Prior authorization codes

CenCal Health

Active CPT codes that appear on the extracted prior authorization list for this health plan.

Search this plan

Check a specific CPT

CodeProcedure / ServiceEffectiveRevisedConfidenceSource
10123
Form CMS- , to the member no later than two (2) calendar days before the
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
1128J
the amount. According to Section (d) of the Social Security Act, a provider must
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
14043
Code section .1(i)
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
14059
Section .5(b)(1)
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
14132
(v)
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
23450
Virginia Beach, VA
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
27446
Joint Replacement Surgery
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
27447
Joint Replacement Surgery
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
33206
Pacemakers
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
33207
Pacemakers
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
33208
Pacemakers
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
33212
Pacemakers
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
33213
Pacemakers
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
33214
Pacemakers
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
33221
Pacemakers
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
33227
Implant Procedure Associated CPT Procedure Codes
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
33228
Implant Procedure Associated CPT Procedure Codes
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
33229
Implant Procedure Associated CPT Procedure Codes
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
33230
Defibrillators
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
33231
Defibrillators
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
33240
Defibrillators
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
33249
Defibrillators
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
33262
Defibrillators
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
33263
Defibrillators
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
33264
Defibrillators
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
33270
Implant Procedure Associated CPT Procedure Codes
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
33271
Implant Procedure Associated CPT Procedure Codes
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
33282
Cardiac Event Recorders
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
33536
https://publications.aap.org/pediatrics/article/146/6/e2020034637/ /Fluoride-Use
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
51215
standard specified in 22 CCR § (except that the distinct part of a hospital does
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
51301
Section . Services to be rendered are subject to exclusions, limitations, exceptions
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
51303
Title 22 CCR, Section (a), CenCal Health Contract 08- , Exhibit E, Attachment
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
51308
California Code of Regulations [CCR], Title 22, Section )
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
51309
be in accordance with the California Code of Regulations (22 CCR , Psychology
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
51315
Code of Regulations (22 CCR )
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
51319
and according to the California Code of Regulations (22 CCR ) for Hearing Aids
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
51321
authorized per California law (California Code of Regulations - 22 CCR ), are
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
51335
and any or all attachments to Exhibit A and in the Member’s Evidence of
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
51348
standards per 22 CCR section . The results of the risk assessment must be
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
53210
for non-covered services provided pursuant to 22 CCR section (d). Even in the
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
53220
required to comply with 22 CCR sections , , and with regard to the
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
53222
required to comply with 22 CCR sections , , and with regard to the
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
53866
required to comply with 22 CCR sections , , and with regard to the
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
59400
Obstetrical care , , , Prenatal care: Z34.0–Z34.93
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
59409
• CPT -XP – Doula support during vaginal delivery only
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
59510
Obstetrical care , , , Prenatal care: Z34.0–Z34.93
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
59610
Obstetrical care , , , Prenatal care: Z34.0–Z34.93
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
59612
• CPT -XP – Doula support during vaginal delivery after previous caesarean
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
59618
(for normal pregnancies)
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
59620
• CPT -XP – Doula support during caesarean section
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
59840
• CPT -XP – Doula support during or after abortion
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
61885
Neurostimulators
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
61886
Neurostimulators
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
62360
Infusion Pumps
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
62361
Infusion Pumps
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
62362
Infusion Pumps
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
63650
Neurostimulators
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
63663
Neurostimulators
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
63664
Neurostimulators
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
63665
Neurostimulators
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
63685
Neurostimulators
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
64568
and
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
64575
and
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
64580
and
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
64581
and
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
64590
and
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
69930
Cochlear Implants
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
83655
procedure code
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
85212
Title 22 CCR, Section (a), CenCal Health Contract 08- , Exhibit E, Attachment
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
90785
Interactive Complexity
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
90791
Psychiatric Diagnostic Evaluation without medical services
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
90792
Psychiatric Diagnostic Evaluation with medical services
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
90832
provider using and
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
90834
Psychotherapy, 45 min
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
90837
provider using and
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
90839
Psychotherapy for crisis, first 60 min
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
90846
Family Psychotherapy (without client present) 50 min
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
90847
Family Psychotherapy (with client present) 50 min
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
90849
Psychotherapy for crisis, each additional 30 min
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
90853
Group psychotherapy
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
90880
Hypnotherapy
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
92004
or
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
92014
or
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
92590
Routine Hearing Exam or $115.11
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
92591
Routine Hearing Exam or $115.11
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
93110
Santa Barbara, CA
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
93116
Goleta, CA -0948
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
94244
Sacramento, CA -2430
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
96110
General Developmental Screening
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
96112
Developmental test administration, first hour
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
96113
Developmental test administration, each additional 30 minutes
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
96114
These codes may not be billed with , , , or
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
96115
These codes may not be billed with , , , or
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
96116
These codes may not be billed with , , , or
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
96121
These codes may not be billed with , , , or
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
96127
Developmental screening, per standardized instrument
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
96132
Neuropsychological testing evaluation services; first hour
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
96133
Neuropsychological testing evaluation services; each additional hour
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
96136
Psychological or neuropsychological test administration and scoring, two or more
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
96137
Psychological or neuropsychological test
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
96138
Psychological or neuropsychological test administration and scoring by
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
96139
Psychological or neuropsychological test
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
96146
Psychological or neuropsychological test administration, with single automated
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
98960
30 Minutes 1
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
98961
30 Minutes 2-4
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
98962
30 Minutes 5-8
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99188
Use CPT code - topical application. Reimbursable for children through age 5
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99203
• Office or other outpatient services: CPT codes through and
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99205
• Office or other outpatient services: CPT codes through and
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99213
• Office or other outpatient services: CPT codes through and
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99215
through
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99340
through
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99342
• Home or residence services: CPT codes , through , and
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99344
• Home or residence services: CPT codes , through , and
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99345
• Home or residence services: CPT codes , through , and
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99348
• Home or residence services: CPT codes , through , and
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99366
These codes may not be billed with , , , or
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99367
These codes may not be billed with , , , or
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99368
These codes may not be billed with , , , or
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99381
Preventive visit, new patient No restriction
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99382
Preventive visit, new patient No restriction
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99383
Preventive visit, new patient No restriction
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99384
Preventive visit, new patient No restriction
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99385
Preventive visit, new patient No restriction
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99386
Preventive visit, new patient No restriction
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99387
Preventive visit, new patient No restriction
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99391
Preventive visit, established patient No restriction
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99392
Preventive visit, established patient No restriction
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99393
Preventive visit, established patient No restriction
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99394
Preventive visit, established patient No restriction
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99395
Preventive visit, established patient No restriction
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99396
Preventive visit, established patient No restriction
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99397
Preventive visit, established patient No restriction
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99406
Tobacco cessation, 3 to 10 minutes
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
99407
Tobacco cessation, more than 10 minutes
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
G0019
HCPCS must be billed with modifier U2: Community Health Integration (CHI)
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
G0022
CHW supervising providers can bill for additional CHI services with HCPCS code
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
G0442
Annual alcohol misuse screening, 15 minutes
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
G8431
Screening for Depression, Positive Result
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
G8510
Screening for Depression, Negative Result
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
G9919
Screening performed – results positive and provisions of 4 and greater
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
G9920
Screening performed – results negative 0 to 3 (low risk)
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
H0031
per 15 min Assessment
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
H0032
per 15 min Treatment Plan development (including supervision)
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
H0049
Drug use screening
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
H0050
Alcohol and drug services, brief intervention
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
H1011
Dyadic Behavioral Health Well-Child Visit
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
H2000
Comprehensive multidisciplinary evaluation
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
H2014
per 15 min Skills Training and development (group)
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
H2015
Dyadic Comprehensive Community Support Services, per 15 minutes
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
H2019
per 15 min Therapeutic Behavioral Services
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
H2027
Dyadic Psychoeducational Services, per 15 minutes
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
H4300
Speech-language therapy, individual, per hour (following procedures or )
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
H4301
Speech-language therapy, individual, per hour (following procedures or )
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
S5102
Day care services, adult; per diem
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
S5111
per session Home care/family training
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
T1023
Screening to determine the appropriateness of consideration of an individual for
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
T1027
Dyadic Family Training and Counseling for Child Development, per 15 minutes
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
T1032
• -XP – Extended postpartum doula support, per 15 minutes
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
T1033
• HCPCS -XP – Doula support during or after miscarriage
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
V2020
applicable sales tax), not to
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
V2025
applicable sales tax), not to
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
V2100
applicable sales tax), not to
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
V2200
2199, -2299
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
V2300
2199, -2299
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
V2410
2399, -2499
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
V2500
2399, -2499
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
V2630
2599, -2632
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
V5010
applicable sales tax), not to
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
V5060
applicable sales tax), not to
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
V5120
applicable sales tax), not to
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
V5160
exceed $1,250.00 per
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
V5171
exceed $1,250.00 per
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
V5190
exceed $1,250.00 per
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
X4502
Code
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
Z1032
HCPCS: , , pregnancies)
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
Z1034
HCPCS: , , pregnancies)
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
Z1038
Postpartum care: Z39.0–Z39.2
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health
Z6500
Postpartum care: Z39.0–Z39.2
2024-11-18Not listed97%
[PDF] 2026 Provider Manual | CenCal Health