGEN TRMBCTPNA 14Prior Authorization Required12/01/2026
10/07/20260268UHEM AHUS GEN SEQ ALYS 15 GENPrior Authorization Required12/01/2026
10/07/20260267URARE DO ID OPT GEN MAPG&SEQPrior Authorization Required12/01/2026
10/07/20260266UUNXPL CNST HRTBL DO GN XPRSNPrior Authorization Required12/01/2026
10/07/20260265URAR DO WHL GN&MTCDRL DNA ALSPrior Authorization Required12/01/2026
10/07/20260264URARE DS ID OPT GENOME MAPGPrior Authorization Required12/01/2026
10/07/20260263UNEURO ASD MEAS 16 C METBLTPrior Authorization Required12/01/2026
10/07/20260262UONC SLD TUM RT-PCR 7 GENPrior Authorization Required12/01/2026
10/07/20260261UONC CLRCT CA IMG ALYS W/AIPrior Authorization Required12/01/2026
10/07/20260260URARE DS ID OPT GENOME MAPGPrior Authorization Required12/01/2026
10/07/20260259UNEPH CKD NUC MRS MEAS GFRPrior Authorization Required12/01/2026
10/07/20260258UAI PSOR MRNA 50-100 GEN ALGPrior Authorization Required12/01/2026
10/07/20260257UVLCAD LEUK NZM ACTV WHL BLDPrior Authorization Required12/01/2026
10/07/20260256UTMA/TMAO PRFL MS/MS UR ALGPrior Authorization Required12/01/2026
10/07/20260255UANDROLOGY INFERTILITY ASSMTPrior Authorization Required12/01/2026
10/07/20260254UREPRDTVE MED ALYS 24 CHRMSMPrior Authorization Required12/01/2026
10/07/20260253URPRDTVE MED RNA GEN PRFL 238Prior Authorization Required12/01/2026
10/07/20260252UFTL ANEUPLOIDY STR ALYS DNAPrior Authorization Required12/01/2026
10/07/20260251UHEPCIDIN-25 ELISA SERUM/PLSMPrior Authorization Required12/01/2026
10/07/20260249UONC BRST ALYS 32 PHSPRTN ALGPrior Authorization Required12/01/2026
10/07/20260248UONC BRN SPHRD CLL 12 RX PNLPrior Authorization Required12/01/2026
10/07/202625448ARTHRP NTRCRPL/CRP/MTCRP SSPPrior Authorization Required12/01/2026
10/07/20260510UONC PNCRTC CA ALG ALYS 16GENPrior Authorization Required12/01/2026
10/07/20260485UONC SOL TUM CFDNA&RNA NGS GMPrior Authorization Required12/01/2026
10/07/20260421UONC CLRCT SCR SGL AMP 8 RNAPrior Authorization Required12/01/2026
10/07/202675580N-INVAS EST C FFR SW ALY CTAPrior Authorization Required12/01/2026
10/07/20260246URBC DNA GNOTYP 16 BLD GROUPSPrior Authorization Required12/01/2026
10/07/20260241UNFCT DS VIR RESP RNA 4 TRGTPrior Authorization Required12/01/2026
10/07/20260066UPAMG-1 IA CERVICO-VAG FLUIDNot reimbursable/not covered11/01/2026
10/07/2026S1040CRANIAL REMOLD ORTHOT PED CUST FABPrior Authorization Required11/01/2026
10/01/20260245UONC THYR MUT ALYS 10 GEN&37Prior Authorization Required12/01/2026
10/01/20260244UONC SOLID ORGN DNA 257 GENESPrior Authorization Required12/01/2026
10/01/20260243UOB PE BIOCHEM ASSAY PGF ALGPrior Authorization Required12/01/2026
10/01/20260242UTRGT GEN SEQ ALYS PNL 55-74Prior Authorization Required12/01/2026
10/01/20260240UNFCT DS VIR RESP RNA 3 TRGTPrior Authorization Required12/01/2026
10/01/20260239UTRGT GEN SEQ ALYS PNL 311+Prior Authorization Required12/01/2026
08/24/2026S0201PART HOSPITALIZATN SRVC<24 HR-DIEMCode Requires Authorization08/25/2026
08/24/2026S9480INTENSIVE OP PSYC SERVICES PER DIEMCode Requires Authorization08/25/2026
08/24/202638222DX BONE MARROW BX & ASPIRCode Does Not Require Authorization09/01/2026
08/24/202646600DIAGNOSTIC ANOSCOPY SPXCode Does Not Require Authorization09/01/2026
08/24/202658555HYSTEROSCOPY DX SEP PROCCode Does Not Require Authorization09/01/2026
08/24/202644205LAP COLECTOMY PART W/ILEUMCode Does Not Require Authorization09/01/2026
08/24/2026S1040CRANIAL REMOLD ORTHOT PED CUST FABCode Requires Prior Authorization11/01/2026
08/24/2026E0603BREAST PUMP ELECTRIC ANY TYPECode Does Not Require Authorization09/01/2026
08/24/2026E0602Breast Pump Manual Any TypeCode Does Not Require Authorization09/01/2026
08/24/202692235FLUORESCEIN ANGRPH UNI/BICode Does Not Require Authorization09/01/2026
08/24/2026A9595PIFLUFOLASTAT F-18 DIAGNOSTIC 1 MCICode Does Not Require Authorization09/01/2026
08/24/202697010Hot of Cold Packs TherapyCodes Does Not Require Authorization07/01/2026
07/31/202626010DRAINAGE OF FINGER ABSCESSCode Does Not Require Authorization09/01/2026
07/31/202626011DRAINAGE OF FINGER ABSCESSCode Does Not Require Authorization09/01/2026
07/31/202636000PLACE NEEDLE IN VEINCode Does Not Require Authorization09/01/2026
07/31/202671271CT THORAX LUNG CANCER SCR C-Code Does Not Require Authorization09/01/2026
07/31/202631237NSL/SINS NDSC SURG BX POLYPCCode Does Not Require Authorization09/01/2026
07/31/202645390COLONOSCOPY W/RESECTIONCode Does Not Require Authorization09/01/2026
07/31/202645350SGMDSC W/BAND LIGATIONCode Does Not Require Authorization09/01/2026
07/31/202645398COLONOSCOPY W/BAND LIGATIONCode Does Not Require Authorization09/01/2026
07/31/202646600DIAGNOSTIC ANOSCOPY SPXCode Does Not Require Authorization09/01/2026
07/31/202646221LIGATION OF HEMORRHOID(S)Code Does Not Require Authorization09/01/2026
07/31/202631237NASAL/SINUS ENDOSCOPY SURGCodes Does Not Require Authorization09/01/2026
06/29/202620526Therapeutic Injection Carpal TunnelCodes Does Not Require Authorization08/01/2026
06/29/202629131APPLICATION OF FINGER SPLINTCode Does Not Require Prior Authorization08/01/2026
06/29/202629086APPLY FINGER CASTCode Does Not Require Prior Authorization08/01/2026
06/29/202660240Removal of thyroidCode Requires Prior Authorization08/01/2026
06/29/202629085APPLY HAND/WRIST CASTCode Does Not Require Authorization08/01/2026
06/29/2026S2900SURG TECH RQR USE ROBOTIC SURG SYSThis procedure/service code is not eligible for reimbursement08/01/2026
06/29/202697535SELF CARE MNGMENT TRAININGCode Does Not Require Authorization08/01/2026
05/22/202636591Insert Tunneled CV CathCodes Does Not Require Authorization07/01/2026
05/22/202636590REMOVAL TUNNELED CV CATHCode Does Not Require Authorization07/01/2026
05/01/2026J0013Esketamine Nasal SprayCode Requires Prior Authorization05/01/2026
05/01/202660240Removal of thyroidCode Requires Prior Authorization05/01/2026
05/01/202641899unlisted procedure code used for dental procedures involving dentoalveolar structures when no specific CPT code applies.Code Requires Prior Authorization05/01/2026
05/01/2026L5992All lower extremity prosthesis, foot shell for modular foot/non-solid ankle cushion heel (SACH) replacement onlyCode Requires Prior Authorization05/01/2026
05/01/2026L2221Addition to lower extremity orthosis, ankle system, microprocessor-controlled feature plantarflexion and/or dorsiflexion, includes power sourceCode Requires Prior Authorization05/01/2026
05/01/2026A6548Accessory to custom gradient compression garment, silicone band, any sizeCode Does Not Require Authorization05/01/2026
05/01/2026A4479Electronic transanal irrigation system, includes electronic pump, water reservoir, tubing, and accessories, without catheter, any typeCode Does Not Require Authorization05/01/2026
05/01/2026A4318Female external urinary collection cup, with or without ring attachment, per dayCode Does Not Require Authorization05/01/2026
03/18/20264070FDVT PROPHYLX RECVD DAY 2Code Does Not Require Authorization03/20/2026
03/18/20264073FORAL ANTIPLAT THX RX DISCHRGCode Does Not Require Authorization03/20/2026
03/18/20264075FANTICOAG THX RX AT DISCHRGCode Does Not Require Authorization03/20/2026
03/18/20264077FDOC T-PA ADMIN CONSIDEREDCode Does Not Require Authorization03/20/2026
03/18/20264079FDOC REHAB SVCS CONSIDEREDCode Does Not Require Authorization03/20/2026
03/18/20264084FASPIRIN RECVD W/IN 24 HRSCode Does Not Require Authorization03/20/2026
03/18/20264086FASPIRIN/CLOPIDOGREL RXDCode Does Not Require Authorization03/20/2026
03/18/20264090FPT RCVNG EPO THXPYCode Does Not Require Authorization03/20/2026
03/18/20264095FPT NOT RCVNG EPO THXPYCode Does Not Require Authorization03/20/2026
03/18/20264100FBIPHOS THXPY VEIN ORD/RECVDCode Does Not Require Authorization03/20/2026
03/18/20264110FINT MAM ART USED FOR CABGCode Does Not Require Authorization03/20/2026
03/18/20264115FBETA BLCKR ADMIN W/IN 24 HRSCode Does Not Require Authorization03/20/2026
03/18/20264120FANTIBIOT RXD/GIVENCode Does Not Require Authorization03/20/2026
03/18/20264124FANTIBIOT NOT RXD/GIVENCode Does Not Require Authorization03/20/2026
03/18/20264130FTOPICAL PREP RX AOECode Does Not Require Authorization03/20/2026
03/18/20264131FSYST ANTIMICROBIAL THX RXCode Does Not Require Authorization03/20/2026
03/18/20264132FNO SYST ANTIMICROBIAL THX RXCode Does Not Require Authorization03/20/2026
03/18/20264133FANTIHIST/DECONG RX/RECOMCode Does Not Require Authorization03/20/2026
03/18/20264134FNO ANTIHIST/DECONG RX/RECOMCode Does Not Require Authorization03/20/2026
03/18/20264135FSYSTEMIC CORTICOSTEROIDS RXCode Does Not Require Authorization03/20/2026
03/18/20264136FSYST CORTICOSTEROIDS NOT RXCode Does Not Require Authorization03/20/2026
03/18/20264140FINHALED CORTICOSTEROIDS RXDCode Does Not Require Authorization03/20/2026
03/18/20264142FCORTICOSTER SPARNG THRPY RXDCode Does Not Require Authorization03/20/2026
03/18/20264144FALT LONG-TERM CNTRL MED RXDCode Does Not Require Authorization03/20/2026
03/18/20264145F2+ ANTI-HYPRTNSV AGENTS TKNCode Does Not Require Authorization03/20/2026
03/18/20264148FHEP A VAC INJXN ADMIN/RECVDCode Does Not Require Authorization03/20/2026
03/18/20264149FHEP B VAC INJXN ADMIN/RECVDCode Does Not Require Authorization03/20/2026
03/18/20264150FPT RECVNG ANTIVIR TXMNT HEPCCode Does Not Require Authorization03/20/2026
03/18/20264151FPT NOT RECVNG ANTIV HEP CCode Does Not Require Authorization03/20/2026
03/18/20264153FCOMBO PEGINTF/RIB RXCode Does Not Require Authorization03/20/2026
03/18/20264155FHEP A VAC SERIES PREV RECVDCode Does Not Require Authorization03/20/2026
03/18/20264157FHEP B VAC SERIES PREV RECVDCode Does Not Require Authorization03/20/2026
03/18/20264158FPT EDU RE ALCOH DRNKNG DONECode Does Not Require Authorization03/20/2026
03/18/20264159FCONTRCP TALK B/4 ANTIV TXMNTCode Does Not Require Authorization03/20/2026
03/18/20264163FPT COUNS 4 TXMNT OPT PROSTCode Does Not Require Authorization03/20/2026
03/18/20264164FADJV HRMNL THXPY RXDCode Does Not Require Authorization03/20/2026
03/18/20264167FHD BED TILTED 1ST DAY VENTCode Does Not Require Authorization03/20/2026
03/18/20264168FPT CARE ICU&VENT W/IN 24HRSCode Does Not Require Authorization03/20/2026
03/18/20264169FNO PT CARE ICU/VENT IN 24HRSCode Does Not Require Authorization03/20/2026
03/18/20264171FPT RCVNG ESA THXPYCode Does Not Require Authorization03/20/2026
03/18/20264172FPT NOT RCVNG ESA THXPYCode Does Not Require Authorization03/20/2026
03/18/20264174FCOUNS POTENT GLAUC IMPCTCode Does Not Require Authorization03/20/2026
03/18/20264175FVIS 20/40/> W/IN 90 DAYSCode Does Not Require Authorization03/20/2026
03/18/20264176FTALK RE UV LIGHT PT/CRGVRCode Does Not Require Authorization03/20/2026
03/18/20264177FTALK PT/CRGVR RE AREDS PREVCode Does Not Require Authorization03/20/2026
03/18/20264178FANTID GLBLN RCVD W/IN 26WKSCode Does Not Require Authorization03/20/2026
03/18/20264179FTAMOXIFEN/AI PRESCRIBEDCode Does Not Require Authorization03/20/2026
03/18/20264180FADJV THXPYRXD/RCVD COLON CACode Does Not Require Authorization03/20/2026
03/18/20264181FCONFORMAL RADN THXPY RCVDCode Does Not Require Authorization03/20/2026
03/18/20264182FNO CONFORMAL RADN THXPYCode Does Not Require Authorization03/20/2026
03/18/20264185FCONTINUOUS PPI OR H2RA RCVDCode Does Not Require Authorization03/20/2026
03/18/20264186FNO CONT PPI OR H2RA RCVDCode Does Not Require Authorization03/20/2026
03/18/20264187FANTI RHEUM DRUGTHXPYRXD/GVNCode Does Not Require Authorization03/20/2026
03/18/20264188FAPPROP ACE/ARB TSTNG DONECode Does Not Require Authorization03/20/2026
03/18/20264189FAPPROP DIGOXIN TSTNG DONECode Does Not Require Authorization03/20/2026
03/18/20264190FAPPROP DIURETIC TSTNG DONECode Does Not Require Authorization03/20/2026
03/18/20264191FAPPROP ANTICONVULS TSTNGCode Does Not Require Authorization03/20/2026
03/18/20264192FPT NOT RCVNG GLUCOCO THXPYCode Does Not Require Authorization03/20/2026
03/18/20264193FPT RCV <10MG DAILY PREDNISOCode Does Not Require Authorization03/20/2026
03/18/20264194FPT RCV =>10MG DAILY PREDNISOCode Does Not Require Authorization03/20/2026
03/18/20264195FPT RCVNG ANTI-RHEUM THXPY RACode Does Not Require Authorization03/20/2026
03/18/20264196FPTNOT RCVNG ANTI-RHM THXPYRACode Does Not Require Authorization03/20/2026
03/18/20264200FEXTERNAL BEAM TO PROST ONLYCode Does Not Require Authorization03/20/2026
03/18/20264201FEXTRNL BEAM OTHER THAN PROSTCode Does Not Require Authorization03/20/2026
03/18/20264210FACE/ARB THXPY FOR MOS/>Code Does Not Require Authorization03/20/2026
03/18/20264220FDIGOXIN THXPY FOR 6 MOS/>Code Does Not Require Authorization03/20/2026
03/18/20264221FDIURETIC THXPY FOR 6 MOS/>Code Does Not Require Authorization03/20/2026
03/18/20264230FANTICONV THXPY FOR 6 MOS/>Code Does Not Require Authorization03/20/2026
03/18/20264240FINSTR XRCZ BACK PAIN 12 WKSCode Does Not Require Authorization03/20/2026
03/18/20264242FSPRVSD XRCZ BACK PN >12 WKSCode Does Not Require Authorization03/20/2026
03/18/20264245FPT INSTR NRML ACTIVITIESCode Does Not Require Authorization03/20/2026
03/18/20264248FPT INSTR NO BD REST 4 DAYS/>Code Does Not Require Authorization03/20/2026
03/18/20264250FWRMNG 4 SURG NORMOTHERMIACode Does Not Require Authorization03/20/2026
03/18/20264255FANESTH 60 MIN/> AS DOCDCode Does Not Require Authorization03/20/2026
03/18/20264256FANESTHE <60 MIN AS DOCDCode Does Not Require Authorization03/20/2026
03/18/20264260FWOUND SRFC CULTURETECH USEDCode Does Not Require Authorization03/20/2026
03/18/20264261FTECH OTHER THAN SURFC CULTRCode Does Not Require Authorization03/20/2026
03/18/20264265FWET-DRY DRESSINGS RX RECMDCode Does Not Require Authorization03/20/2026
03/18/20264266FNO WET-DRY DRSSINGS RX RECMDCode Does Not Require Authorization03/20/2026
03/18/20264267FCOMPRSSION THXPY PRESCRIBEDCode Does Not Require Authorization03/20/2026
03/18/20264268FPT ED RE COMP THXPY RCVDCode Does Not Require Authorization03/20/2026
03/18/20264269FAPPROPOS MTHD OFFLOADING RXDCode Does Not Require Authorization03/20/2026
03/18/20264270FPT RCVNG ANTI R-VIRAL THXPYCode Does Not Require Authorization03/20/2026
03/18/20264271FPT RCVNG ANTI R-VIRAL THXPYCode Does Not Require Authorization03/20/2026
03/18/20264274FFLU IMMUNO ADMIND RCVDCode Does Not Require Authorization03/20/2026
03/18/20264276FPOTENT ANTIVIR THXPY RXDCode Does Not Require Authorization03/20/2026
03/18/20264279FPCP PROPHYLAXIS RXDCode Does Not Require Authorization03/20/2026
03/18/20264280FPCP PROPHYLAX RXD 3MON LOW %Code Does Not Require Authorization03/20/2026
03/18/20264290FPT SCRNED FOR INJ DRUG USECode Does Not Require Authorization03/20/2026
03/18/20264293FPT SCRND HGH-RISK SEX BEHAVCode Does Not Require Authorization03/20/2026
03/18/20264300FPT RCVNG WARF THXPYCode Does Not Require Authorization03/20/2026
03/18/20264301FPT NOT RCVNG WARF THXPYCode Does Not Require Authorization03/20/2026
03/18/20264305FPT ED RE FT CARE INSPCT RCVDCode Does Not Require Authorization03/20/2026
03/18/20264306FPT TLK PSYCH & RX OPD ADDICCode Does Not Require Authorization03/20/2026
03/18/20264320FPT TALK PSYCHSOC&RX OH DPNDCode Does Not Require Authorization03/20/2026
03/18/20264322FCRGVR PROV W/ ED ADDL RSRCSCode Does Not Require Authorization03/20/2026
03/18/20264324FPT QUERIED PRKNS COMPLICCode Does Not Require Authorization03/20/2026
03/18/20264325FMED TXMNT OPTIONS RVWD W/PTCode Does Not Require Authorization03/20/2026
03/18/20264326FPT ASKED RE SYMP AUTO DYSFXNCode Does Not Require Authorization03/20/2026
03/18/20264328FPT ASKED RE SLEEP DISTURBCode Does Not Require Authorization03/20/2026
03/18/20264330FCNSLNG EPI SPEC SFTY ISSUESCode Does Not Require Authorization03/20/2026
03/18/20264340FCNSLNG CHLDBRNG WOMEN EPICode Does Not Require Authorization03/20/2026
03/18/20264350FCNSLNG PROVIDED SYMP MNGMNTCode Does Not Require Authorization03/20/2026
03/18/20264400FREHAB THXPY OPTIONS W/PTCode Does Not Require Authorization03/20/2026
03/18/20264470FICD COUNSELING PROVIDEDCode Does Not Require Authorization03/20/2026
03/18/20264480FPT RCVNG ACE/ARB B-BLOCKERTXCode Does Not Require Authorization03/20/2026
03/18/20264481FPT RCVNG ACE/ARB BLKER <3MOSCode Does Not Require Authorization03/20/2026
03/18/20264500FREF TO OUTPT CARD REHAB PROGCode Does Not Require Authorization03/20/2026
03/18/20264510FPREV CARDREHAB QUALCARDEVENTCode Does Not Require Authorization03/20/2026
03/18/20264525FNEUROPSYCHIA INTERVEN ORDERCode Does Not Require Authorization03/20/2026
03/18/20264526FNEUROPSYCHIA INTERVEN RCVDCode Does Not Require Authorization03/20/2026
03/18/20264540FDISEASE MODIF PHARMACOTHXPYCode Does Not Require Authorization03/20/2026
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08/31/20253354FCLIN SIG DEP SYM BY DEP TOOLNo Prior Authorization Required10/01/2025
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08/31/20253520FCLOSTRIDIUM DIFFICILE TESTING PERFORMEDNo Prior Authorization Required10/01/2025
08/31/20253517FHBV ASSESS&RESULTS INTRP 1YRNo Prior Authorization Required10/01/2025
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08/31/202564455NJX AA&/STRD PLTR COM DG NRVNo Prior Authorization Required10/01/2025
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07/31/202597602RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESSNo Prior Authorization Required09/01/2025
07/25/2025L8624Lith Ion Batt Cid Ear LevelEar, Nose, and ThroatNo Prior Authorization Required09/01/2025
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07/25/2025V5298HEARING AID NOCNo Prior Authorization Required09/01/2025
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07/25/2025V5080GLASSES BONE CONDUCTIONNo Prior Authorization Required09/01/2025
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07/25/2025V5060HEARING AID MONAURAL BEHIND THE EARNo Prior Authorization Required09/01/2025
07/25/2025V5050HEARING AID MONAURAL IN THE EARNo Prior Authorization Required09/01/2025
07/25/2025V5040HEAR AID MONAURL BDY WORN BN CONDCTNo Prior Authorization Required09/01/2025
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07/25/202592595Electro hearing Aid Test BothNo Prior Authorization Required09/01/2025
07/25/202592594Electro hearing aid test oneNo Prior Authorization Required09/01/2025
07/25/202592593Hearing Aid check both earsNo Prior Authorization Required09/01/2025
07/25/202592592Hearing Aid check One EarNo Prior Authorization Required09/01/2025
07/25/202592591Hearing Aid Exam Both EarsNo Prior Authorization Required09/01/2025
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07/25/20253345FMAMMO ASSESSMENT CAT HIGH CHANCE MALIG DOCDNo Prior Authorization Required09/01/2025
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07/25/20253340FMAMMO ASSESSMENT CAT INCOMP ADDTNL IMAGE DOCDNo Prior Authorization Required09/01/2025
07/25/20253266FHEPATITIS C GENOTYPE PRIOR ANTIVIRAL TREATMENTNo Prior Authorization Required09/01/2025
07/25/20253265FRNA TESTING FOR HEP C VIREMIA ORDERED/DOCDNo Prior Authorization Required09/01/2025
07/25/20253230FHEARING TEST 6 MOS PRIOR TO EAR TUBE INSERTIONNo Prior Authorization Required09/01/2025
07/25/20253220FHEP C QUANT RNA TEST 12 WKS AFTER ANTIVIRAL TXNo Prior Authorization Required09/01/2025
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07/25/20253118FNEW YORK HEART ASSOCIATION (NYHA) CLASS DOCDNo Prior Authorization Required09/01/2025
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07/25/20253100FCAROTID IMAGNG REPORT DIR/INDIR MEAS VESSEL DIAMNo Prior Authorization Required09/01/2025
07/25/20253096FCENTRAL DUAL ENERGY ABSORPTIOMETRY ORDEREDNo Prior Authorization Required09/01/2025
07/25/20253095FCENTRAL DUAL ENERGY ABSORPTIOMETRY DOCDNo Prior Authorization Required09/01/2025
07/25/20253093FDOC NEW DIAG DX INIT/RECURRENT EPISODE OF MDDNo Prior Authorization Required09/01/2025
07/25/20253092FMAJOR DEPRESSIVE DISORDER REMISSIONNo Prior Authorization Required09/01/2025
07/25/20253091FMAJOR DESPRESV DISORDER SEVERE W/PSYCHOT FEATURENo Prior Authorization Required09/01/2025
07/25/20253090FMDD SEVERE WITHOUT PSYCHOTIC FEATURESNo Prior Authorization Required09/01/2025
07/25/20253089FMAJOR DEPRESSIVE DISORDER MODERATENo Prior Authorization Required09/01/2025
07/25/20253088FMAJOR DEPRESSIVE DISORDER MILDNo Prior Authorization Required09/01/2025
07/25/20253085FSUICIDE RISK ASSESSEDNo Prior Authorization Required09/01/2025
07/25/20253044FMOST RECENT HEMOGLOBIN A1C LEVEL < 7.0%No Prior Authorization Required09/01/2025
07/25/20253042FFUNCTJL EXPIR VOLUME >/EQUAL 40% PREDICTED VALUENo Prior Authorization Required09/01/2025
07/25/20253040FFUNCTIONAL EXPIRATORY VOLUME < 40%No Prior Authorization Required09/01/2025
07/25/20253038FPULMONARY FUNC TEST WITHIN 12 MON PRIOR SURGNo Prior Authorization Required09/01/2025
07/25/20253037FOXYGEN SATURATION >88%/PAO2 >55 MM HGNo Prior Authorization Required09/01/2025
07/25/20253035FPULMONARY FUNC TEST WITHIN 12 MON PRIOR SURGNo Prior Authorization Required09/01/2025
07/25/20253028FOXYGEN SATURATION RESULTS DOCUMENTED & REVIEWENo Prior Authorization Required09/01/2025
07/25/20253027FSPIROM FEV/FVC>/=70%/W/OCOPDNo Prior Authorization Required09/01/2025
07/25/20253025FSPIROMETRY TEST RESULTS FEV/FVC <70% W/COPDNo Prior Authorization Required09/01/2025
07/25/20253023FSPIROMETRY RESULTS DOCUMENTED AND REVIEWEDNo Prior Authorization Required09/01/2025
07/25/20253022FLEFT VENTRICULAR EJECTION FRACTION >/EQUAL 40%No Prior Authorization Required09/01/2025
07/25/20253021FLEFT VENTRICULAR EJECTION FRACTION <40%No Prior Authorization Required09/01/2025
07/25/20253020FLVF ASSESSNo Prior Authorization Required09/01/2025
07/25/20253019FLVEF ASSESS PLANPOST DSCHRGENo Prior Authorization Required09/01/2025
07/25/20253018FPRE-PRXD RSK ET AL DOCDNo Prior Authorization Required09/01/2025
07/25/20253017FCOLORECTAL CA SCREEN DOC REVNo Prior Authorization Required09/01/2025
07/25/20253016FPT SCRND UNHLTHY OH USENo Prior Authorization Required09/01/2025
07/25/20253015FCERV CANCER SCREEN DOCDNo Prior Authorization Required09/01/2025
07/25/20253014FSCREEN MAMMO DOC REVNo Prior Authorization Required09/01/2025
07/25/202596567PDT DSTR PRMLG LES SKNNo Prior Authorization Required09/01/2025
07/25/202593268ECG RECORD/REVIEWNo Prior Authorization Required09/01/2025
07/25/20253008FBODY MASS INDEX DOCDNo Prior Authorization Required09/01/2025
07/25/20253044FHG A1C LEVEL LT 7.0%No Prior Authorization Required09/01/2025
07/25/2025A4216STERL H2O SALINE & OR DXT DIL 10 MLNo Prior Authorization Required09/01/2025
06/30/20253011FLIPID PANEL DOC REVNo Prior Authorization Required08/01/2025
06/30/20253008FBODY MASS INDEX DOCDNo Prior Authorization Required08/01/2025
06/30/20253006FCXR DOC REVNo Prior Authorization Required08/01/2025
06/30/20253080FDIAST BP >/= 90 MM HGNo Prior Authorization Required08/01/2025
06/30/20253079FDIAST BP 80-89 MM HGNo Prior Authorization Required08/01/2025
06/30/20253078FDIAST BP <80 MM HGNo Prior Authorization Required08/01/2025
06/30/20253077FSYST BP >/= 140 MM HGNo Prior Authorization Required08/01/2025
06/30/20253075FSYST BP GE 130 - 139MM HGNo Prior Authorization Required08/01/2025
06/30/20253074FSYST BP LT 130 MM HGNo Prior Authorization Required08/01/2025
06/30/20253073FDiabetic Retinal screeningNo Prior Authorization Required08/01/2025
06/30/20253072FLOW RISK FOR RETINOPATHYNo Prior Authorization Required08/01/2025
06/30/20253066FNEPHROPATHY DOC TXNo Prior Authorization Required08/01/2025
06/30/20253062FPOS MACROALBUMINURIA REVNo Prior Authorization Required08/01/2025
06/30/20253061FNEG MICROALBUMINURIA REVNo Prior Authorization Required08/01/2025
06/30/20253060FPOS MICROALBUMINURIA REVNo Prior Authorization Required08/01/2025
06/30/20253056FLVEF GREATER THAN 35%No Prior Authorization Required08/01/2025
06/30/20253055FLVEF LESS THAN/EQUAL TO 35%No Prior Authorization Required08/01/2025
06/30/202569210REMOVE IMPACTED EAR WAX UNINo Prior Authorization Required08/01/2025
06/30/202569209REMOVE IMPACTED EAR WAX UNINo Prior Authorization Required08/01/2025
06/30/202569205CLEAR OUTER EAR CANALNo Prior Authorization Required08/01/2025
06/30/202569200CLEAR OUTER EAR CANALNo Prior Authorization Required08/01/2025
06/30/202569210REMOVE IMPACTED EAR WAX UNINo Prior Authorization Required08/01/2025
06/30/202569209REMOVE IMPACTED EAR WAX UNINo Prior Authorization Required08/01/2025
06/30/202529130APPLICATION OF FINGER SPLINTNo Prior Authorization Required08/01/2025
06/30/202588344IMMUNOHISTO ANTIBODY SLIDENo Prior Authorization Required08/01/2025
06/30/202588342IMHCHEM/IMCYTCHM 1ST ANTBNo Prior Authorization Required08/01/2025
06/30/202588341IMHCHEM/IMCYTCHM EA ADD ANTBNo Prior Authorization Required08/01/2025
06/30/202595870MUSCLE TEST NONPARASPINALNo Prior Authorization Required08/01/2025
06/30/202596377APPLICATION ON-BODY INJECTORNo Prior Authorization Required08/01/2025
06/30/202596146PSYCL/NRPSYC TST AUTO RESULTNo Prior Authorization Required08/01/2025
06/30/20252060FPT INTRVWD BY EVAL CLINICIAN </DATE DIAG MDDNo Prior Authorization Required08/01/2025
06/30/20252050FWOUND CHARACTERISTICS DOCD PRIOR DEBRIDEMENTNo Prior Authorization Required08/01/2025
06/30/20252040FPHYS EXAM ON DATE OF INIT VST FOR LBP DONENo Prior Authorization Required08/01/2025
06/30/20252035FTYMPANIC MEMBRANE MOBILITY ASSESSNo Prior Authorization Required08/01/2025
06/30/20252033FEYE IMG VLD MTCH DX 7 STND FLD W/O EVC RTNOPTHYNo Prior Authorization Required08/01/2025
06/30/20252031FHYDRATION STATUS DOCUMENTED DEHYDRATEDNo Prior Authorization Required08/01/2025
06/30/20252030FHYDRATION STATUS DOCD NORMALLY HYDRATEDNo Prior Authorization Required08/01/2025
06/30/20252029FCOMPLETE PHYS SKIN EXAM DONENo Prior Authorization Required08/01/2025
06/30/20252028FFOOT EXAM PERFORMED on DM PATIENTNo Prior Authorization Required08/01/2025
06/30/20252026FEYE IMG VALID EVC RTNOPTHYNo Prior Authorization Required08/01/2025
06/30/20252027FOPTIC NERVE HEAD EVAL DONENo Prior Authorization Required08/01/2025
06/30/20252025F7 FLD RTA PHOTO W/O RTNOPTHYNo Prior Authorization Required08/01/2025
06/30/20252024F7 FLD RTA PHOTO EVC RTNOPTHY |No Prior Authorization Required08/01/2025
06/30/20252023FDILAT RTA XM W/O RTNOPTHYNo Prior Authorization Required08/01/2025
06/30/20252022FDILAT RTA XM EVC RTNOPTHYNo Prior Authorization Required08/01/2025
06/30/20252021FDILAT MACULAR EXAM DONENo Prior Authorization Required08/01/2025
06/30/20252020FDILATED FUNDUS EVAL DONENo Prior Authorization Required08/01/2025
06/30/20252019FDILATED MACUL EXAM DONENo Prior Authorization Required08/01/2025
06/30/20252018FHYDRATION STATUS ASSESSNo Prior Authorization Required08/01/2025
06/30/20252016FASTHMA RISK ASSESSEDNo Prior Authorization Required08/01/2025
06/30/20252015FASTHMA IMPAIRMENT ASSESSEDNo Prior Authorization Required08/01/2025
06/30/20252014FMENTAL STATUS ASSESSNo Prior Authorization Required08/01/2025
06/30/20252010FVITAL SIGNS RECORDEDNo Prior Authorization Required08/01/2025
06/03/20253052FMOST RECENT HG A1C>EQUAL TO 8.0%&<EQUAL TO 9.0%No Prior Authorization Required07/01/2025
06/03/20253051FMOST RECENT HG A1C>EQUAL TO 7.0%&<8.0%No Prior Authorization Required07/01/2025
06/03/20253050FMOST RECENT LDL-C >/EQUAL 130 MG/DLNo Prior Authorization Required07/01/2025
06/03/20253049FMOST RECENT LDL-C 100-129 MG/DLNo Prior Authorization Required07/01/2025
06/03/20253048FLDL-C <100 MG/DLNo Prior Authorization Required07/01/2025
06/03/20253046FHEMOGLOBIN A1C LEVEL >9.0%No Prior Authorization Required07/01/2025
06/03/202529700REMOVAL/REVISION OF CASTNo Prior Authorization Required07/01/2025
05/20/202587810CHLMYD TRACH ASSAY W/OPTICNo Prior Authorization Required07/01/2025
05/20/202585018HEMOGLOBINNo Prior Authorization Required07/01/2025
05/20/202584478ASSAY OF TRIGLYCERIDESNo Prior Authorization Required07/01/2025
05/20/202583036GLYCOSYLATED HEMOGLOBIN TESTNo Prior Authorization Required07/01/2025
05/20/202583036GLYCOSYLATED HEMOGLOBIN TESTNo Prior Authorization Required07/01/2025
05/20/202582044UR ALBUMIN SEMIQUANTITATIVENo Prior Authorization Required07/01/2025
05/20/202582043UR ALBUMIN QUANTITATIVENo Prior Authorization Required07/01/2025
05/20/202582042OTHER SOURCE ALBUMIN QUAN EANo Prior Authorization Required07/01/2025
05/20/202582010ACETONE ASSAYNo Prior Authorization Required07/01/2025
05/20/202582009TEST FOR ACETONE/KETONESNo Prior Authorization Required07/01/2025
05/20/202581596NFCT DS CHRNC HCV 6 ASSAYSNo Prior Authorization Required07/01/2025
05/20/202581536ONCOLOGY GYNECOLOGICPrior Authorization Required07/01/2025
05/20/202581535ONCOLOGY GYNECOLOGICPrior Authorization Required07/01/2025
05/20/202522513PERQ VERTEBRAL AUGMENTATIONPrior Authorization Required07/01/2025
05/20/202522512VERTEBROPLASTY ADDL INJECTPrior Authorization Required07/01/2025
05/20/202522511PERQ LUMBOSACRAL INJECTIONPrior Authorization Required07/01/2025
05/20/202522510PERQ CERVICOTHORACIC INJECTPrior Authorization Required07/01/2025
05/20/202522220OSTEOT DSC ANT 1 VRT SGM CRVPrior Authorization Required07/01/2025
05/20/202522216INCIS ADDL SPINE SEGMENTPrior Authorization Required07/01/2025
05/20/202522214INCIS 1 VERTEBRAL SEG LUMBARPrior Authorization Required07/01/2025
05/20/202522212INCIS 1 VERTEBRAL SEG THORACPrior Authorization Required07/01/2025
05/20/202522210INCIS 1 VERTEBRAL SEG CERVPrior Authorization Required07/01/2025
05/20/202522208INCIS SPINE 3 COLUMN ADL SEGPrior Authorization Required07/01/2025
05/20/202522110REMOVE PART OF NECK VERTEBRAPrior Authorization Required07/01/2025
05/20/202522103REMOVE EXTRA SPINE SEGMENTPrior Authorization Required07/01/2025
05/20/202522100REMOVE PART OF NECK VERTEBRAPrior Authorization Required07/01/2025
05/20/202521743REPAIR STERNUM/NUSS W/SCOPEPrior Authorization Required07/01/2025
05/20/20253725FScreening for DepressionCode Does Not Require Authorization07/01/2025
05/20/20250354UHPV Qualitative MRNACode not found. Please try again or contact customer support at 1-855-579-3879.07/01/2025
05/20/20250500THPV Lab test codeCode not found. Please try again or contact customer support at 1-855-579-3879.07/01/2025
05/20/2025K1005Disposable collection and storage bags for breast milkCode not found. Please try again or contact customer support at 1-855-579-3879.07/01/2025
05/14/202595913NRV CNDJ TEST 13/> STUDIESCode Does Not Require Authorization07/01/2025
05/14/202595912Nerve Conduction Test 11-12 studiesCode Does Not Require Authorization07/01/2025
05/14/202595911NRV CNDJ TEST 9-10 STUDIESCode Does Not Require Authorization07/01/2025
05/14/202595910NRV CNDJ TEST 7-8 STUDIESCode Does Not Require Authorization07/01/2025
05/14/202595909NRV CNDJ TST 5-6 STUDIESCode Does Not Require Authorization07/01/2025
05/14/202595908NRV CNDJ TST 3-4 STUDIESCode Does Not Require Authorization07/01/2025
05/14/202529540Strapping of anke and/or ftCode Does Not Require Authorization07/01/2025
05/13/202593356MYOCRD STRAIN IMG SPCKL TRCKCode Does Not Require Authorization05/20/2024
05/13/202529105Apply long arm splintCode Does Not Require Authorization07/01/2025
05/13/202520610Drain/inj bursa w/out USCode Does Not Require Authorization07/01/2025
05/13/202520612aspirate/inj ganglion cystCode Does Not Require Authorization07/01/2025
05/13/202520606drain/inj bursa w/usCode Does Not Require Authorization07/01/2025
05/13/202520605DRAIN/INJ JOINT/BURSA W/O USCode Does Not Require Authorization07/01/2025
05/13/202520604drain/inj bursa w/usCode Does Not Require Authorization07/01/2025
05/13/202520600Drain/inj bursa w/out USCode Does Not Require Authorization07/01/2025
05/13/202544408COLONOSCOPY W/DECOMPRESSIONCode Does Not Require Authorization07/01/2025
05/13/202544407colonoscopy w/needle aspirationCode Does Not Require Authorization07/01/2025
05/13/202544405colonoscopy w/ablationCode Does Not Require Authorization07/01/2025
05/13/202544404COLONOSCOPY W/INJECTIONCode Does Not Require Authorization07/01/2025
05/13/202544403COLONOSCOPY W/RESECTIONCode Does Not Require Authorization07/01/2025
05/13/202544402COLONOSCOPY W/STENT PLCMTCode Does Not Require Authorization07/01/2025
05/13/202544401Colonoscopy w/ablationCode Does Not Require Authorization07/01/2025
05/13/202544394colonoscopy w/snareCode Does Not Require Authorization07/01/2025
05/13/202544391colonoscopy for bleedingCode Does Not Require Authorization07/01/2025
05/13/202544390colonoscopy for foreign bodyCode Does Not Require Authorization07/01/2025
05/13/202544389Colonoscopy w/biopsyCode Does Not Require Authorization07/01/2025
05/13/202544388Colonoscopy thru stomaCode Does Not Require Authorization07/01/2025
05/13/202529705Removal/Revision of CastCode Does Not Require Authorization07/01/2025
05/13/202529710Removal/Revision of CastCode Does Not Require Authorization07/01/2025
05/13/202529705Removal/Revision of CastCode Does Not Require Authorization07/01/2025
05/13/202529550Strapping of ToesCode Does Not Require Authorization07/01/2025
05/13/202529530Strapping of KneesCode Does Not Require Authorization07/01/2025
05/13/202529520STRAPPING OF HIPCode Does Not Require Authorization07/01/2025
05/13/202555250VasectomyCode Does Not Require Authorization07/01/2025
05/13/2025E0603Breast Pump ElectricCode Does Not Require Authorization07/01/2025
05/13/202536416Capillary blood drawCode Does Not Require Authorization07/01/2025
05/13/202557421Exam/Biopsy of Va w/ScopeCode Does Not Require Authorization07/01/2025
05/13/202557420Exam of Vagina w/ScopeCode Does Not Require Authorization07/01/2025
05/13/20255005FPT COUNSLD ON EXAM FOR MOLESCode Does Not Require Authorization07/01/2025
05/13/202545393COLONOSCOPY W/DECOMPRESSIONCode Does Not Require Authorization07/01/2025
05/13/202545392COLONOSCOPY W/ENDOSCOPIC FNBCode Does Not Require Authorization07/01/2025
05/13/202545391COLONOSCOPY W/ENDOSCOPE USCode Does Not Require Authorization07/01/2025
05/13/202545389COLONOSCOPY W/STENT PLCMTCode Does Not Require Authorization07/01/2025
05/13/202545382COLONOSCOPY W/CONTROL BLEEDCode Does Not Require Authorization07/01/2025
05/13/202545379COLONOSCOPY W/FB REMOVALCode Does Not Require Authorization07/01/2025
05/13/20254450FSelf care education to patientCode Does Not Require Authorization07/01/2025
05/13/202593280Eval of dual chamber pacemaker deviceCode Does Not Require Authorization07/01/2025
05/13/202599202OP office new ptAdded to Chiropractor policy to allow to bill07/01/2025
05/13/202590695Influenza VaccineAdded to Preventive Policy07/01/2025
05/13/202590684Pnuemococcal vaccineAdded to Preventive Policy07/01/2025
05/13/202591322Covid vaccineAdded to Preventive Policy07/01/2025
05/13/202591321Covid vaccineAdded to Preventive Policy07/01/2025
05/13/202591320Covid vaccineAdded to Preventive Policy07/01/2025
05/13/202591319Covid vaccineAdded to Preventive Policy07/01/2025
05/13/202591318Covid vaccineAdded to Preventive Policy07/01/2025
05/13/2025A4287Breast Milk Storage BagsAdded to Preventive Policy07/01/2025
03/19/2025S9480INTENSIVE OP PSYC SERVICES PER DIEMCode REQUIRES AUTHORIZATION06/01/2025
03/19/2025S3600STAT LABORATORY REQUESTCode Does Not Require Authorization03/15/2025
03/19/202595886MUSC TEST DONE W/N TEST COMPCode Does Not Require Authorization03/15/2025
03/19/202597112NEUROMUSCULAR REEDUCATIONCode Does Not Require Authorization03/15/2025
03/19/202597140MANUAL THERAPY 1/> REGIONSCode Does Not Require Authorization03/15/2025
03/19/202551785ANAL/URINARY MUSCLE STUDYCode Does Not Require Authorization03/15/2025
03/19/202551784ANAL/URINARY MUSCLE STUDYCode Does Not Require Authorization03/15/2025
03/19/202551798US URINE CAPACITY MEASURECode Does Not Require Authorization03/15/2025
03/19/202551792URINARY REFLEX STUDYCode Does Not Require Authorization03/15/2025
03/19/2025G0443BRF F/F BHVR CNSL ALC MISUSE 15 MINCode Does Not Require Authorization03/15/2025
03/19/2025G0447FCE-FCE BEHAVRL CNSL OBESITY 15 MINCode Does Not Require Authorization03/15/2025
03/19/202584403ASSAY OF TOTAL TESTOSTERONECode Does Not Require Authorization03/15/2025
03/19/202553600DILATE URETHRA STRICTURECode Does Not Require Authorization03/15/2025
03/19/202531231NASAL ENDOSCOPY DXCode Does Not Require Authorization03/15/2025
03/19/202557454BX/CURETT OF CERVIX W/SCOPECode Does Not Require Authorization03/15/2025
03/19/202558340CATHETER FOR HYSTEROGRAPHYCode Does Not Require Authorization03/15/2025
03/19/202531575DIAGNOSTIC LARYNGOSCOPYCode Does Not Require Authorization03/15/2025
03/19/202562270DX LMBR SPI PNXRCode Does Not Require Authorization03/15/2025
03/19/202564450NJX AA&/STRD OTHER PN/BRANCHCode Does Not Require Authorization03/15/2025
03/19/202564447NJX AA&/STRD FEMORAL NRV IMGCode Does Not Require Authorization03/15/2025
03/19/202597598RMVL DEVITAL TIS ADDL 20CM/<Code Does Not Require Authorization03/15/2025
03/19/202597597RMVL DEVITAL TIS 20 CM/<Code Does Not Require Authorization03/15/2025
03/19/202595923AUTONOMIC NRV SYST FUNJ TESTCode Does Not Require Authorization03/15/2025
03/19/202595921AUTONOMIC NRV PARASYM INERVJCode Does Not Require Authorization03/15/2025
08/20/202420553INJECT TRIGGER POINTS 3/>Code No Longer Requiring Prior Authorization09/01/2024
08/20/202420552INJ TRIGGER POINT 1/2 MUSCLCode No Longer Requiring Prior Authorization09/01/2024
08/20/2024B4199PARNTRAL NUT; AMINO ACID&CARB >100GMCode Requires Prior Authorization11/01/2024
07/15/2024G9316DOC PT RSK ASSESS RSK CALC W/PT/FAMCode No Longer Requiring Prior Authorization08/01/2024
07/15/202495885MUSC TST DONE W/NERV TST LIMCode No Longer Requiring Prior Authorization08/01/2024
07/15/202495907NVR CNDJ TST 1-2 STUDIESCode No Longer Requiring Prior Authorization08/01/2024
07/15/202495937NEUROMUSCULAR JUNCTION TEST EA NERV ANY 1 METHDCode No Longer Requiring Prior Authorization08/01/2024
07/15/202495938SOMATOSENSORY TESTINGCode No Longer Requiring Prior Authorization08/01/2024
05/15/202493356MYOCRD STRAIN IMG SPCKL TRCKCode No Longer Requiring Prior Authorization05/20/2024
04/25/202493288INTERROGO EVL PM/LDLS PM IPCode No Longer Requiring Prior Authorization04/30/2024

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