Prior authorization codes
Clover Health
Active CPT codes that appear on the extracted prior authorization list for this health plan.
| Code | Procedure / Service | Effective | Revised | Confidence | Source |
|---|---|---|---|---|---|
| 0191T | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 15823 | CPT/HCPCS Codes # – # Continued on page 3 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 19318 | 19340 22853 29824 31267 33270 43247 49659 55866 64555 67903 72148 74174 78472 93306 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 19340 | 19342 22854 29825 31276 33282 43259 49999 56620 60220 64590 67908 72149 74175 78473 93451 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 19342 | 19350 22859 29826 31287 36475 43264 57240 60240 64702 67921 72156 74177 78492 93452 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 19350 | 19357 22902 29827 31288 36476 43274 50590 57260 61623 64704 68320 72157 74182 78608 93453 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 19357 | 19366 23472 29828 31295 36478 43275 51845 57288 61781 64708 69604 72158 74183 78650 93454 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 19366 | 19370 27130 29875 31296 37224 43276 51860 57425 61796 65730 69641 72195 75561 78707 93455 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 19370 | 19380 27132 29876 31297 37225 43644 52310 58260 61798 65755 69644 72196 75574 78708 93456 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 19380 | 27134 29877 31299 37227 43860 52315 58262 61800 65780 72197 75635 78709 93457 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 20931 | 20937 27427 29880 33208 37230 45384 52318 58541 63030 65870 70543 73202 77321 78803 93459 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 20937 | 21215 27446 29881 33213 37231 45385 52320 58542 63035 65875 70551 73218 77333 78804 93460 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 21215 | 21235 27447 29882 33216 37238 46250 52327 58544 63042 66172 70552 73220 77371 78806 93461 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 21235 | 21248 27486 29883 33217 37722 46255 52330 58552 63045 66180 70553 73221 77372 78811 93656 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 21248 | 22513 27487 29887 33225 46260 52332 58554 63046 66183 71250 73222 77373 78812 93662 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 22513 | 22514 27570 29893 33227 42415 46261 52500 58555 63047 66184 71260 73223 77412 78814 93701 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 22514 | 22551 27685 29895 33228 42440 47562 52601 58558 63048 66185 71270 73700 77432 78815 93880 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 22551 | 22552 27823 29897 33230 42826 49650 52630 58560 63056 66250 71275 73701 77435 78816 93886 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 22552 | 22554 28740 29899 33231 43235 49651 52647 58561 63075 66682 71551 73706 77778 93890 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 22554 | 22600 29805 29999 33233 43237 49652 52648 58563 63076 66710 72125 73718 78300 81162 93892 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 22600 | 22610 29807 33240 43238 49653 54400 58571 63081 66982 72131 73719 78305 81211 93923 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 22610 | 22612 29820 31239 33249 43239 49654 54401 58573 63650 66986 72132 73720 78306 93925 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 22612 | 22614 29821 31240 33262 43242 49655 54405 58660 63663 67031 72141 73721 78320 90870 93970 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 22614 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 22630 | 19318 22633 29823 31256 33264 43246 49657 54416 58662 63685 67900 72147 74170 78454 92928 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 22633 | 19340 22853 29824 31267 33270 43247 49659 55866 64555 67903 72148 74174 78472 93306 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 22853 | 19342 22854 29825 31276 33282 43259 49999 56620 60220 64590 67908 72149 74175 78473 93451 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 22854 | 19350 22859 29826 31287 36475 43264 57240 60240 64702 67921 72156 74177 78492 93452 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 22859 | 19357 22902 29827 31288 36476 43274 50590 57260 61623 64704 68320 72157 74182 78608 93453 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 22902 | 19366 23472 29828 31295 36478 43275 51845 57288 61781 64708 69604 72158 74183 78650 93454 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 23472 | 19370 27130 29875 31296 37224 43276 51860 57425 61796 65730 69641 72195 75561 78707 93455 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 27130 | 19380 27132 29876 31297 37225 43644 52310 58260 61798 65755 69644 72196 75574 78708 93456 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 27132 | 27134 29877 31299 37227 43860 52315 58262 61800 65780 72197 75635 78709 93457 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 27134 | 20931 27425 29879 33207 37229 45380 52317 58356 63015 65855 70542 73201 76001 78802 93458 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 27425 | 20937 27427 29880 33208 37230 45384 52318 58541 63030 65870 70543 73202 77321 78803 93459 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 27427 | 21215 27446 29881 33213 37231 45385 52320 58542 63035 65875 70551 73218 77333 78804 93460 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 27446 | 21235 27447 29882 33216 37238 46250 52327 58544 63042 66172 70552 73220 77371 78806 93461 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 27447 | 21248 27486 29883 33217 37722 46255 52330 58552 63045 66180 70553 73221 77372 78811 93656 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 27486 | 22513 27487 29887 33225 46260 52332 58554 63046 66183 71250 73222 77373 78812 93662 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 27487 | 22514 27570 29893 33227 42415 46261 52500 58555 63047 66184 71260 73223 77412 78814 93701 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 27570 | 22551 27685 29895 33228 42440 47562 52601 58558 63048 66185 71270 73700 77432 78815 93880 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 27685 | 22552 27823 29897 33230 42826 49650 52630 58560 63056 66250 71275 73701 77435 78816 93886 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 27823 | 22554 28740 29899 33231 43235 49651 52647 58561 63075 66682 71551 73706 77778 93890 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 28740 | 22600 29805 29999 33233 43237 49652 52648 58563 63076 66710 72125 73718 78300 81162 93892 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 29805 | 22610 29807 33240 43238 49653 54400 58571 63081 66982 72131 73719 78305 81211 93923 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 29807 | 22612 29820 31239 33249 43239 49654 54401 58573 63650 66986 72132 73720 78306 93925 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 29820 | 22614 29821 31240 33262 43242 49655 54405 58660 63663 67031 72141 73721 78320 90870 93970 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 29821 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 29822 | 19318 22633 29823 31256 33264 43246 49657 54416 58662 63685 67900 72147 74170 78454 92928 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 29823 | 19340 22853 29824 31267 33270 43247 49659 55866 64555 67903 72148 74174 78472 93306 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 29824 | 19342 22854 29825 31276 33282 43259 49999 56620 60220 64590 67908 72149 74175 78473 93451 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 29825 | 19350 22859 29826 31287 36475 43264 57240 60240 64702 67921 72156 74177 78492 93452 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 29826 | 19357 22902 29827 31288 36476 43274 50590 57260 61623 64704 68320 72157 74182 78608 93453 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 29827 | 19366 23472 29828 31295 36478 43275 51845 57288 61781 64708 69604 72158 74183 78650 93454 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 29828 | 19370 27130 29875 31296 37224 43276 51860 57425 61796 65730 69641 72195 75561 78707 93455 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 29875 | 19380 27132 29876 31297 37225 43644 52310 58260 61798 65755 69644 72196 75574 78708 93456 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 29876 | 27134 29877 31299 37227 43860 52315 58262 61800 65780 72197 75635 78709 93457 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 29877 | 20931 27425 29879 33207 37229 45380 52317 58356 63015 65855 70542 73201 76001 78802 93458 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 29879 | 20937 27427 29880 33208 37230 45384 52318 58541 63030 65870 70543 73202 77321 78803 93459 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 29880 | 21215 27446 29881 33213 37231 45385 52320 58542 63035 65875 70551 73218 77333 78804 93460 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 29881 | 21235 27447 29882 33216 37238 46250 52327 58544 63042 66172 70552 73220 77371 78806 93461 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 29882 | 21248 27486 29883 33217 37722 46255 52330 58552 63045 66180 70553 73221 77372 78811 93656 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 29883 | 22513 27487 29887 33225 46260 52332 58554 63046 66183 71250 73222 77373 78812 93662 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 29887 | 22514 27570 29893 33227 42415 46261 52500 58555 63047 66184 71260 73223 77412 78814 93701 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 29893 | 22551 27685 29895 33228 42440 47562 52601 58558 63048 66185 71270 73700 77432 78815 93880 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 29895 | 22552 27823 29897 33230 42826 49650 52630 58560 63056 66250 71275 73701 77435 78816 93886 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 29897 | 22554 28740 29899 33231 43235 49651 52647 58561 63075 66682 71551 73706 77778 93890 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 29899 | 22600 29805 29999 33233 43237 49652 52648 58563 63076 66710 72125 73718 78300 81162 93892 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 29999 | 22610 29807 33240 43238 49653 54400 58571 63081 66982 72131 73719 78305 81211 93923 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 31239 | 22614 29821 31240 33262 43242 49655 54405 58660 63663 67031 72141 73721 78320 90870 93970 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 31240 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 31255 | 19318 22633 29823 31256 33264 43246 49657 54416 58662 63685 67900 72147 74170 78454 92928 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 31256 | 19340 22853 29824 31267 33270 43247 49659 55866 64555 67903 72148 74174 78472 93306 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 31267 | 19342 22854 29825 31276 33282 43259 49999 56620 60220 64590 67908 72149 74175 78473 93451 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 31276 | 19350 22859 29826 31287 36475 43264 57240 60240 64702 67921 72156 74177 78492 93452 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 31287 | 19357 22902 29827 31288 36476 43274 50590 57260 61623 64704 68320 72157 74182 78608 93453 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 31288 | 19366 23472 29828 31295 36478 43275 51845 57288 61781 64708 69604 72158 74183 78650 93454 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 31295 | 19370 27130 29875 31296 37224 43276 51860 57425 61796 65730 69641 72195 75561 78707 93455 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 31296 | 19380 27132 29876 31297 37225 43644 52310 58260 61798 65755 69644 72196 75574 78708 93456 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 31297 | 27134 29877 31299 37227 43860 52315 58262 61800 65780 72197 75635 78709 93457 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 31299 | 20931 27425 29879 33207 37229 45380 52317 58356 63015 65855 70542 73201 76001 78802 93458 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 33207 | 20937 27427 29880 33208 37230 45384 52318 58541 63030 65870 70543 73202 77321 78803 93459 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 33208 | 21215 27446 29881 33213 37231 45385 52320 58542 63035 65875 70551 73218 77333 78804 93460 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 33213 | 21235 27447 29882 33216 37238 46250 52327 58544 63042 66172 70552 73220 77371 78806 93461 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 33216 | 21248 27486 29883 33217 37722 46255 52330 58552 63045 66180 70553 73221 77372 78811 93656 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 33217 | 22513 27487 29887 33225 46260 52332 58554 63046 66183 71250 73222 77373 78812 93662 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 33225 | 22514 27570 29893 33227 42415 46261 52500 58555 63047 66184 71260 73223 77412 78814 93701 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 33227 | 22551 27685 29895 33228 42440 47562 52601 58558 63048 66185 71270 73700 77432 78815 93880 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 33228 | 22552 27823 29897 33230 42826 49650 52630 58560 63056 66250 71275 73701 77435 78816 93886 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 33230 | 22554 28740 29899 33231 43235 49651 52647 58561 63075 66682 71551 73706 77778 93890 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 33231 | 22600 29805 29999 33233 43237 49652 52648 58563 63076 66710 72125 73718 78300 81162 93892 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 33233 | 22610 29807 33240 43238 49653 54400 58571 63081 66982 72131 73719 78305 81211 93923 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 33240 | 22612 29820 31239 33249 43239 49654 54401 58573 63650 66986 72132 73720 78306 93925 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 33249 | 22614 29821 31240 33262 43242 49655 54405 58660 63663 67031 72141 73721 78320 90870 93970 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 33262 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 33263 | 19318 22633 29823 31256 33264 43246 49657 54416 58662 63685 67900 72147 74170 78454 92928 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 33264 | 19340 22853 29824 31267 33270 43247 49659 55866 64555 67903 72148 74174 78472 93306 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 33270 | 19342 22854 29825 31276 33282 43259 49999 56620 60220 64590 67908 72149 74175 78473 93451 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 33282 | 19350 22859 29826 31287 36475 43264 57240 60240 64702 67921 72156 74177 78492 93452 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 36475 | 19357 22902 29827 31288 36476 43274 50590 57260 61623 64704 68320 72157 74182 78608 93453 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 36476 | 19366 23472 29828 31295 36478 43275 51845 57288 61781 64708 69604 72158 74183 78650 93454 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 36478 | 19370 27130 29875 31296 37224 43276 51860 57425 61796 65730 69641 72195 75561 78707 93455 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 37224 | 19380 27132 29876 31297 37225 43644 52310 58260 61798 65755 69644 72196 75574 78708 93456 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 37225 | 27134 29877 31299 37227 43860 52315 58262 61800 65780 72197 75635 78709 93457 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 37227 | 20931 27425 29879 33207 37229 45380 52317 58356 63015 65855 70542 73201 76001 78802 93458 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 37229 | 20937 27427 29880 33208 37230 45384 52318 58541 63030 65870 70543 73202 77321 78803 93459 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 37230 | 21215 27446 29881 33213 37231 45385 52320 58542 63035 65875 70551 73218 77333 78804 93460 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 37231 | 21235 27447 29882 33216 37238 46250 52327 58544 63042 66172 70552 73220 77371 78806 93461 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 37238 | 21248 27486 29883 33217 37722 46255 52330 58552 63045 66180 70553 73221 77372 78811 93656 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 37722 | 22513 27487 29887 33225 46260 52332 58554 63046 66183 71250 73222 77373 78812 93662 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 42415 | 22551 27685 29895 33228 42440 47562 52601 58558 63048 66185 71270 73700 77432 78815 93880 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 42440 | 22552 27823 29897 33230 42826 49650 52630 58560 63056 66250 71275 73701 77435 78816 93886 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 42826 | 22554 28740 29899 33231 43235 49651 52647 58561 63075 66682 71551 73706 77778 93890 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 43235 | 22600 29805 29999 33233 43237 49652 52648 58563 63076 66710 72125 73718 78300 81162 93892 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 43237 | 22610 29807 33240 43238 49653 54400 58571 63081 66982 72131 73719 78305 81211 93923 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 43238 | 22612 29820 31239 33249 43239 49654 54401 58573 63650 66986 72132 73720 78306 93925 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 43239 | 22614 29821 31240 33262 43242 49655 54405 58660 63663 67031 72141 73721 78320 90870 93970 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 43242 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 43244 | 19318 22633 29823 31256 33264 43246 49657 54416 58662 63685 67900 72147 74170 78454 92928 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 43246 | 19340 22853 29824 31267 33270 43247 49659 55866 64555 67903 72148 74174 78472 93306 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 43247 | 19342 22854 29825 31276 33282 43259 49999 56620 60220 64590 67908 72149 74175 78473 93451 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 43259 | 19350 22859 29826 31287 36475 43264 57240 60240 64702 67921 72156 74177 78492 93452 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 43264 | 19357 22902 29827 31288 36476 43274 50590 57260 61623 64704 68320 72157 74182 78608 93453 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 43274 | 19366 23472 29828 31295 36478 43275 51845 57288 61781 64708 69604 72158 74183 78650 93454 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 43275 | 19370 27130 29875 31296 37224 43276 51860 57425 61796 65730 69641 72195 75561 78707 93455 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 43276 | 19380 27132 29876 31297 37225 43644 52310 58260 61798 65755 69644 72196 75574 78708 93456 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 43644 | 27134 29877 31299 37227 43860 52315 58262 61800 65780 72197 75635 78709 93457 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 43860 | 20931 27425 29879 33207 37229 45380 52317 58356 63015 65855 70542 73201 76001 78802 93458 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 45380 | 20937 27427 29880 33208 37230 45384 52318 58541 63030 65870 70543 73202 77321 78803 93459 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 45384 | 21215 27446 29881 33213 37231 45385 52320 58542 63035 65875 70551 73218 77333 78804 93460 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 45385 | 21235 27447 29882 33216 37238 46250 52327 58544 63042 66172 70552 73220 77371 78806 93461 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 46250 | 21248 27486 29883 33217 37722 46255 52330 58552 63045 66180 70553 73221 77372 78811 93656 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 46255 | 22513 27487 29887 33225 46260 52332 58554 63046 66183 71250 73222 77373 78812 93662 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 46260 | 22514 27570 29893 33227 42415 46261 52500 58555 63047 66184 71260 73223 77412 78814 93701 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 46261 | 22551 27685 29895 33228 42440 47562 52601 58558 63048 66185 71270 73700 77432 78815 93880 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 47562 | 22552 27823 29897 33230 42826 49650 52630 58560 63056 66250 71275 73701 77435 78816 93886 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 49650 | 22554 28740 29899 33231 43235 49651 52647 58561 63075 66682 71551 73706 77778 93890 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 49651 | 22600 29805 29999 33233 43237 49652 52648 58563 63076 66710 72125 73718 78300 81162 93892 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 49652 | 22610 29807 33240 43238 49653 54400 58571 63081 66982 72131 73719 78305 81211 93923 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 49653 | 22612 29820 31239 33249 43239 49654 54401 58573 63650 66986 72132 73720 78306 93925 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 49654 | 22614 29821 31240 33262 43242 49655 54405 58660 63663 67031 72141 73721 78320 90870 93970 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 49655 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 49656 | 19318 22633 29823 31256 33264 43246 49657 54416 58662 63685 67900 72147 74170 78454 92928 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 49657 | 19340 22853 29824 31267 33270 43247 49659 55866 64555 67903 72148 74174 78472 93306 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 49659 | 19342 22854 29825 31276 33282 43259 49999 56620 60220 64590 67908 72149 74175 78473 93451 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 49999 | 19350 22859 29826 31287 36475 43264 57240 60240 64702 67921 72156 74177 78492 93452 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 50590 | 19366 23472 29828 31295 36478 43275 51845 57288 61781 64708 69604 72158 74183 78650 93454 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 51845 | 19370 27130 29875 31296 37224 43276 51860 57425 61796 65730 69641 72195 75561 78707 93455 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 51860 | 19380 27132 29876 31297 37225 43644 52310 58260 61798 65755 69644 72196 75574 78708 93456 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 52310 | 27134 29877 31299 37227 43860 52315 58262 61800 65780 72197 75635 78709 93457 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 52315 | 20931 27425 29879 33207 37229 45380 52317 58356 63015 65855 70542 73201 76001 78802 93458 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 52317 | 20937 27427 29880 33208 37230 45384 52318 58541 63030 65870 70543 73202 77321 78803 93459 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 52318 | 21215 27446 29881 33213 37231 45385 52320 58542 63035 65875 70551 73218 77333 78804 93460 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 52320 | 21235 27447 29882 33216 37238 46250 52327 58544 63042 66172 70552 73220 77371 78806 93461 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 52327 | 21248 27486 29883 33217 37722 46255 52330 58552 63045 66180 70553 73221 77372 78811 93656 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 52330 | 22513 27487 29887 33225 46260 52332 58554 63046 66183 71250 73222 77373 78812 93662 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 52332 | 22514 27570 29893 33227 42415 46261 52500 58555 63047 66184 71260 73223 77412 78814 93701 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 52500 | 22551 27685 29895 33228 42440 47562 52601 58558 63048 66185 71270 73700 77432 78815 93880 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 52601 | 22552 27823 29897 33230 42826 49650 52630 58560 63056 66250 71275 73701 77435 78816 93886 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 52630 | 22554 28740 29899 33231 43235 49651 52647 58561 63075 66682 71551 73706 77778 93890 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 52647 | 22600 29805 29999 33233 43237 49652 52648 58563 63076 66710 72125 73718 78300 81162 93892 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 52648 | 22610 29807 33240 43238 49653 54400 58571 63081 66982 72131 73719 78305 81211 93923 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 54400 | 22612 29820 31239 33249 43239 49654 54401 58573 63650 66986 72132 73720 78306 93925 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 54401 | 22614 29821 31240 33262 43242 49655 54405 58660 63663 67031 72141 73721 78320 90870 93970 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 54405 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 54410 | 19318 22633 29823 31256 33264 43246 49657 54416 58662 63685 67900 72147 74170 78454 92928 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 54416 | 19340 22853 29824 31267 33270 43247 49659 55866 64555 67903 72148 74174 78472 93306 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 55866 | 19342 22854 29825 31276 33282 43259 49999 56620 60220 64590 67908 72149 74175 78473 93451 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 56620 | 19350 22859 29826 31287 36475 43264 57240 60240 64702 67921 72156 74177 78492 93452 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 57240 | 19357 22902 29827 31288 36476 43274 50590 57260 61623 64704 68320 72157 74182 78608 93453 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 57260 | 19366 23472 29828 31295 36478 43275 51845 57288 61781 64708 69604 72158 74183 78650 93454 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 57288 | 19370 27130 29875 31296 37224 43276 51860 57425 61796 65730 69641 72195 75561 78707 93455 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 57425 | 19380 27132 29876 31297 37225 43644 52310 58260 61798 65755 69644 72196 75574 78708 93456 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 58260 | 27134 29877 31299 37227 43860 52315 58262 61800 65780 72197 75635 78709 93457 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 58262 | 20931 27425 29879 33207 37229 45380 52317 58356 63015 65855 70542 73201 76001 78802 93458 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 58356 | 20937 27427 29880 33208 37230 45384 52318 58541 63030 65870 70543 73202 77321 78803 93459 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 58541 | 21215 27446 29881 33213 37231 45385 52320 58542 63035 65875 70551 73218 77333 78804 93460 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 58542 | 21235 27447 29882 33216 37238 46250 52327 58544 63042 66172 70552 73220 77371 78806 93461 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 58544 | 21248 27486 29883 33217 37722 46255 52330 58552 63045 66180 70553 73221 77372 78811 93656 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 58552 | 22513 27487 29887 33225 46260 52332 58554 63046 66183 71250 73222 77373 78812 93662 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 58554 | 22514 27570 29893 33227 42415 46261 52500 58555 63047 66184 71260 73223 77412 78814 93701 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 58555 | 22551 27685 29895 33228 42440 47562 52601 58558 63048 66185 71270 73700 77432 78815 93880 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 58558 | 22552 27823 29897 33230 42826 49650 52630 58560 63056 66250 71275 73701 77435 78816 93886 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 58560 | 22554 28740 29899 33231 43235 49651 52647 58561 63075 66682 71551 73706 77778 93890 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 58561 | 22600 29805 29999 33233 43237 49652 52648 58563 63076 66710 72125 73718 78300 81162 93892 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 58563 | 22610 29807 33240 43238 49653 54400 58571 63081 66982 72131 73719 78305 81211 93923 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 58571 | 22612 29820 31239 33249 43239 49654 54401 58573 63650 66986 72132 73720 78306 93925 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 58573 | 22614 29821 31240 33262 43242 49655 54405 58660 63663 67031 72141 73721 78320 90870 93970 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 58660 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 58661 | 19318 22633 29823 31256 33264 43246 49657 54416 58662 63685 67900 72147 74170 78454 92928 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 58662 | 19340 22853 29824 31267 33270 43247 49659 55866 64555 67903 72148 74174 78472 93306 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 60220 | 19350 22859 29826 31287 36475 43264 57240 60240 64702 67921 72156 74177 78492 93452 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 60240 | 19357 22902 29827 31288 36476 43274 50590 57260 61623 64704 68320 72157 74182 78608 93453 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 61623 | 19366 23472 29828 31295 36478 43275 51845 57288 61781 64708 69604 72158 74183 78650 93454 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 61781 | 19370 27130 29875 31296 37224 43276 51860 57425 61796 65730 69641 72195 75561 78707 93455 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 61796 | 19380 27132 29876 31297 37225 43644 52310 58260 61798 65755 69644 72196 75574 78708 93456 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 61798 | 27134 29877 31299 37227 43860 52315 58262 61800 65780 72197 75635 78709 93457 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 61800 | 20931 27425 29879 33207 37229 45380 52317 58356 63015 65855 70542 73201 76001 78802 93458 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 63015 | 20937 27427 29880 33208 37230 45384 52318 58541 63030 65870 70543 73202 77321 78803 93459 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 63030 | 21215 27446 29881 33213 37231 45385 52320 58542 63035 65875 70551 73218 77333 78804 93460 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 63035 | 21235 27447 29882 33216 37238 46250 52327 58544 63042 66172 70552 73220 77371 78806 93461 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 63042 | 21248 27486 29883 33217 37722 46255 52330 58552 63045 66180 70553 73221 77372 78811 93656 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 63045 | 22513 27487 29887 33225 46260 52332 58554 63046 66183 71250 73222 77373 78812 93662 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 63046 | 22514 27570 29893 33227 42415 46261 52500 58555 63047 66184 71260 73223 77412 78814 93701 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 63047 | 22551 27685 29895 33228 42440 47562 52601 58558 63048 66185 71270 73700 77432 78815 93880 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 63048 | 22552 27823 29897 33230 42826 49650 52630 58560 63056 66250 71275 73701 77435 78816 93886 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 63056 | 22554 28740 29899 33231 43235 49651 52647 58561 63075 66682 71551 73706 77778 93890 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 63075 | 22600 29805 29999 33233 43237 49652 52648 58563 63076 66710 72125 73718 78300 81162 93892 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 63076 | 22610 29807 33240 43238 49653 54400 58571 63081 66982 72131 73719 78305 81211 93923 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 63081 | 22612 29820 31239 33249 43239 49654 54401 58573 63650 66986 72132 73720 78306 93925 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 63650 | 22614 29821 31240 33262 43242 49655 54405 58660 63663 67031 72141 73721 78320 90870 93970 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 63663 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 63664 | 19318 22633 29823 31256 33264 43246 49657 54416 58662 63685 67900 72147 74170 78454 92928 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 63685 | 19340 22853 29824 31267 33270 43247 49659 55866 64555 67903 72148 74174 78472 93306 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 64555 | 19342 22854 29825 31276 33282 43259 49999 56620 60220 64590 67908 72149 74175 78473 93451 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 64590 | 19350 22859 29826 31287 36475 43264 57240 60240 64702 67921 72156 74177 78492 93452 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 64702 | 19357 22902 29827 31288 36476 43274 50590 57260 61623 64704 68320 72157 74182 78608 93453 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 64704 | 19366 23472 29828 31295 36478 43275 51845 57288 61781 64708 69604 72158 74183 78650 93454 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 64708 | 19370 27130 29875 31296 37224 43276 51860 57425 61796 65730 69641 72195 75561 78707 93455 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 65730 | 19380 27132 29876 31297 37225 43644 52310 58260 61798 65755 69644 72196 75574 78708 93456 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 65755 | 27134 29877 31299 37227 43860 52315 58262 61800 65780 72197 75635 78709 93457 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 65780 | 20931 27425 29879 33207 37229 45380 52317 58356 63015 65855 70542 73201 76001 78802 93458 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 65855 | 20937 27427 29880 33208 37230 45384 52318 58541 63030 65870 70543 73202 77321 78803 93459 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 65870 | 21215 27446 29881 33213 37231 45385 52320 58542 63035 65875 70551 73218 77333 78804 93460 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 65875 | 21235 27447 29882 33216 37238 46250 52327 58544 63042 66172 70552 73220 77371 78806 93461 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 66172 | 21248 27486 29883 33217 37722 46255 52330 58552 63045 66180 70553 73221 77372 78811 93656 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 66180 | 22513 27487 29887 33225 46260 52332 58554 63046 66183 71250 73222 77373 78812 93662 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 66183 | 22514 27570 29893 33227 42415 46261 52500 58555 63047 66184 71260 73223 77412 78814 93701 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 66184 | 22551 27685 29895 33228 42440 47562 52601 58558 63048 66185 71270 73700 77432 78815 93880 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 66185 | 22552 27823 29897 33230 42826 49650 52630 58560 63056 66250 71275 73701 77435 78816 93886 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 66250 | 22554 28740 29899 33231 43235 49651 52647 58561 63075 66682 71551 73706 77778 93890 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 66682 | 22600 29805 29999 33233 43237 49652 52648 58563 63076 66710 72125 73718 78300 81162 93892 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 66710 | 22610 29807 33240 43238 49653 54400 58571 63081 66982 72131 73719 78305 81211 93923 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 66982 | 22612 29820 31239 33249 43239 49654 54401 58573 63650 66986 72132 73720 78306 93925 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 66986 | 22614 29821 31240 33262 43242 49655 54405 58660 63663 67031 72141 73721 78320 90870 93970 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 67031 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 67039 | 19318 22633 29823 31256 33264 43246 49657 54416 58662 63685 67900 72147 74170 78454 92928 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 67900 | 19340 22853 29824 31267 33270 43247 49659 55866 64555 67903 72148 74174 78472 93306 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 67903 | 19342 22854 29825 31276 33282 43259 49999 56620 60220 64590 67908 72149 74175 78473 93451 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 67908 | 19350 22859 29826 31287 36475 43264 57240 60240 64702 67921 72156 74177 78492 93452 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 67921 | 19357 22902 29827 31288 36476 43274 50590 57260 61623 64704 68320 72157 74182 78608 93453 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 68320 | 19366 23472 29828 31295 36478 43275 51845 57288 61781 64708 69604 72158 74183 78650 93454 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 69604 | 19370 27130 29875 31296 37224 43276 51860 57425 61796 65730 69641 72195 75561 78707 93455 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 69641 | 19380 27132 29876 31297 37225 43644 52310 58260 61798 65755 69644 72196 75574 78708 93456 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 69644 | 27134 29877 31299 37227 43860 52315 58262 61800 65780 72197 75635 78709 93457 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 70542 | 20937 27427 29880 33208 37230 45384 52318 58541 63030 65870 70543 73202 77321 78803 93459 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 70543 | 21215 27446 29881 33213 37231 45385 52320 58542 63035 65875 70551 73218 77333 78804 93460 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 70551 | 21235 27447 29882 33216 37238 46250 52327 58544 63042 66172 70552 73220 77371 78806 93461 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 70552 | 21248 27486 29883 33217 37722 46255 52330 58552 63045 66180 70553 73221 77372 78811 93656 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 70553 | 22513 27487 29887 33225 46260 52332 58554 63046 66183 71250 73222 77373 78812 93662 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 71250 | 22514 27570 29893 33227 42415 46261 52500 58555 63047 66184 71260 73223 77412 78814 93701 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 71260 | 22551 27685 29895 33228 42440 47562 52601 58558 63048 66185 71270 73700 77432 78815 93880 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 71270 | 22552 27823 29897 33230 42826 49650 52630 58560 63056 66250 71275 73701 77435 78816 93886 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 71275 | 22554 28740 29899 33231 43235 49651 52647 58561 63075 66682 71551 73706 77778 93890 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 71551 | 22600 29805 29999 33233 43237 49652 52648 58563 63076 66710 72125 73718 78300 81162 93892 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 72125 | 22610 29807 33240 43238 49653 54400 58571 63081 66982 72131 73719 78305 81211 93923 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 72131 | 22612 29820 31239 33249 43239 49654 54401 58573 63650 66986 72132 73720 78306 93925 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 72132 | 22614 29821 31240 33262 43242 49655 54405 58660 63663 67031 72141 73721 78320 90870 93970 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 72141 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 72146 | 19318 22633 29823 31256 33264 43246 49657 54416 58662 63685 67900 72147 74170 78454 92928 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 72147 | 19340 22853 29824 31267 33270 43247 49659 55866 64555 67903 72148 74174 78472 93306 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 72148 | 19342 22854 29825 31276 33282 43259 49999 56620 60220 64590 67908 72149 74175 78473 93451 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 72149 | 19350 22859 29826 31287 36475 43264 57240 60240 64702 67921 72156 74177 78492 93452 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 72156 | 19357 22902 29827 31288 36476 43274 50590 57260 61623 64704 68320 72157 74182 78608 93453 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 72157 | 19366 23472 29828 31295 36478 43275 51845 57288 61781 64708 69604 72158 74183 78650 93454 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 72158 | 19370 27130 29875 31296 37224 43276 51860 57425 61796 65730 69641 72195 75561 78707 93455 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 72195 | 19380 27132 29876 31297 37225 43644 52310 58260 61798 65755 69644 72196 75574 78708 93456 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 72196 | 27134 29877 31299 37227 43860 52315 58262 61800 65780 72197 75635 78709 93457 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 72197 | 20931 27425 29879 33207 37229 45380 52317 58356 63015 65855 70542 73201 76001 78802 93458 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 73201 | 20937 27427 29880 33208 37230 45384 52318 58541 63030 65870 70543 73202 77321 78803 93459 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 73202 | 21215 27446 29881 33213 37231 45385 52320 58542 63035 65875 70551 73218 77333 78804 93460 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 73218 | 21235 27447 29882 33216 37238 46250 52327 58544 63042 66172 70552 73220 77371 78806 93461 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 73220 | 21248 27486 29883 33217 37722 46255 52330 58552 63045 66180 70553 73221 77372 78811 93656 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 73221 | 22513 27487 29887 33225 46260 52332 58554 63046 66183 71250 73222 77373 78812 93662 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 73222 | 22514 27570 29893 33227 42415 46261 52500 58555 63047 66184 71260 73223 77412 78814 93701 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 73223 | 22551 27685 29895 33228 42440 47562 52601 58558 63048 66185 71270 73700 77432 78815 93880 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 73700 | 22552 27823 29897 33230 42826 49650 52630 58560 63056 66250 71275 73701 77435 78816 93886 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 73701 | 22554 28740 29899 33231 43235 49651 52647 58561 63075 66682 71551 73706 77778 93890 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 73706 | 22600 29805 29999 33233 43237 49652 52648 58563 63076 66710 72125 73718 78300 81162 93892 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 73718 | 22610 29807 33240 43238 49653 54400 58571 63081 66982 72131 73719 78305 81211 93923 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 73719 | 22612 29820 31239 33249 43239 49654 54401 58573 63650 66986 72132 73720 78306 93925 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 73720 | 22614 29821 31240 33262 43242 49655 54405 58660 63663 67031 72141 73721 78320 90870 93970 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 73721 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 73723 | 19318 22633 29823 31256 33264 43246 49657 54416 58662 63685 67900 72147 74170 78454 92928 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 74170 | 19340 22853 29824 31267 33270 43247 49659 55866 64555 67903 72148 74174 78472 93306 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 74174 | 19342 22854 29825 31276 33282 43259 49999 56620 60220 64590 67908 72149 74175 78473 93451 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 74175 | 19350 22859 29826 31287 36475 43264 57240 60240 64702 67921 72156 74177 78492 93452 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 74177 | 19357 22902 29827 31288 36476 43274 50590 57260 61623 64704 68320 72157 74182 78608 93453 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 74182 | 19366 23472 29828 31295 36478 43275 51845 57288 61781 64708 69604 72158 74183 78650 93454 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 74183 | 19370 27130 29875 31296 37224 43276 51860 57425 61796 65730 69641 72195 75561 78707 93455 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 75561 | 19380 27132 29876 31297 37225 43644 52310 58260 61798 65755 69644 72196 75574 78708 93456 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 75574 | 27134 29877 31299 37227 43860 52315 58262 61800 65780 72197 75635 78709 93457 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 75635 | 20931 27425 29879 33207 37229 45380 52317 58356 63015 65855 70542 73201 76001 78802 93458 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 76001 | 20937 27427 29880 33208 37230 45384 52318 58541 63030 65870 70543 73202 77321 78803 93459 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 77321 | 21215 27446 29881 33213 37231 45385 52320 58542 63035 65875 70551 73218 77333 78804 93460 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 77333 | 21235 27447 29882 33216 37238 46250 52327 58544 63042 66172 70552 73220 77371 78806 93461 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 77371 | 21248 27486 29883 33217 37722 46255 52330 58552 63045 66180 70553 73221 77372 78811 93656 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 77372 | 22513 27487 29887 33225 46260 52332 58554 63046 66183 71250 73222 77373 78812 93662 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 77373 | 22514 27570 29893 33227 42415 46261 52500 58555 63047 66184 71260 73223 77412 78814 93701 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 77412 | 22551 27685 29895 33228 42440 47562 52601 58558 63048 66185 71270 73700 77432 78815 93880 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 77432 | 22552 27823 29897 33230 42826 49650 52630 58560 63056 66250 71275 73701 77435 78816 93886 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 77435 | 22554 28740 29899 33231 43235 49651 52647 58561 63075 66682 71551 73706 77778 93890 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 77778 | 22600 29805 29999 33233 43237 49652 52648 58563 63076 66710 72125 73718 78300 81162 93892 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 78300 | 22610 29807 33240 43238 49653 54400 58571 63081 66982 72131 73719 78305 81211 93923 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 78305 | 22612 29820 31239 33249 43239 49654 54401 58573 63650 66986 72132 73720 78306 93925 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 78306 | 22614 29821 31240 33262 43242 49655 54405 58660 63663 67031 72141 73721 78320 90870 93970 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 78320 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 78452 | 19318 22633 29823 31256 33264 43246 49657 54416 58662 63685 67900 72147 74170 78454 92928 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 78454 | 19340 22853 29824 31267 33270 43247 49659 55866 64555 67903 72148 74174 78472 93306 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 78472 | 19342 22854 29825 31276 33282 43259 49999 56620 60220 64590 67908 72149 74175 78473 93451 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 78473 | 19350 22859 29826 31287 36475 43264 57240 60240 64702 67921 72156 74177 78492 93452 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 78492 | 19357 22902 29827 31288 36476 43274 50590 57260 61623 64704 68320 72157 74182 78608 93453 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 78608 | 19366 23472 29828 31295 36478 43275 51845 57288 61781 64708 69604 72158 74183 78650 93454 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 78650 | 19370 27130 29875 31296 37224 43276 51860 57425 61796 65730 69641 72195 75561 78707 93455 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 78707 | 19380 27132 29876 31297 37225 43644 52310 58260 61798 65755 69644 72196 75574 78708 93456 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 78708 | 27134 29877 31299 37227 43860 52315 58262 61800 65780 72197 75635 78709 93457 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 78709 | 20931 27425 29879 33207 37229 45380 52317 58356 63015 65855 70542 73201 76001 78802 93458 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 78802 | 20937 27427 29880 33208 37230 45384 52318 58541 63030 65870 70543 73202 77321 78803 93459 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 78803 | 21215 27446 29881 33213 37231 45385 52320 58542 63035 65875 70551 73218 77333 78804 93460 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 78804 | 21235 27447 29882 33216 37238 46250 52327 58544 63042 66172 70552 73220 77371 78806 93461 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 78806 | 21248 27486 29883 33217 37722 46255 52330 58552 63045 66180 70553 73221 77372 78811 93656 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 78811 | 22513 27487 29887 33225 46260 52332 58554 63046 66183 71250 73222 77373 78812 93662 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 78812 | 22514 27570 29893 33227 42415 46261 52500 58555 63047 66184 71260 73223 77412 78814 93701 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 78814 | 22551 27685 29895 33228 42440 47562 52601 58558 63048 66185 71270 73700 77432 78815 93880 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 78815 | 22552 27823 29897 33230 42826 49650 52630 58560 63056 66250 71275 73701 77435 78816 93886 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 78816 | 22554 28740 29899 33231 43235 49651 52647 58561 63075 66682 71551 73706 77778 93890 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 81162 | 22610 29807 33240 43238 49653 54400 58571 63081 66982 72131 73719 78305 81211 93923 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 81211 | 22612 29820 31239 33249 43239 49654 54401 58573 63650 66986 72132 73720 78306 93925 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 90870 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 91110 | 19318 22633 29823 31256 33264 43246 49657 54416 58662 63685 67900 72147 74170 78454 92928 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 92928 | 19340 22853 29824 31267 33270 43247 49659 55866 64555 67903 72148 74174 78472 93306 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 93306 | 19342 22854 29825 31276 33282 43259 49999 56620 60220 64590 67908 72149 74175 78473 93451 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 93451 | 19350 22859 29826 31287 36475 43264 57240 60240 64702 67921 72156 74177 78492 93452 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 93452 | 19357 22902 29827 31288 36476 43274 50590 57260 61623 64704 68320 72157 74182 78608 93453 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 93453 | 19366 23472 29828 31295 36478 43275 51845 57288 61781 64708 69604 72158 74183 78650 93454 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 93454 | 19370 27130 29875 31296 37224 43276 51860 57425 61796 65730 69641 72195 75561 78707 93455 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 93455 | 19380 27132 29876 31297 37225 43644 52310 58260 61798 65755 69644 72196 75574 78708 93456 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 93456 | 27134 29877 31299 37227 43860 52315 58262 61800 65780 72197 75635 78709 93457 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 93457 | 20931 27425 29879 33207 37229 45380 52317 58356 63015 65855 70542 73201 76001 78802 93458 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 93458 | 20937 27427 29880 33208 37230 45384 52318 58541 63030 65870 70543 73202 77321 78803 93459 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 93459 | 21215 27446 29881 33213 37231 45385 52320 58542 63035 65875 70551 73218 77333 78804 93460 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 93460 | 21235 27447 29882 33216 37238 46250 52327 58544 63042 66172 70552 73220 77371 78806 93461 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 93461 | 21248 27486 29883 33217 37722 46255 52330 58552 63045 66180 70553 73221 77372 78811 93656 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 93656 | 22513 27487 29887 33225 46260 52332 58554 63046 66183 71250 73222 77373 78812 93662 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 93662 | 22514 27570 29893 33227 42415 46261 52500 58555 63047 66184 71260 73223 77412 78814 93701 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 93701 | 22551 27685 29895 33228 42440 47562 52601 58558 63048 66185 71270 73700 77432 78815 93880 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 93880 | 22552 27823 29897 33230 42826 49650 52630 58560 63056 66250 71275 73701 77435 78816 93886 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 93886 | 22554 28740 29899 33231 43235 49651 52647 58561 63075 66682 71551 73706 77778 93890 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 93890 | 22600 29805 29999 33233 43237 49652 52648 58563 63076 66710 72125 73718 78300 81162 93892 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 93892 | 22610 29807 33240 43238 49653 54400 58571 63081 66982 72131 73719 78305 81211 93923 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 93923 | 22612 29820 31239 33249 43239 49654 54401 58573 63650 66986 72132 73720 78306 93925 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 93925 | 22614 29821 31240 33262 43242 49655 54405 58660 63663 67031 72141 73721 78320 90870 93970 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 93970 | CPT/HCPCS Codes # – # Continued on page 3 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 93971 | CPT/HCPCS Codes # - # Continued on page 4 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 95810 | 95811 A0434 E0482 E0764 E1070 E1800 E2330 G0493 J1650 J9032 K0826 K0860 L1000 L2034 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 95811 | 95812 E0483 E0781 E1084 E1801 E2373 G0494 J1740 J9033 K0004 K0827 K0861 L1005 L2036 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 95812 | 95816 E0170 E0486 E0782 E1087 E1802 E2376 G0495 J1745 J9041 K0005 K0828 K0862 L1200 L2037 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 95816 | 95819 E0193 E0500 E0783 E1088 E1805 E2402 G0496 J1756 J9047 K0010 K0829 K0863 L1300 L2038 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 95819 | 95822 E0194 E0575 E0786 E1092 E1806 E2502 G6015 J2020 J9055 K0011 K0835 K0864 L1310 L2108 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 95822 | 95923 E0260 E0601 E0791 E1093 E1810 E2504 J2323 J9060 K0012 K0836 L1680 L2126 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 95923 | 95950 E0265 E0617 E0983 E1100 E1811 E2506 J0130 J2354 J9070 K0455 K0837 L0112 L1685 L2128 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 95950 | 95951 E0266 E0618 E0984 E1110 E1815 E2508 J0132 J2357 J9155 K0606 K0838 L0456 L1686 L2134 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 95951 | 95953 E0277 E0635 E0986 E1161 E1816 E2510 J0178 J2426 J9171 K0730 K0839 L0462 L1690 L2136 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 95953 | 95957 E0296 E0636 E0988 E1180 E1818 E2627 J0180 J2469 J9201 K0800 K0840 L0464 L1700 L2350 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 95957 | 96367 E0300 E0639 E1002 E1190 E1825 E2629 J0490 J2505 J9202 K0801 K0841 L0480 L1710 L2525 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 96367 | 96413 E0301 E0640 E1003 E1195 E1830 J0583 J2562 J9206 K0802 K0842 L0482 L1720 L2627 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 96413 | 96521 E0302 E0651 E1004 E1230 E1840 G0151 J0585 J2778 J9217 K0806 K0843 L0484 L1730 L2628 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 96521 | 96920 E0303 E0652 E1005 E1232 E1841 G0152 J0587 J2785 J9228 K0807 K0848 L0486 L1755 L3674 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 96920 | 96921 E0304 E0670 E1006 E1233 E2120 G0153 J0637 J2796 J9263 K0808 K0849 L0631 L1833 L3730 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 96921 | 96922 E0316 E0675 E1007 E1234 E2227 G0155 J0881 J2997 J9264 K0813 K0850 L0636 L1844 L3740 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 96922 | 97110 E0371 E0692 E1008 E1235 E2310 G0156 J0885 J3315 J9299 K0814 K0851 L0637 L1845 L3765 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 97110 | 97112 E0372 E0693 E1010 E1236 E2311 G0158 J0894 J3489 J9301 K0815 K0852 L0638 L1846 L3766 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 97112 | 97140 E0373 E0694 E1012 E1237 E2312 G0159 J0897 J3590 J9303 K0816 K0853 L0650 L1860 L3900 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 97140 | 97530 E0462 E0744 E1030 E1238 E2321 G0161 J1327 J7189 J9305 K0820 K0854 L0700 L1970 L3901 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 97530 | 99304 E0465 E0747 E1035 E1240 E2322 G0162 J1442 J7312 J9306 K0821 K0855 L0710 L2000 L3904 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| 99304 | E0466 E0748 E1036 E1280 E2325 G0277 J1453 J7324 J9310 K0822 K0856 L0810 L2005 L3961 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| A0428 | 95810 A0431 E0472 E0762 E1060 E1405 E2329 G0483 J1570 J9031 J9999 K0825 K0859 L0859 L2030 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| A0431 | 95811 A0434 E0482 E0764 E1070 E1800 E2330 G0493 J1650 J9032 K0826 K0860 L1000 L2034 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| A0434 | 95812 E0483 E0781 E1084 E1801 E2373 G0494 J1740 J9033 K0004 K0827 K0861 L1005 L2036 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0170 | 95819 E0193 E0500 E0783 E1088 E1805 E2402 G0496 J1756 J9047 K0010 K0829 K0863 L1300 L2038 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0193 | 95822 E0194 E0575 E0786 E1092 E1806 E2502 G6015 J2020 J9055 K0011 K0835 K0864 L1310 L2108 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0194 | 95923 E0260 E0601 E0791 E1093 E1810 E2504 J2323 J9060 K0012 K0836 L1680 L2126 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0260 | 95950 E0265 E0617 E0983 E1100 E1811 E2506 J0130 J2354 J9070 K0455 K0837 L0112 L1685 L2128 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0265 | 95951 E0266 E0618 E0984 E1110 E1815 E2508 J0132 J2357 J9155 K0606 K0838 L0456 L1686 L2134 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0266 | 95953 E0277 E0635 E0986 E1161 E1816 E2510 J0178 J2426 J9171 K0730 K0839 L0462 L1690 L2136 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0277 | 95957 E0296 E0636 E0988 E1180 E1818 E2627 J0180 J2469 J9201 K0800 K0840 L0464 L1700 L2350 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0296 | 96367 E0300 E0639 E1002 E1190 E1825 E2629 J0490 J2505 J9202 K0801 K0841 L0480 L1710 L2525 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0300 | 96413 E0301 E0640 E1003 E1195 E1830 J0583 J2562 J9206 K0802 K0842 L0482 L1720 L2627 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0301 | 96521 E0302 E0651 E1004 E1230 E1840 G0151 J0585 J2778 J9217 K0806 K0843 L0484 L1730 L2628 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0302 | 96920 E0303 E0652 E1005 E1232 E1841 G0152 J0587 J2785 J9228 K0807 K0848 L0486 L1755 L3674 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0303 | 96921 E0304 E0670 E1006 E1233 E2120 G0153 J0637 J2796 J9263 K0808 K0849 L0631 L1833 L3730 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0304 | 96922 E0316 E0675 E1007 E1234 E2227 G0155 J0881 J2997 J9264 K0813 K0850 L0636 L1844 L3740 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0316 | 97110 E0371 E0692 E1008 E1235 E2310 G0156 J0885 J3315 J9299 K0814 K0851 L0637 L1845 L3765 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0371 | 97112 E0372 E0693 E1010 E1236 E2311 G0158 J0894 J3489 J9301 K0815 K0852 L0638 L1846 L3766 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0372 | 97140 E0373 E0694 E1012 E1237 E2312 G0159 J0897 J3590 J9303 K0816 K0853 L0650 L1860 L3900 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0373 | 97530 E0462 E0744 E1030 E1238 E2321 G0161 J1327 J7189 J9305 K0820 K0854 L0700 L1970 L3901 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0462 | 99304 E0465 E0747 E1035 E1240 E2322 G0162 J1442 J7312 J9306 K0821 K0855 L0710 L2000 L3904 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0465 | E0466 E0748 E1036 E1280 E2325 G0277 J1453 J7324 J9310 K0822 K0856 L0810 L2005 L3961 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0466 | 0191T E0470 E0749 E1037 E1295 E2327 G0299 J1561 J7325 J9355 K0823 K0857 L0820 L2010 L3967 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0470 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0471 | 95810 A0431 E0472 E0762 E1060 E1405 E2329 G0483 J1570 J9031 J9999 K0825 K0859 L0859 L2030 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0472 | 95811 A0434 E0482 E0764 E1070 E1800 E2330 G0493 J1650 J9032 K0826 K0860 L1000 L2034 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0482 | 95812 E0483 E0781 E1084 E1801 E2373 G0494 J1740 J9033 K0004 K0827 K0861 L1005 L2036 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0483 | 95816 E0170 E0486 E0782 E1087 E1802 E2376 G0495 J1745 J9041 K0005 K0828 K0862 L1200 L2037 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0486 | 95819 E0193 E0500 E0783 E1088 E1805 E2402 G0496 J1756 J9047 K0010 K0829 K0863 L1300 L2038 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0500 | 95822 E0194 E0575 E0786 E1092 E1806 E2502 G6015 J2020 J9055 K0011 K0835 K0864 L1310 L2108 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0575 | 95923 E0260 E0601 E0791 E1093 E1810 E2504 J2323 J9060 K0012 K0836 L1680 L2126 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0601 | 95950 E0265 E0617 E0983 E1100 E1811 E2506 J0130 J2354 J9070 K0455 K0837 L0112 L1685 L2128 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0617 | 95951 E0266 E0618 E0984 E1110 E1815 E2508 J0132 J2357 J9155 K0606 K0838 L0456 L1686 L2134 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0618 | 95953 E0277 E0635 E0986 E1161 E1816 E2510 J0178 J2426 J9171 K0730 K0839 L0462 L1690 L2136 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0635 | 95957 E0296 E0636 E0988 E1180 E1818 E2627 J0180 J2469 J9201 K0800 K0840 L0464 L1700 L2350 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0636 | 96367 E0300 E0639 E1002 E1190 E1825 E2629 J0490 J2505 J9202 K0801 K0841 L0480 L1710 L2525 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0639 | 96413 E0301 E0640 E1003 E1195 E1830 J0583 J2562 J9206 K0802 K0842 L0482 L1720 L2627 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0640 | 96521 E0302 E0651 E1004 E1230 E1840 G0151 J0585 J2778 J9217 K0806 K0843 L0484 L1730 L2628 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0650 | with Venous Stasis Ulcers segmented compressor, , with a segmented | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0651 | 96920 E0303 E0652 E1005 E1232 E1841 G0152 J0587 J2785 J9228 K0807 K0848 L0486 L1755 L3674 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0652 | 96921 E0304 E0670 E1006 E1233 E2120 G0153 J0637 J2796 J9263 K0808 K0849 L0631 L1833 L3730 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0670 | 96922 E0316 E0675 E1007 E1234 E2227 G0155 J0881 J2997 J9264 K0813 K0850 L0636 L1844 L3740 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0671 | • Previous conservative treatments attempted appliance, - ) had been tried and the results | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0673 | • Previous conservative treatments attempted appliance, - ) had been tried and the results | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0675 | 97110 E0371 E0692 E1008 E1235 E2310 G0156 J0885 J3315 J9299 K0814 K0851 L0637 L1845 L3765 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0692 | 97112 E0372 E0693 E1010 E1236 E2311 G0158 J0894 J3489 J9301 K0815 K0852 L0638 L1846 L3766 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0693 | 97140 E0373 E0694 E1012 E1237 E2312 G0159 J0897 J3590 J9303 K0816 K0853 L0650 L1860 L3900 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0694 | 97530 E0462 E0744 E1030 E1238 E2321 G0161 J1327 J7189 J9305 K0820 K0854 L0700 L1970 L3901 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0744 | 99304 E0465 E0747 E1035 E1240 E2322 G0162 J1442 J7312 J9306 K0821 K0855 L0710 L2000 L3904 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0747 | E0466 E0748 E1036 E1280 E2325 G0277 J1453 J7324 J9310 K0822 K0856 L0810 L2005 L3961 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0748 | 0191T E0470 E0749 E1037 E1295 E2327 G0299 J1561 J7325 J9355 K0823 K0857 L0820 L2010 L3967 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0749 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0760 | 95810 A0431 E0472 E0762 E1060 E1405 E2329 G0483 J1570 J9031 J9999 K0825 K0859 L0859 L2030 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0762 | 95811 A0434 E0482 E0764 E1070 E1800 E2330 G0493 J1650 J9032 K0826 K0860 L1000 L2034 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0764 | 95812 E0483 E0781 E1084 E1801 E2373 G0494 J1740 J9033 K0004 K0827 K0861 L1005 L2036 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0781 | 95816 E0170 E0486 E0782 E1087 E1802 E2376 G0495 J1745 J9041 K0005 K0828 K0862 L1200 L2037 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0782 | 95819 E0193 E0500 E0783 E1088 E1805 E2402 G0496 J1756 J9047 K0010 K0829 K0863 L1300 L2038 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0783 | 95822 E0194 E0575 E0786 E1092 E1806 E2502 G6015 J2020 J9055 K0011 K0835 K0864 L1310 L2108 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0786 | 95923 E0260 E0601 E0791 E1093 E1810 E2504 J2323 J9060 K0012 K0836 L1680 L2126 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0791 | 95950 E0265 E0617 E0983 E1100 E1811 E2506 J0130 J2354 J9070 K0455 K0837 L0112 L1685 L2128 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0983 | 95951 E0266 E0618 E0984 E1110 E1815 E2508 J0132 J2357 J9155 K0606 K0838 L0456 L1686 L2134 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0984 | 95953 E0277 E0635 E0986 E1161 E1816 E2510 J0178 J2426 J9171 K0730 K0839 L0462 L1690 L2136 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0986 | 95957 E0296 E0636 E0988 E1180 E1818 E2627 J0180 J2469 J9201 K0800 K0840 L0464 L1700 L2350 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E0988 | 96367 E0300 E0639 E1002 E1190 E1825 E2629 J0490 J2505 J9202 K0801 K0841 L0480 L1710 L2525 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1002 | 96413 E0301 E0640 E1003 E1195 E1830 J0583 J2562 J9206 K0802 K0842 L0482 L1720 L2627 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1003 | 96521 E0302 E0651 E1004 E1230 E1840 G0151 J0585 J2778 J9217 K0806 K0843 L0484 L1730 L2628 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1004 | 96920 E0303 E0652 E1005 E1232 E1841 G0152 J0587 J2785 J9228 K0807 K0848 L0486 L1755 L3674 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1005 | 96921 E0304 E0670 E1006 E1233 E2120 G0153 J0637 J2796 J9263 K0808 K0849 L0631 L1833 L3730 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1006 | 96922 E0316 E0675 E1007 E1234 E2227 G0155 J0881 J2997 J9264 K0813 K0850 L0636 L1844 L3740 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1007 | 97110 E0371 E0692 E1008 E1235 E2310 G0156 J0885 J3315 J9299 K0814 K0851 L0637 L1845 L3765 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1008 | 97112 E0372 E0693 E1010 E1236 E2311 G0158 J0894 J3489 J9301 K0815 K0852 L0638 L1846 L3766 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1010 | 97140 E0373 E0694 E1012 E1237 E2312 G0159 J0897 J3590 J9303 K0816 K0853 L0650 L1860 L3900 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1012 | 97530 E0462 E0744 E1030 E1238 E2321 G0161 J1327 J7189 J9305 K0820 K0854 L0700 L1970 L3901 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1030 | 99304 E0465 E0747 E1035 E1240 E2322 G0162 J1442 J7312 J9306 K0821 K0855 L0710 L2000 L3904 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1035 | E0466 E0748 E1036 E1280 E2325 G0277 J1453 J7324 J9310 K0822 K0856 L0810 L2005 L3961 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1036 | 0191T E0470 E0749 E1037 E1295 E2327 G0299 J1561 J7325 J9355 K0823 K0857 L0820 L2010 L3967 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1037 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1050 | 95810 A0431 E0472 E0762 E1060 E1405 E2329 G0483 J1570 J9031 J9999 K0825 K0859 L0859 L2030 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1060 | 95811 A0434 E0482 E0764 E1070 E1800 E2330 G0493 J1650 J9032 K0826 K0860 L1000 L2034 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1070 | 95812 E0483 E0781 E1084 E1801 E2373 G0494 J1740 J9033 K0004 K0827 K0861 L1005 L2036 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1084 | 95816 E0170 E0486 E0782 E1087 E1802 E2376 G0495 J1745 J9041 K0005 K0828 K0862 L1200 L2037 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1087 | 95819 E0193 E0500 E0783 E1088 E1805 E2402 G0496 J1756 J9047 K0010 K0829 K0863 L1300 L2038 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1088 | 95822 E0194 E0575 E0786 E1092 E1806 E2502 G6015 J2020 J9055 K0011 K0835 K0864 L1310 L2108 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1092 | 95923 E0260 E0601 E0791 E1093 E1810 E2504 J2323 J9060 K0012 K0836 L1680 L2126 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1093 | 95950 E0265 E0617 E0983 E1100 E1811 E2506 J0130 J2354 J9070 K0455 K0837 L0112 L1685 L2128 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1100 | 95951 E0266 E0618 E0984 E1110 E1815 E2508 J0132 J2357 J9155 K0606 K0838 L0456 L1686 L2134 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1110 | 95953 E0277 E0635 E0986 E1161 E1816 E2510 J0178 J2426 J9171 K0730 K0839 L0462 L1690 L2136 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1161 | 95957 E0296 E0636 E0988 E1180 E1818 E2627 J0180 J2469 J9201 K0800 K0840 L0464 L1700 L2350 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1180 | 96367 E0300 E0639 E1002 E1190 E1825 E2629 J0490 J2505 J9202 K0801 K0841 L0480 L1710 L2525 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1190 | 96413 E0301 E0640 E1003 E1195 E1830 J0583 J2562 J9206 K0802 K0842 L0482 L1720 L2627 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1195 | 96521 E0302 E0651 E1004 E1230 E1840 G0151 J0585 J2778 J9217 K0806 K0843 L0484 L1730 L2628 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1230 | 96920 E0303 E0652 E1005 E1232 E1841 G0152 J0587 J2785 J9228 K0807 K0848 L0486 L1755 L3674 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1232 | 96921 E0304 E0670 E1006 E1233 E2120 G0153 J0637 J2796 J9263 K0808 K0849 L0631 L1833 L3730 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1233 | 96922 E0316 E0675 E1007 E1234 E2227 G0155 J0881 J2997 J9264 K0813 K0850 L0636 L1844 L3740 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1234 | 97110 E0371 E0692 E1008 E1235 E2310 G0156 J0885 J3315 J9299 K0814 K0851 L0637 L1845 L3765 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1235 | 97112 E0372 E0693 E1010 E1236 E2311 G0158 J0894 J3489 J9301 K0815 K0852 L0638 L1846 L3766 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1236 | 97140 E0373 E0694 E1012 E1237 E2312 G0159 J0897 J3590 J9303 K0816 K0853 L0650 L1860 L3900 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1237 | 97530 E0462 E0744 E1030 E1238 E2321 G0161 J1327 J7189 J9305 K0820 K0854 L0700 L1970 L3901 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1238 | 99304 E0465 E0747 E1035 E1240 E2322 G0162 J1442 J7312 J9306 K0821 K0855 L0710 L2000 L3904 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1240 | E0466 E0748 E1036 E1280 E2325 G0277 J1453 J7324 J9310 K0822 K0856 L0810 L2005 L3961 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1280 | 0191T E0470 E0749 E1037 E1295 E2327 G0299 J1561 J7325 J9355 K0823 K0857 L0820 L2010 L3967 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1295 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1310 | 95810 A0431 E0472 E0762 E1060 E1405 E2329 G0483 J1570 J9031 J9999 K0825 K0859 L0859 L2030 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1405 | 95811 A0434 E0482 E0764 E1070 E1800 E2330 G0493 J1650 J9032 K0826 K0860 L1000 L2034 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1800 | 95812 E0483 E0781 E1084 E1801 E2373 G0494 J1740 J9033 K0004 K0827 K0861 L1005 L2036 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1801 | 95816 E0170 E0486 E0782 E1087 E1802 E2376 G0495 J1745 J9041 K0005 K0828 K0862 L1200 L2037 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1802 | 95819 E0193 E0500 E0783 E1088 E1805 E2402 G0496 J1756 J9047 K0010 K0829 K0863 L1300 L2038 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1805 | 95822 E0194 E0575 E0786 E1092 E1806 E2502 G6015 J2020 J9055 K0011 K0835 K0864 L1310 L2108 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1806 | 95923 E0260 E0601 E0791 E1093 E1810 E2504 J2323 J9060 K0012 K0836 L1680 L2126 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1810 | 95950 E0265 E0617 E0983 E1100 E1811 E2506 J0130 J2354 J9070 K0455 K0837 L0112 L1685 L2128 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1811 | 95951 E0266 E0618 E0984 E1110 E1815 E2508 J0132 J2357 J9155 K0606 K0838 L0456 L1686 L2134 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1815 | 95953 E0277 E0635 E0986 E1161 E1816 E2510 J0178 J2426 J9171 K0730 K0839 L0462 L1690 L2136 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1816 | 95957 E0296 E0636 E0988 E1180 E1818 E2627 J0180 J2469 J9201 K0800 K0840 L0464 L1700 L2350 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1818 | 96367 E0300 E0639 E1002 E1190 E1825 E2629 J0490 J2505 J9202 K0801 K0841 L0480 L1710 L2525 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1825 | 96413 E0301 E0640 E1003 E1195 E1830 J0583 J2562 J9206 K0802 K0842 L0482 L1720 L2627 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1830 | 96521 E0302 E0651 E1004 E1230 E1840 G0151 J0585 J2778 J9217 K0806 K0843 L0484 L1730 L2628 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1840 | 96920 E0303 E0652 E1005 E1232 E1841 G0152 J0587 J2785 J9228 K0807 K0848 L0486 L1755 L3674 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E1841 | 96921 E0304 E0670 E1006 E1233 E2120 G0153 J0637 J2796 J9263 K0808 K0849 L0631 L1833 L3730 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E2120 | 96922 E0316 E0675 E1007 E1234 E2227 G0155 J0881 J2997 J9264 K0813 K0850 L0636 L1844 L3740 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E2227 | 97110 E0371 E0692 E1008 E1235 E2310 G0156 J0885 J3315 J9299 K0814 K0851 L0637 L1845 L3765 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E2310 | 97112 E0372 E0693 E1010 E1236 E2311 G0158 J0894 J3489 J9301 K0815 K0852 L0638 L1846 L3766 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E2311 | 97140 E0373 E0694 E1012 E1237 E2312 G0159 J0897 J3590 J9303 K0816 K0853 L0650 L1860 L3900 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E2312 | 97530 E0462 E0744 E1030 E1238 E2321 G0161 J1327 J7189 J9305 K0820 K0854 L0700 L1970 L3901 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E2321 | 99304 E0465 E0747 E1035 E1240 E2322 G0162 J1442 J7312 J9306 K0821 K0855 L0710 L2000 L3904 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E2322 | E0466 E0748 E1036 E1280 E2325 G0277 J1453 J7324 J9310 K0822 K0856 L0810 L2005 L3961 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E2325 | 0191T E0470 E0749 E1037 E1295 E2327 G0299 J1561 J7325 J9355 K0823 K0857 L0820 L2010 L3967 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E2327 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E2328 | 95810 A0431 E0472 E0762 E1060 E1405 E2329 G0483 J1570 J9031 J9999 K0825 K0859 L0859 L2030 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E2329 | 95811 A0434 E0482 E0764 E1070 E1800 E2330 G0493 J1650 J9032 K0826 K0860 L1000 L2034 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E2330 | 95812 E0483 E0781 E1084 E1801 E2373 G0494 J1740 J9033 K0004 K0827 K0861 L1005 L2036 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E2373 | 95816 E0170 E0486 E0782 E1087 E1802 E2376 G0495 J1745 J9041 K0005 K0828 K0862 L1200 L2037 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E2376 | 95819 E0193 E0500 E0783 E1088 E1805 E2402 G0496 J1756 J9047 K0010 K0829 K0863 L1300 L2038 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E2402 | 95822 E0194 E0575 E0786 E1092 E1806 E2502 G6015 J2020 J9055 K0011 K0835 K0864 L1310 L2108 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E2502 | 95923 E0260 E0601 E0791 E1093 E1810 E2504 J2323 J9060 K0012 K0836 L1680 L2126 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E2504 | 95950 E0265 E0617 E0983 E1100 E1811 E2506 J0130 J2354 J9070 K0455 K0837 L0112 L1685 L2128 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E2506 | 95951 E0266 E0618 E0984 E1110 E1815 E2508 J0132 J2357 J9155 K0606 K0838 L0456 L1686 L2134 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E2508 | 95953 E0277 E0635 E0986 E1161 E1816 E2510 J0178 J2426 J9171 K0730 K0839 L0462 L1690 L2136 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E2510 | 95957 E0296 E0636 E0988 E1180 E1818 E2627 J0180 J2469 J9201 K0800 K0840 L0464 L1700 L2350 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E2627 | 96367 E0300 E0639 E1002 E1190 E1825 E2629 J0490 J2505 J9202 K0801 K0841 L0480 L1710 L2525 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| E2629 | 96413 E0301 E0640 E1003 E1195 E1830 J0583 J2562 J9206 K0802 K0842 L0482 L1720 L2627 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| G0151 | 96920 E0303 E0652 E1005 E1232 E1841 G0152 J0587 J2785 J9228 K0807 K0848 L0486 L1755 L3674 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| G0152 | 96921 E0304 E0670 E1006 E1233 E2120 G0153 J0637 J2796 J9263 K0808 K0849 L0631 L1833 L3730 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| G0153 | 96922 E0316 E0675 E1007 E1234 E2227 G0155 J0881 J2997 J9264 K0813 K0850 L0636 L1844 L3740 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| G0155 | 97110 E0371 E0692 E1008 E1235 E2310 G0156 J0885 J3315 J9299 K0814 K0851 L0637 L1845 L3765 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| G0156 | 97112 E0372 E0693 E1010 E1236 E2311 G0158 J0894 J3489 J9301 K0815 K0852 L0638 L1846 L3766 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| G0158 | 97140 E0373 E0694 E1012 E1237 E2312 G0159 J0897 J3590 J9303 K0816 K0853 L0650 L1860 L3900 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| G0159 | 97530 E0462 E0744 E1030 E1238 E2321 G0161 J1327 J7189 J9305 K0820 K0854 L0700 L1970 L3901 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| G0161 | 99304 E0465 E0747 E1035 E1240 E2322 G0162 J1442 J7312 J9306 K0821 K0855 L0710 L2000 L3904 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| G0162 | E0466 E0748 E1036 E1280 E2325 G0277 J1453 J7324 J9310 K0822 K0856 L0810 L2005 L3961 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| G0277 | 0191T E0470 E0749 E1037 E1295 E2327 G0299 J1561 J7325 J9355 K0823 K0857 L0820 L2010 L3967 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| G0299 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| G0300 | 95810 A0431 E0472 E0762 E1060 E1405 E2329 G0483 J1570 J9031 J9999 K0825 K0859 L0859 L2030 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| G0483 | 95811 A0434 E0482 E0764 E1070 E1800 E2330 G0493 J1650 J9032 K0826 K0860 L1000 L2034 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| G0493 | 95812 E0483 E0781 E1084 E1801 E2373 G0494 J1740 J9033 K0004 K0827 K0861 L1005 L2036 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| G0494 | 95816 E0170 E0486 E0782 E1087 E1802 E2376 G0495 J1745 J9041 K0005 K0828 K0862 L1200 L2037 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| G0495 | 95819 E0193 E0500 E0783 E1088 E1805 E2402 G0496 J1756 J9047 K0010 K0829 K0863 L1300 L2038 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| G0496 | 95822 E0194 E0575 E0786 E1092 E1806 E2502 G6015 J2020 J9055 K0011 K0835 K0864 L1310 L2108 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| G6015 | 95923 E0260 E0601 E0791 E1093 E1810 E2504 J2323 J9060 K0012 K0836 L1680 L2126 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J0130 | 95951 E0266 E0618 E0984 E1110 E1815 E2508 J0132 J2357 J9155 K0606 K0838 L0456 L1686 L2134 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J0132 | 95953 E0277 E0635 E0986 E1161 E1816 E2510 J0178 J2426 J9171 K0730 K0839 L0462 L1690 L2136 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J0178 | 95957 E0296 E0636 E0988 E1180 E1818 E2627 J0180 J2469 J9201 K0800 K0840 L0464 L1700 L2350 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J0180 | 96367 E0300 E0639 E1002 E1190 E1825 E2629 J0490 J2505 J9202 K0801 K0841 L0480 L1710 L2525 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J0490 | 96413 E0301 E0640 E1003 E1195 E1830 J0583 J2562 J9206 K0802 K0842 L0482 L1720 L2627 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J0583 | 96521 E0302 E0651 E1004 E1230 E1840 G0151 J0585 J2778 J9217 K0806 K0843 L0484 L1730 L2628 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J0585 | 96920 E0303 E0652 E1005 E1232 E1841 G0152 J0587 J2785 J9228 K0807 K0848 L0486 L1755 L3674 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J0587 | 96921 E0304 E0670 E1006 E1233 E2120 G0153 J0637 J2796 J9263 K0808 K0849 L0631 L1833 L3730 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J0637 | 96922 E0316 E0675 E1007 E1234 E2227 G0155 J0881 J2997 J9264 K0813 K0850 L0636 L1844 L3740 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J0881 | 97110 E0371 E0692 E1008 E1235 E2310 G0156 J0885 J3315 J9299 K0814 K0851 L0637 L1845 L3765 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J0885 | 97112 E0372 E0693 E1010 E1236 E2311 G0158 J0894 J3489 J9301 K0815 K0852 L0638 L1846 L3766 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J0894 | 97140 E0373 E0694 E1012 E1237 E2312 G0159 J0897 J3590 J9303 K0816 K0853 L0650 L1860 L3900 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J0897 | 97530 E0462 E0744 E1030 E1238 E2321 G0161 J1327 J7189 J9305 K0820 K0854 L0700 L1970 L3901 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J1327 | 99304 E0465 E0747 E1035 E1240 E2322 G0162 J1442 J7312 J9306 K0821 K0855 L0710 L2000 L3904 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J1442 | E0466 E0748 E1036 E1280 E2325 G0277 J1453 J7324 J9310 K0822 K0856 L0810 L2005 L3961 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J1453 | 0191T E0470 E0749 E1037 E1295 E2327 G0299 J1561 J7325 J9355 K0823 K0857 L0820 L2010 L3967 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J1561 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J1568 | 95810 A0431 E0472 E0762 E1060 E1405 E2329 G0483 J1570 J9031 J9999 K0825 K0859 L0859 L2030 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J1570 | 95811 A0434 E0482 E0764 E1070 E1800 E2330 G0493 J1650 J9032 K0826 K0860 L1000 L2034 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J1650 | 95812 E0483 E0781 E1084 E1801 E2373 G0494 J1740 J9033 K0004 K0827 K0861 L1005 L2036 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J1740 | 95816 E0170 E0486 E0782 E1087 E1802 E2376 G0495 J1745 J9041 K0005 K0828 K0862 L1200 L2037 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J1745 | 95819 E0193 E0500 E0783 E1088 E1805 E2402 G0496 J1756 J9047 K0010 K0829 K0863 L1300 L2038 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J1756 | 95822 E0194 E0575 E0786 E1092 E1806 E2502 G6015 J2020 J9055 K0011 K0835 K0864 L1310 L2108 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J2020 | 95923 E0260 E0601 E0791 E1093 E1810 E2504 J2323 J9060 K0012 K0836 L1680 L2126 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J2323 | 95950 E0265 E0617 E0983 E1100 E1811 E2506 J0130 J2354 J9070 K0455 K0837 L0112 L1685 L2128 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J2354 | 95951 E0266 E0618 E0984 E1110 E1815 E2508 J0132 J2357 J9155 K0606 K0838 L0456 L1686 L2134 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J2357 | 95953 E0277 E0635 E0986 E1161 E1816 E2510 J0178 J2426 J9171 K0730 K0839 L0462 L1690 L2136 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J2426 | 95957 E0296 E0636 E0988 E1180 E1818 E2627 J0180 J2469 J9201 K0800 K0840 L0464 L1700 L2350 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J2469 | 96367 E0300 E0639 E1002 E1190 E1825 E2629 J0490 J2505 J9202 K0801 K0841 L0480 L1710 L2525 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J2505 | 96413 E0301 E0640 E1003 E1195 E1830 J0583 J2562 J9206 K0802 K0842 L0482 L1720 L2627 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J2562 | 96521 E0302 E0651 E1004 E1230 E1840 G0151 J0585 J2778 J9217 K0806 K0843 L0484 L1730 L2628 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J2778 | 96920 E0303 E0652 E1005 E1232 E1841 G0152 J0587 J2785 J9228 K0807 K0848 L0486 L1755 L3674 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J2785 | 96921 E0304 E0670 E1006 E1233 E2120 G0153 J0637 J2796 J9263 K0808 K0849 L0631 L1833 L3730 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J2796 | 96922 E0316 E0675 E1007 E1234 E2227 G0155 J0881 J2997 J9264 K0813 K0850 L0636 L1844 L3740 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J2997 | 97110 E0371 E0692 E1008 E1235 E2310 G0156 J0885 J3315 J9299 K0814 K0851 L0637 L1845 L3765 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J3315 | 97112 E0372 E0693 E1010 E1236 E2311 G0158 J0894 J3489 J9301 K0815 K0852 L0638 L1846 L3766 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J3489 | 97140 E0373 E0694 E1012 E1237 E2312 G0159 J0897 J3590 J9303 K0816 K0853 L0650 L1860 L3900 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J3590 | 97530 E0462 E0744 E1030 E1238 E2321 G0161 J1327 J7189 J9305 K0820 K0854 L0700 L1970 L3901 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J7189 | 99304 E0465 E0747 E1035 E1240 E2322 G0162 J1442 J7312 J9306 K0821 K0855 L0710 L2000 L3904 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J7312 | E0466 E0748 E1036 E1280 E2325 G0277 J1453 J7324 J9310 K0822 K0856 L0810 L2005 L3961 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J7324 | 0191T E0470 E0749 E1037 E1295 E2327 G0299 J1561 J7325 J9355 K0823 K0857 L0820 L2010 L3967 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J7325 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9025 | 95810 A0431 E0472 E0762 E1060 E1405 E2329 G0483 J1570 J9031 J9999 K0825 K0859 L0859 L2030 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9031 | 95811 A0434 E0482 E0764 E1070 E1800 E2330 G0493 J1650 J9032 K0826 K0860 L1000 L2034 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9032 | 95812 E0483 E0781 E1084 E1801 E2373 G0494 J1740 J9033 K0004 K0827 K0861 L1005 L2036 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9033 | 95816 E0170 E0486 E0782 E1087 E1802 E2376 G0495 J1745 J9041 K0005 K0828 K0862 L1200 L2037 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9041 | 95819 E0193 E0500 E0783 E1088 E1805 E2402 G0496 J1756 J9047 K0010 K0829 K0863 L1300 L2038 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9047 | 95822 E0194 E0575 E0786 E1092 E1806 E2502 G6015 J2020 J9055 K0011 K0835 K0864 L1310 L2108 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9055 | 95923 E0260 E0601 E0791 E1093 E1810 E2504 J2323 J9060 K0012 K0836 L1680 L2126 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9060 | 95950 E0265 E0617 E0983 E1100 E1811 E2506 J0130 J2354 J9070 K0455 K0837 L0112 L1685 L2128 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9070 | 95951 E0266 E0618 E0984 E1110 E1815 E2508 J0132 J2357 J9155 K0606 K0838 L0456 L1686 L2134 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9155 | 95953 E0277 E0635 E0986 E1161 E1816 E2510 J0178 J2426 J9171 K0730 K0839 L0462 L1690 L2136 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9171 | 95957 E0296 E0636 E0988 E1180 E1818 E2627 J0180 J2469 J9201 K0800 K0840 L0464 L1700 L2350 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9201 | 96367 E0300 E0639 E1002 E1190 E1825 E2629 J0490 J2505 J9202 K0801 K0841 L0480 L1710 L2525 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9202 | 96413 E0301 E0640 E1003 E1195 E1830 J0583 J2562 J9206 K0802 K0842 L0482 L1720 L2627 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9206 | 96521 E0302 E0651 E1004 E1230 E1840 G0151 J0585 J2778 J9217 K0806 K0843 L0484 L1730 L2628 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9217 | 96920 E0303 E0652 E1005 E1232 E1841 G0152 J0587 J2785 J9228 K0807 K0848 L0486 L1755 L3674 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9228 | 96921 E0304 E0670 E1006 E1233 E2120 G0153 J0637 J2796 J9263 K0808 K0849 L0631 L1833 L3730 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9263 | 96922 E0316 E0675 E1007 E1234 E2227 G0155 J0881 J2997 J9264 K0813 K0850 L0636 L1844 L3740 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9264 | 97110 E0371 E0692 E1008 E1235 E2310 G0156 J0885 J3315 J9299 K0814 K0851 L0637 L1845 L3765 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9299 | 97112 E0372 E0693 E1010 E1236 E2311 G0158 J0894 J3489 J9301 K0815 K0852 L0638 L1846 L3766 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9301 | 97140 E0373 E0694 E1012 E1237 E2312 G0159 J0897 J3590 J9303 K0816 K0853 L0650 L1860 L3900 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9303 | 97530 E0462 E0744 E1030 E1238 E2321 G0161 J1327 J7189 J9305 K0820 K0854 L0700 L1970 L3901 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9305 | 99304 E0465 E0747 E1035 E1240 E2322 G0162 J1442 J7312 J9306 K0821 K0855 L0710 L2000 L3904 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9306 | E0466 E0748 E1036 E1280 E2325 G0277 J1453 J7324 J9310 K0822 K0856 L0810 L2005 L3961 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9310 | 0191T E0470 E0749 E1037 E1295 E2327 G0299 J1561 J7325 J9355 K0823 K0857 L0820 L2010 L3967 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9355 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9395 | 95810 A0431 E0472 E0762 E1060 E1405 E2329 G0483 J1570 J9031 J9999 K0825 K0859 L0859 L2030 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| J9999 | 95811 A0434 E0482 E0764 E1070 E1800 E2330 G0493 J1650 J9032 K0826 K0860 L1000 L2034 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0004 | 95816 E0170 E0486 E0782 E1087 E1802 E2376 G0495 J1745 J9041 K0005 K0828 K0862 L1200 L2037 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0005 | 95819 E0193 E0500 E0783 E1088 E1805 E2402 G0496 J1756 J9047 K0010 K0829 K0863 L1300 L2038 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0010 | 95822 E0194 E0575 E0786 E1092 E1806 E2502 G6015 J2020 J9055 K0011 K0835 K0864 L1310 L2108 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0011 | 95923 E0260 E0601 E0791 E1093 E1810 E2504 J2323 J9060 K0012 K0836 L1680 L2126 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0012 | 95950 E0265 E0617 E0983 E1100 E1811 E2506 J0130 J2354 J9070 K0455 K0837 L0112 L1685 L2128 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0455 | 95951 E0266 E0618 E0984 E1110 E1815 E2508 J0132 J2357 J9155 K0606 K0838 L0456 L1686 L2134 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0606 | 95953 E0277 E0635 E0986 E1161 E1816 E2510 J0178 J2426 J9171 K0730 K0839 L0462 L1690 L2136 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0730 | 95957 E0296 E0636 E0988 E1180 E1818 E2627 J0180 J2469 J9201 K0800 K0840 L0464 L1700 L2350 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0800 | 96367 E0300 E0639 E1002 E1190 E1825 E2629 J0490 J2505 J9202 K0801 K0841 L0480 L1710 L2525 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0801 | 96413 E0301 E0640 E1003 E1195 E1830 J0583 J2562 J9206 K0802 K0842 L0482 L1720 L2627 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0802 | 96521 E0302 E0651 E1004 E1230 E1840 G0151 J0585 J2778 J9217 K0806 K0843 L0484 L1730 L2628 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0806 | 96920 E0303 E0652 E1005 E1232 E1841 G0152 J0587 J2785 J9228 K0807 K0848 L0486 L1755 L3674 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0807 | 96921 E0304 E0670 E1006 E1233 E2120 G0153 J0637 J2796 J9263 K0808 K0849 L0631 L1833 L3730 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0808 | 96922 E0316 E0675 E1007 E1234 E2227 G0155 J0881 J2997 J9264 K0813 K0850 L0636 L1844 L3740 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0813 | 97110 E0371 E0692 E1008 E1235 E2310 G0156 J0885 J3315 J9299 K0814 K0851 L0637 L1845 L3765 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0814 | 97112 E0372 E0693 E1010 E1236 E2311 G0158 J0894 J3489 J9301 K0815 K0852 L0638 L1846 L3766 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0815 | 97140 E0373 E0694 E1012 E1237 E2312 G0159 J0897 J3590 J9303 K0816 K0853 L0650 L1860 L3900 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0816 | 97530 E0462 E0744 E1030 E1238 E2321 G0161 J1327 J7189 J9305 K0820 K0854 L0700 L1970 L3901 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0820 | 99304 E0465 E0747 E1035 E1240 E2322 G0162 J1442 J7312 J9306 K0821 K0855 L0710 L2000 L3904 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0821 | E0466 E0748 E1036 E1280 E2325 G0277 J1453 J7324 J9310 K0822 K0856 L0810 L2005 L3961 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0822 | 0191T E0470 E0749 E1037 E1295 E2327 G0299 J1561 J7325 J9355 K0823 K0857 L0820 L2010 L3967 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0823 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0824 | 95810 A0431 E0472 E0762 E1060 E1405 E2329 G0483 J1570 J9031 J9999 K0825 K0859 L0859 L2030 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0825 | 95811 A0434 E0482 E0764 E1070 E1800 E2330 G0493 J1650 J9032 K0826 K0860 L1000 L2034 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0826 | 95812 E0483 E0781 E1084 E1801 E2373 G0494 J1740 J9033 K0004 K0827 K0861 L1005 L2036 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0827 | 95816 E0170 E0486 E0782 E1087 E1802 E2376 G0495 J1745 J9041 K0005 K0828 K0862 L1200 L2037 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0828 | 95819 E0193 E0500 E0783 E1088 E1805 E2402 G0496 J1756 J9047 K0010 K0829 K0863 L1300 L2038 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0829 | 95822 E0194 E0575 E0786 E1092 E1806 E2502 G6015 J2020 J9055 K0011 K0835 K0864 L1310 L2108 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0835 | 95923 E0260 E0601 E0791 E1093 E1810 E2504 J2323 J9060 K0012 K0836 L1680 L2126 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0836 | 95950 E0265 E0617 E0983 E1100 E1811 E2506 J0130 J2354 J9070 K0455 K0837 L0112 L1685 L2128 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0837 | 95951 E0266 E0618 E0984 E1110 E1815 E2508 J0132 J2357 J9155 K0606 K0838 L0456 L1686 L2134 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0838 | 95953 E0277 E0635 E0986 E1161 E1816 E2510 J0178 J2426 J9171 K0730 K0839 L0462 L1690 L2136 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0839 | 95957 E0296 E0636 E0988 E1180 E1818 E2627 J0180 J2469 J9201 K0800 K0840 L0464 L1700 L2350 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0840 | 96367 E0300 E0639 E1002 E1190 E1825 E2629 J0490 J2505 J9202 K0801 K0841 L0480 L1710 L2525 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0841 | 96413 E0301 E0640 E1003 E1195 E1830 J0583 J2562 J9206 K0802 K0842 L0482 L1720 L2627 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0842 | 96521 E0302 E0651 E1004 E1230 E1840 G0151 J0585 J2778 J9217 K0806 K0843 L0484 L1730 L2628 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0843 | 96920 E0303 E0652 E1005 E1232 E1841 G0152 J0587 J2785 J9228 K0807 K0848 L0486 L1755 L3674 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0848 | 96921 E0304 E0670 E1006 E1233 E2120 G0153 J0637 J2796 J9263 K0808 K0849 L0631 L1833 L3730 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0849 | 96922 E0316 E0675 E1007 E1234 E2227 G0155 J0881 J2997 J9264 K0813 K0850 L0636 L1844 L3740 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0850 | 97110 E0371 E0692 E1008 E1235 E2310 G0156 J0885 J3315 J9299 K0814 K0851 L0637 L1845 L3765 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0851 | 97112 E0372 E0693 E1010 E1236 E2311 G0158 J0894 J3489 J9301 K0815 K0852 L0638 L1846 L3766 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0852 | 97140 E0373 E0694 E1012 E1237 E2312 G0159 J0897 J3590 J9303 K0816 K0853 L0650 L1860 L3900 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0853 | 97530 E0462 E0744 E1030 E1238 E2321 G0161 J1327 J7189 J9305 K0820 K0854 L0700 L1970 L3901 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0854 | 99304 E0465 E0747 E1035 E1240 E2322 G0162 J1442 J7312 J9306 K0821 K0855 L0710 L2000 L3904 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0855 | E0466 E0748 E1036 E1280 E2325 G0277 J1453 J7324 J9310 K0822 K0856 L0810 L2005 L3961 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0856 | 0191T E0470 E0749 E1037 E1295 E2327 G0299 J1561 J7325 J9355 K0823 K0857 L0820 L2010 L3967 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0857 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0858 | 95810 A0431 E0472 E0762 E1060 E1405 E2329 G0483 J1570 J9031 J9999 K0825 K0859 L0859 L2030 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0859 | 95811 A0434 E0482 E0764 E1070 E1800 E2330 G0493 J1650 J9032 K0826 K0860 L1000 L2034 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0860 | 95812 E0483 E0781 E1084 E1801 E2373 G0494 J1740 J9033 K0004 K0827 K0861 L1005 L2036 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0861 | 95816 E0170 E0486 E0782 E1087 E1802 E2376 G0495 J1745 J9041 K0005 K0828 K0862 L1200 L2037 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0862 | 95819 E0193 E0500 E0783 E1088 E1805 E2402 G0496 J1756 J9047 K0010 K0829 K0863 L1300 L2038 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0863 | 95822 E0194 E0575 E0786 E1092 E1806 E2502 G6015 J2020 J9055 K0011 K0835 K0864 L1310 L2108 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| K0864 | 95923 E0260 E0601 E0791 E1093 E1810 E2504 J2323 J9060 K0012 K0836 L1680 L2126 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L0112 | 95951 E0266 E0618 E0984 E1110 E1815 E2508 J0132 J2357 J9155 K0606 K0838 L0456 L1686 L2134 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L0456 | 95953 E0277 E0635 E0986 E1161 E1816 E2510 J0178 J2426 J9171 K0730 K0839 L0462 L1690 L2136 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L0462 | 95957 E0296 E0636 E0988 E1180 E1818 E2627 J0180 J2469 J9201 K0800 K0840 L0464 L1700 L2350 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L0464 | 96367 E0300 E0639 E1002 E1190 E1825 E2629 J0490 J2505 J9202 K0801 K0841 L0480 L1710 L2525 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L0480 | 96413 E0301 E0640 E1003 E1195 E1830 J0583 J2562 J9206 K0802 K0842 L0482 L1720 L2627 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L0482 | 96521 E0302 E0651 E1004 E1230 E1840 G0151 J0585 J2778 J9217 K0806 K0843 L0484 L1730 L2628 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L0484 | 96920 E0303 E0652 E1005 E1232 E1841 G0152 J0587 J2785 J9228 K0807 K0848 L0486 L1755 L3674 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L0486 | 96921 E0304 E0670 E1006 E1233 E2120 G0153 J0637 J2796 J9263 K0808 K0849 L0631 L1833 L3730 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L0631 | 96922 E0316 E0675 E1007 E1234 E2227 G0155 J0881 J2997 J9264 K0813 K0850 L0636 L1844 L3740 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L0636 | 97110 E0371 E0692 E1008 E1235 E2310 G0156 J0885 J3315 J9299 K0814 K0851 L0637 L1845 L3765 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L0637 | 97112 E0372 E0693 E1010 E1236 E2311 G0158 J0894 J3489 J9301 K0815 K0852 L0638 L1846 L3766 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L0638 | 97140 E0373 E0694 E1012 E1237 E2312 G0159 J0897 J3590 J9303 K0816 K0853 L0650 L1860 L3900 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L0650 | 97530 E0462 E0744 E1030 E1238 E2321 G0161 J1327 J7189 J9305 K0820 K0854 L0700 L1970 L3901 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L0700 | 99304 E0465 E0747 E1035 E1240 E2322 G0162 J1442 J7312 J9306 K0821 K0855 L0710 L2000 L3904 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L0710 | E0466 E0748 E1036 E1280 E2325 G0277 J1453 J7324 J9310 K0822 K0856 L0810 L2005 L3961 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L0810 | 0191T E0470 E0749 E1037 E1295 E2327 G0299 J1561 J7325 J9355 K0823 K0857 L0820 L2010 L3967 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L0820 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L0830 | 95810 A0431 E0472 E0762 E1060 E1405 E2329 G0483 J1570 J9031 J9999 K0825 K0859 L0859 L2030 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L0859 | 95811 A0434 E0482 E0764 E1070 E1800 E2330 G0493 J1650 J9032 K0826 K0860 L1000 L2034 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L1000 | 95812 E0483 E0781 E1084 E1801 E2373 G0494 J1740 J9033 K0004 K0827 K0861 L1005 L2036 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L1005 | 95816 E0170 E0486 E0782 E1087 E1802 E2376 G0495 J1745 J9041 K0005 K0828 K0862 L1200 L2037 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L1200 | 95819 E0193 E0500 E0783 E1088 E1805 E2402 G0496 J1756 J9047 K0010 K0829 K0863 L1300 L2038 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L1300 | 95822 E0194 E0575 E0786 E1092 E1806 E2502 G6015 J2020 J9055 K0011 K0835 K0864 L1310 L2108 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L1310 | 95923 E0260 E0601 E0791 E1093 E1810 E2504 J2323 J9060 K0012 K0836 L1680 L2126 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L1680 | 95950 E0265 E0617 E0983 E1100 E1811 E2506 J0130 J2354 J9070 K0455 K0837 L0112 L1685 L2128 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L1685 | 95951 E0266 E0618 E0984 E1110 E1815 E2508 J0132 J2357 J9155 K0606 K0838 L0456 L1686 L2134 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L1686 | 95953 E0277 E0635 E0986 E1161 E1816 E2510 J0178 J2426 J9171 K0730 K0839 L0462 L1690 L2136 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L1690 | 95957 E0296 E0636 E0988 E1180 E1818 E2627 J0180 J2469 J9201 K0800 K0840 L0464 L1700 L2350 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L1700 | 96367 E0300 E0639 E1002 E1190 E1825 E2629 J0490 J2505 J9202 K0801 K0841 L0480 L1710 L2525 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L1710 | 96413 E0301 E0640 E1003 E1195 E1830 J0583 J2562 J9206 K0802 K0842 L0482 L1720 L2627 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L1720 | 96521 E0302 E0651 E1004 E1230 E1840 G0151 J0585 J2778 J9217 K0806 K0843 L0484 L1730 L2628 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L1730 | 96920 E0303 E0652 E1005 E1232 E1841 G0152 J0587 J2785 J9228 K0807 K0848 L0486 L1755 L3674 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L1755 | 96921 E0304 E0670 E1006 E1233 E2120 G0153 J0637 J2796 J9263 K0808 K0849 L0631 L1833 L3730 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L1833 | 96922 E0316 E0675 E1007 E1234 E2227 G0155 J0881 J2997 J9264 K0813 K0850 L0636 L1844 L3740 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L1844 | 97110 E0371 E0692 E1008 E1235 E2310 G0156 J0885 J3315 J9299 K0814 K0851 L0637 L1845 L3765 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L1845 | 97112 E0372 E0693 E1010 E1236 E2311 G0158 J0894 J3489 J9301 K0815 K0852 L0638 L1846 L3766 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L1846 | 97140 E0373 E0694 E1012 E1237 E2312 G0159 J0897 J3590 J9303 K0816 K0853 L0650 L1860 L3900 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L1860 | 97530 E0462 E0744 E1030 E1238 E2321 G0161 J1327 J7189 J9305 K0820 K0854 L0700 L1970 L3901 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L1970 | 99304 E0465 E0747 E1035 E1240 E2322 G0162 J1442 J7312 J9306 K0821 K0855 L0710 L2000 L3904 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L2000 | E0466 E0748 E1036 E1280 E2325 G0277 J1453 J7324 J9310 K0822 K0856 L0810 L2005 L3961 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L2005 | 0191T E0470 E0749 E1037 E1295 E2327 G0299 J1561 J7325 J9355 K0823 K0857 L0820 L2010 L3967 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L2010 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L2020 | 95810 A0431 E0472 E0762 E1060 E1405 E2329 G0483 J1570 J9031 J9999 K0825 K0859 L0859 L2030 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L2030 | 95811 A0434 E0482 E0764 E1070 E1800 E2330 G0493 J1650 J9032 K0826 K0860 L1000 L2034 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L2034 | 95812 E0483 E0781 E1084 E1801 E2373 G0494 J1740 J9033 K0004 K0827 K0861 L1005 L2036 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L2036 | 95816 E0170 E0486 E0782 E1087 E1802 E2376 G0495 J1745 J9041 K0005 K0828 K0862 L1200 L2037 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L2037 | 95819 E0193 E0500 E0783 E1088 E1805 E2402 G0496 J1756 J9047 K0010 K0829 K0863 L1300 L2038 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L2038 | 95822 E0194 E0575 E0786 E1092 E1806 E2502 G6015 J2020 J9055 K0011 K0835 K0864 L1310 L2108 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L2108 | 95923 E0260 E0601 E0791 E1093 E1810 E2504 J2323 J9060 K0012 K0836 L1680 L2126 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L2126 | 95950 E0265 E0617 E0983 E1100 E1811 E2506 J0130 J2354 J9070 K0455 K0837 L0112 L1685 L2128 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L2128 | 95951 E0266 E0618 E0984 E1110 E1815 E2508 J0132 J2357 J9155 K0606 K0838 L0456 L1686 L2134 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L2134 | 95953 E0277 E0635 E0986 E1161 E1816 E2510 J0178 J2426 J9171 K0730 K0839 L0462 L1690 L2136 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L2136 | 95957 E0296 E0636 E0988 E1180 E1818 E2627 J0180 J2469 J9201 K0800 K0840 L0464 L1700 L2350 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L2350 | 96367 E0300 E0639 E1002 E1190 E1825 E2629 J0490 J2505 J9202 K0801 K0841 L0480 L1710 L2525 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L2525 | 96413 E0301 E0640 E1003 E1195 E1830 J0583 J2562 J9206 K0802 K0842 L0482 L1720 L2627 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L2627 | 96521 E0302 E0651 E1004 E1230 E1840 G0151 J0585 J2778 J9217 K0806 K0843 L0484 L1730 L2628 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L2628 | 96920 E0303 E0652 E1005 E1232 E1841 G0152 J0587 J2785 J9228 K0807 K0848 L0486 L1755 L3674 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L3674 | 96921 E0304 E0670 E1006 E1233 E2120 G0153 J0637 J2796 J9263 K0808 K0849 L0631 L1833 L3730 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L3730 | 96922 E0316 E0675 E1007 E1234 E2227 G0155 J0881 J2997 J9264 K0813 K0850 L0636 L1844 L3740 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L3740 | 97110 E0371 E0692 E1008 E1235 E2310 G0156 J0885 J3315 J9299 K0814 K0851 L0637 L1845 L3765 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L3765 | 97112 E0372 E0693 E1010 E1236 E2311 G0158 J0894 J3489 J9301 K0815 K0852 L0638 L1846 L3766 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L3766 | 97140 E0373 E0694 E1012 E1237 E2312 G0159 J0897 J3590 J9303 K0816 K0853 L0650 L1860 L3900 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L3900 | 97530 E0462 E0744 E1030 E1238 E2321 G0161 J1327 J7189 J9305 K0820 K0854 L0700 L1970 L3901 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L3901 | 99304 E0465 E0747 E1035 E1240 E2322 G0162 J1442 J7312 J9306 K0821 K0855 L0710 L2000 L3904 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L3904 | E0466 E0748 E1036 E1280 E2325 G0277 J1453 J7324 J9310 K0822 K0856 L0810 L2005 L3961 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L3961 | 0191T E0470 E0749 E1037 E1295 E2327 G0299 J1561 J7325 J9355 K0823 K0857 L0820 L2010 L3967 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L3967 | CPT/HCPCS Codes # - # Continued on page 4 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L3971 | CPT/HCPCS Codes # - # Continued from page 3 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L3973 | L3975 L5341 L5651 L5840 L5985 L6380 L6698 L6945 L7405 L8693 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L3975 | L3976 L5400 L5673 L5845 L5986 L6382 L6707 L6950 L7499 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L3976 | L3977 L5420 L5681 L5848 L5987 L6384 L6709 L6955 L8035 Q0479 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L3977 | L3978 L5500 L5683 L5856 L5988 L6400 L6712 L6960 L8040 Q0480 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L3978 | L4000 L5505 L5685 L5857 L5990 L6450 L6713 L6965 L8041 Q0481 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L4000 | L4631 L5510 L5699 L5858 L5999 L6500 L6714 L6970 L8042 Q0482 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L4631 | L5010 L5520 L5700 L5859 L6000 L6550 L6715 L6975 L8043 Q0483 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5010 | L5020 L5530 L5701 L5930 L6010 L6570 L6721 L7007 L8044 Q0484 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5020 | L5050 L5535 L5702 L5960 L6020 L6580 L6722 L7008 L8045 Q0489 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5050 | L5060 L5540 L5703 L5961 L6026 L6582 L6880 L7009 L8046 Q0491 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5060 | L5100 L5560 L5705 L5966 L6050 L6584 L6881 L7040 L8047 Q0495 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5100 | L5105 L5570 L5707 L5968 L6055 L6586 L6882 L7045 L8609 Q0496 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5105 | L5150 L5580 L5724 L5970 L6100 L6588 L6883 L7170 L8614 Q0503 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5150 | L5160 L5585 L5726 L5971 L6110 L6590 L6884 L7180 L8619 Q5001 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5160 | L5200 L5590 L5728 L5972 L6120 L6611 L6885 L7181 L8627 Q5002 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5200 | L5210 L5595 L5780 L5973 L6130 L6621 L6890 L7185 L8628 Q5009 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5210 | L5220 L5600 L5781 L5974 L6200 L6624 L6895 L7186 L8631 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5220 | L5230 L5610 L5782 L5975 L6205 L6638 L6900 L7190 L8659 V2623 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5230 | L5250 L5611 L5795 L5976 L6250 L6646 L6905 L7191 L8679 V2627 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5250 | L5270 L5613 L5814 L5978 L6300 L6648 L6910 L7259 L8681 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5270 | L5280 L5614 L5822 L5979 L6310 L6693 L6920 L7400 L8682 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5280 | L5301 L5616 L5824 L5980 L6320 L6694 L6925 L7401 L8683 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5301 | L5312 L5639 L5826 L5981 L6350 L6695 L6930 L7402 L8689 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5312 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5321 | L3973 L5331 L5649 L5830 L5984 L6370 L6697 L6940 L7404 L8691 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5331 | L3975 L5341 L5651 L5840 L5985 L6380 L6698 L6945 L7405 L8693 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5341 | L3976 L5400 L5673 L5845 L5986 L6382 L6707 L6950 L7499 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5400 | L3977 L5420 L5681 L5848 L5987 L6384 L6709 L6955 L8035 Q0479 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5420 | L3978 L5500 L5683 L5856 L5988 L6400 L6712 L6960 L8040 Q0480 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5500 | L4000 L5505 L5685 L5857 L5990 L6450 L6713 L6965 L8041 Q0481 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5505 | L4631 L5510 L5699 L5858 L5999 L6500 L6714 L6970 L8042 Q0482 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5510 | L5010 L5520 L5700 L5859 L6000 L6550 L6715 L6975 L8043 Q0483 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5520 | L5020 L5530 L5701 L5930 L6010 L6570 L6721 L7007 L8044 Q0484 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5530 | L5050 L5535 L5702 L5960 L6020 L6580 L6722 L7008 L8045 Q0489 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5535 | L5060 L5540 L5703 L5961 L6026 L6582 L6880 L7009 L8046 Q0491 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5540 | L5100 L5560 L5705 L5966 L6050 L6584 L6881 L7040 L8047 Q0495 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5560 | L5105 L5570 L5707 L5968 L6055 L6586 L6882 L7045 L8609 Q0496 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5570 | L5150 L5580 L5724 L5970 L6100 L6588 L6883 L7170 L8614 Q0503 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5580 | L5160 L5585 L5726 L5971 L6110 L6590 L6884 L7180 L8619 Q5001 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5585 | L5200 L5590 L5728 L5972 L6120 L6611 L6885 L7181 L8627 Q5002 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5590 | L5210 L5595 L5780 L5973 L6130 L6621 L6890 L7185 L8628 Q5009 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5595 | L5220 L5600 L5781 L5974 L6200 L6624 L6895 L7186 L8631 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5600 | L5230 L5610 L5782 L5975 L6205 L6638 L6900 L7190 L8659 V2623 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5610 | L5250 L5611 L5795 L5976 L6250 L6646 L6905 L7191 L8679 V2627 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5611 | L5270 L5613 L5814 L5978 L6300 L6648 L6910 L7259 L8681 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5613 | L5280 L5614 L5822 L5979 L6310 L6693 L6920 L7400 L8682 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5614 | L5301 L5616 L5824 L5980 L6320 L6694 L6925 L7401 L8683 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5616 | L5312 L5639 L5826 L5981 L6350 L6695 L6930 L7402 L8689 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5639 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5643 | L3973 L5331 L5649 L5830 L5984 L6370 L6697 L6940 L7404 L8691 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5649 | L3975 L5341 L5651 L5840 L5985 L6380 L6698 L6945 L7405 L8693 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5651 | L3976 L5400 L5673 L5845 L5986 L6382 L6707 L6950 L7499 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5673 | L3977 L5420 L5681 L5848 L5987 L6384 L6709 L6955 L8035 Q0479 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5681 | L3978 L5500 L5683 L5856 L5988 L6400 L6712 L6960 L8040 Q0480 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5683 | L4000 L5505 L5685 L5857 L5990 L6450 L6713 L6965 L8041 Q0481 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5685 | L4631 L5510 L5699 L5858 L5999 L6500 L6714 L6970 L8042 Q0482 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5699 | L5010 L5520 L5700 L5859 L6000 L6550 L6715 L6975 L8043 Q0483 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5700 | L5020 L5530 L5701 L5930 L6010 L6570 L6721 L7007 L8044 Q0484 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5701 | L5050 L5535 L5702 L5960 L6020 L6580 L6722 L7008 L8045 Q0489 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5702 | L5060 L5540 L5703 L5961 L6026 L6582 L6880 L7009 L8046 Q0491 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5703 | L5100 L5560 L5705 L5966 L6050 L6584 L6881 L7040 L8047 Q0495 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5705 | L5105 L5570 L5707 L5968 L6055 L6586 L6882 L7045 L8609 Q0496 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5707 | L5150 L5580 L5724 L5970 L6100 L6588 L6883 L7170 L8614 Q0503 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5724 | L5160 L5585 L5726 L5971 L6110 L6590 L6884 L7180 L8619 Q5001 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5726 | L5200 L5590 L5728 L5972 L6120 L6611 L6885 L7181 L8627 Q5002 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5728 | L5210 L5595 L5780 L5973 L6130 L6621 L6890 L7185 L8628 Q5009 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5780 | L5220 L5600 L5781 L5974 L6200 L6624 L6895 L7186 L8631 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5781 | L5230 L5610 L5782 L5975 L6205 L6638 L6900 L7190 L8659 V2623 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5782 | L5250 L5611 L5795 L5976 L6250 L6646 L6905 L7191 L8679 V2627 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5795 | L5270 L5613 L5814 L5978 L6300 L6648 L6910 L7259 L8681 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5814 | L5280 L5614 L5822 L5979 L6310 L6693 L6920 L7400 L8682 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5822 | L5301 L5616 L5824 L5980 L6320 L6694 L6925 L7401 L8683 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5824 | L5312 L5639 L5826 L5981 L6350 L6695 L6930 L7402 L8689 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5826 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5828 | L3973 L5331 L5649 L5830 L5984 L6370 L6697 L6940 L7404 L8691 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5830 | L3975 L5341 L5651 L5840 L5985 L6380 L6698 L6945 L7405 L8693 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5840 | L3976 L5400 L5673 L5845 L5986 L6382 L6707 L6950 L7499 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5845 | L3977 L5420 L5681 L5848 L5987 L6384 L6709 L6955 L8035 Q0479 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5848 | L3978 L5500 L5683 L5856 L5988 L6400 L6712 L6960 L8040 Q0480 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5856 | L4000 L5505 L5685 L5857 L5990 L6450 L6713 L6965 L8041 Q0481 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5857 | L4631 L5510 L5699 L5858 L5999 L6500 L6714 L6970 L8042 Q0482 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5858 | L5010 L5520 L5700 L5859 L6000 L6550 L6715 L6975 L8043 Q0483 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5859 | L5020 L5530 L5701 L5930 L6010 L6570 L6721 L7007 L8044 Q0484 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5930 | L5050 L5535 L5702 L5960 L6020 L6580 L6722 L7008 L8045 Q0489 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5960 | L5060 L5540 L5703 L5961 L6026 L6582 L6880 L7009 L8046 Q0491 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5961 | L5100 L5560 L5705 L5966 L6050 L6584 L6881 L7040 L8047 Q0495 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5966 | L5105 L5570 L5707 L5968 L6055 L6586 L6882 L7045 L8609 Q0496 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5968 | L5150 L5580 L5724 L5970 L6100 L6588 L6883 L7170 L8614 Q0503 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5970 | L5160 L5585 L5726 L5971 L6110 L6590 L6884 L7180 L8619 Q5001 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5971 | L5200 L5590 L5728 L5972 L6120 L6611 L6885 L7181 L8627 Q5002 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5972 | L5210 L5595 L5780 L5973 L6130 L6621 L6890 L7185 L8628 Q5009 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5973 | L5220 L5600 L5781 L5974 L6200 L6624 L6895 L7186 L8631 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5974 | L5230 L5610 L5782 L5975 L6205 L6638 L6900 L7190 L8659 V2623 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5975 | L5250 L5611 L5795 L5976 L6250 L6646 L6905 L7191 L8679 V2627 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5976 | L5270 L5613 L5814 L5978 L6300 L6648 L6910 L7259 L8681 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5978 | L5280 L5614 L5822 L5979 L6310 L6693 L6920 L7400 L8682 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5979 | L5301 L5616 L5824 L5980 L6320 L6694 L6925 L7401 L8683 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5980 | L5312 L5639 L5826 L5981 L6350 L6695 L6930 L7402 L8689 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5981 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5982 | L3973 L5331 L5649 L5830 L5984 L6370 L6697 L6940 L7404 L8691 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5984 | L3975 L5341 L5651 L5840 L5985 L6380 L6698 L6945 L7405 L8693 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5985 | L3976 L5400 L5673 L5845 L5986 L6382 L6707 L6950 L7499 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5986 | L3977 L5420 L5681 L5848 L5987 L6384 L6709 L6955 L8035 Q0479 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5987 | L3978 L5500 L5683 L5856 L5988 L6400 L6712 L6960 L8040 Q0480 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5988 | L4000 L5505 L5685 L5857 L5990 L6450 L6713 L6965 L8041 Q0481 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5990 | L4631 L5510 L5699 L5858 L5999 L6500 L6714 L6970 L8042 Q0482 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L5999 | L5010 L5520 L5700 L5859 L6000 L6550 L6715 L6975 L8043 Q0483 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6000 | L5020 L5530 L5701 L5930 L6010 L6570 L6721 L7007 L8044 Q0484 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6010 | L5050 L5535 L5702 L5960 L6020 L6580 L6722 L7008 L8045 Q0489 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6020 | L5060 L5540 L5703 L5961 L6026 L6582 L6880 L7009 L8046 Q0491 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6026 | L5100 L5560 L5705 L5966 L6050 L6584 L6881 L7040 L8047 Q0495 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6050 | L5105 L5570 L5707 L5968 L6055 L6586 L6882 L7045 L8609 Q0496 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6055 | L5150 L5580 L5724 L5970 L6100 L6588 L6883 L7170 L8614 Q0503 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6100 | L5160 L5585 L5726 L5971 L6110 L6590 L6884 L7180 L8619 Q5001 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6110 | L5200 L5590 L5728 L5972 L6120 L6611 L6885 L7181 L8627 Q5002 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6120 | L5210 L5595 L5780 L5973 L6130 L6621 L6890 L7185 L8628 Q5009 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6130 | L5220 L5600 L5781 L5974 L6200 L6624 L6895 L7186 L8631 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6200 | L5230 L5610 L5782 L5975 L6205 L6638 L6900 L7190 L8659 V2623 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6205 | L5250 L5611 L5795 L5976 L6250 L6646 L6905 L7191 L8679 V2627 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6250 | L5270 L5613 L5814 L5978 L6300 L6648 L6910 L7259 L8681 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6300 | L5280 L5614 L5822 L5979 L6310 L6693 L6920 L7400 L8682 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6310 | L5301 L5616 L5824 L5980 L6320 L6694 L6925 L7401 L8683 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6320 | L5312 L5639 L5826 L5981 L6350 L6695 L6930 L7402 L8689 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6350 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6360 | L3973 L5331 L5649 L5830 L5984 L6370 L6697 L6940 L7404 L8691 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6370 | L3975 L5341 L5651 L5840 L5985 L6380 L6698 L6945 L7405 L8693 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6380 | L3976 L5400 L5673 L5845 L5986 L6382 L6707 L6950 L7499 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6382 | L3977 L5420 L5681 L5848 L5987 L6384 L6709 L6955 L8035 Q0479 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6384 | L3978 L5500 L5683 L5856 L5988 L6400 L6712 L6960 L8040 Q0480 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6400 | L4000 L5505 L5685 L5857 L5990 L6450 L6713 L6965 L8041 Q0481 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6450 | L4631 L5510 L5699 L5858 L5999 L6500 L6714 L6970 L8042 Q0482 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6500 | L5010 L5520 L5700 L5859 L6000 L6550 L6715 L6975 L8043 Q0483 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6550 | L5020 L5530 L5701 L5930 L6010 L6570 L6721 L7007 L8044 Q0484 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6570 | L5050 L5535 L5702 L5960 L6020 L6580 L6722 L7008 L8045 Q0489 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6580 | L5060 L5540 L5703 L5961 L6026 L6582 L6880 L7009 L8046 Q0491 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6582 | L5100 L5560 L5705 L5966 L6050 L6584 L6881 L7040 L8047 Q0495 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6584 | L5105 L5570 L5707 L5968 L6055 L6586 L6882 L7045 L8609 Q0496 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6586 | L5150 L5580 L5724 L5970 L6100 L6588 L6883 L7170 L8614 Q0503 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6588 | L5160 L5585 L5726 L5971 L6110 L6590 L6884 L7180 L8619 Q5001 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6590 | L5200 L5590 L5728 L5972 L6120 L6611 L6885 L7181 L8627 Q5002 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6611 | L5210 L5595 L5780 L5973 L6130 L6621 L6890 L7185 L8628 Q5009 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6621 | L5220 L5600 L5781 L5974 L6200 L6624 L6895 L7186 L8631 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6624 | L5230 L5610 L5782 L5975 L6205 L6638 L6900 L7190 L8659 V2623 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6638 | L5250 L5611 L5795 L5976 L6250 L6646 L6905 L7191 L8679 V2627 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6646 | L5270 L5613 L5814 L5978 L6300 L6648 L6910 L7259 L8681 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6648 | L5280 L5614 L5822 L5979 L6310 L6693 L6920 L7400 L8682 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6693 | L5301 L5616 L5824 L5980 L6320 L6694 L6925 L7401 L8683 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6694 | L5312 L5639 L5826 L5981 L6350 L6695 L6930 L7402 L8689 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6695 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6696 | L3973 L5331 L5649 L5830 L5984 L6370 L6697 L6940 L7404 L8691 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6697 | L3975 L5341 L5651 L5840 L5985 L6380 L6698 L6945 L7405 L8693 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6698 | L3976 L5400 L5673 L5845 L5986 L6382 L6707 L6950 L7499 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6707 | L3977 L5420 L5681 L5848 L5987 L6384 L6709 L6955 L8035 Q0479 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6709 | L3978 L5500 L5683 L5856 L5988 L6400 L6712 L6960 L8040 Q0480 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6712 | L4000 L5505 L5685 L5857 L5990 L6450 L6713 L6965 L8041 Q0481 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6713 | L4631 L5510 L5699 L5858 L5999 L6500 L6714 L6970 L8042 Q0482 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6714 | L5010 L5520 L5700 L5859 L6000 L6550 L6715 L6975 L8043 Q0483 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6715 | L5020 L5530 L5701 L5930 L6010 L6570 L6721 L7007 L8044 Q0484 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6721 | L5050 L5535 L5702 L5960 L6020 L6580 L6722 L7008 L8045 Q0489 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6722 | L5060 L5540 L5703 L5961 L6026 L6582 L6880 L7009 L8046 Q0491 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6880 | L5100 L5560 L5705 L5966 L6050 L6584 L6881 L7040 L8047 Q0495 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6881 | L5105 L5570 L5707 L5968 L6055 L6586 L6882 L7045 L8609 Q0496 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6882 | L5150 L5580 L5724 L5970 L6100 L6588 L6883 L7170 L8614 Q0503 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6883 | L5160 L5585 L5726 L5971 L6110 L6590 L6884 L7180 L8619 Q5001 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6884 | L5200 L5590 L5728 L5972 L6120 L6611 L6885 L7181 L8627 Q5002 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6885 | L5210 L5595 L5780 L5973 L6130 L6621 L6890 L7185 L8628 Q5009 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6890 | L5220 L5600 L5781 L5974 L6200 L6624 L6895 L7186 L8631 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6895 | L5230 L5610 L5782 L5975 L6205 L6638 L6900 L7190 L8659 V2623 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6900 | L5250 L5611 L5795 L5976 L6250 L6646 L6905 L7191 L8679 V2627 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6905 | L5270 L5613 L5814 L5978 L6300 L6648 L6910 L7259 L8681 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6910 | L5280 L5614 L5822 L5979 L6310 L6693 L6920 L7400 L8682 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6920 | L5301 L5616 L5824 L5980 L6320 L6694 L6925 L7401 L8683 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6925 | L5312 L5639 L5826 L5981 L6350 L6695 L6930 L7402 L8689 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6930 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6935 | L3973 L5331 L5649 L5830 L5984 L6370 L6697 L6940 L7404 L8691 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6940 | L3975 L5341 L5651 L5840 L5985 L6380 L6698 L6945 L7405 L8693 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6945 | L3976 L5400 L5673 L5845 L5986 L6382 L6707 L6950 L7499 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6950 | L3977 L5420 L5681 L5848 L5987 L6384 L6709 L6955 L8035 Q0479 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6955 | L3978 L5500 L5683 L5856 L5988 L6400 L6712 L6960 L8040 Q0480 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6960 | L4000 L5505 L5685 L5857 L5990 L6450 L6713 L6965 L8041 Q0481 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6965 | L4631 L5510 L5699 L5858 L5999 L6500 L6714 L6970 L8042 Q0482 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6970 | L5010 L5520 L5700 L5859 L6000 L6550 L6715 L6975 L8043 Q0483 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L6975 | L5020 L5530 L5701 L5930 L6010 L6570 L6721 L7007 L8044 Q0484 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L7007 | L5050 L5535 L5702 L5960 L6020 L6580 L6722 L7008 L8045 Q0489 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L7008 | L5060 L5540 L5703 L5961 L6026 L6582 L6880 L7009 L8046 Q0491 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L7009 | L5100 L5560 L5705 L5966 L6050 L6584 L6881 L7040 L8047 Q0495 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L7040 | L5105 L5570 L5707 L5968 L6055 L6586 L6882 L7045 L8609 Q0496 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L7045 | L5150 L5580 L5724 L5970 L6100 L6588 L6883 L7170 L8614 Q0503 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L7170 | L5160 L5585 L5726 L5971 L6110 L6590 L6884 L7180 L8619 Q5001 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L7180 | L5200 L5590 L5728 L5972 L6120 L6611 L6885 L7181 L8627 Q5002 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L7181 | L5210 L5595 L5780 L5973 L6130 L6621 L6890 L7185 L8628 Q5009 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L7185 | L5220 L5600 L5781 L5974 L6200 L6624 L6895 L7186 L8631 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L7186 | L5230 L5610 L5782 L5975 L6205 L6638 L6900 L7190 L8659 V2623 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L7190 | L5250 L5611 L5795 L5976 L6250 L6646 L6905 L7191 L8679 V2627 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L7191 | L5270 L5613 L5814 L5978 L6300 L6648 L6910 L7259 L8681 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L7259 | L5280 L5614 L5822 L5979 L6310 L6693 L6920 L7400 L8682 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L7400 | L5301 L5616 L5824 L5980 L6320 L6694 L6925 L7401 L8683 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L7401 | L5312 L5639 L5826 L5981 L6350 L6695 L6930 L7402 L8689 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L7402 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L7403 | L3973 L5331 L5649 L5830 L5984 L6370 L6697 L6940 L7404 L8691 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L7404 | L3975 L5341 L5651 L5840 L5985 L6380 L6698 L6945 L7405 L8693 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L7405 | L3976 L5400 L5673 L5845 L5986 L6382 L6707 L6950 L7499 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L7499 | L3977 L5420 L5681 L5848 L5987 L6384 L6709 L6955 L8035 Q0479 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L8035 | L3978 L5500 L5683 L5856 L5988 L6400 L6712 L6960 L8040 Q0480 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L8040 | L4000 L5505 L5685 L5857 L5990 L6450 L6713 L6965 L8041 Q0481 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L8041 | L4631 L5510 L5699 L5858 L5999 L6500 L6714 L6970 L8042 Q0482 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L8042 | L5010 L5520 L5700 L5859 L6000 L6550 L6715 L6975 L8043 Q0483 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L8043 | L5020 L5530 L5701 L5930 L6010 L6570 L6721 L7007 L8044 Q0484 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L8044 | L5050 L5535 L5702 L5960 L6020 L6580 L6722 L7008 L8045 Q0489 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L8045 | L5060 L5540 L5703 L5961 L6026 L6582 L6880 L7009 L8046 Q0491 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L8046 | L5100 L5560 L5705 L5966 L6050 L6584 L6881 L7040 L8047 Q0495 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L8047 | L5105 L5570 L5707 L5968 L6055 L6586 L6882 L7045 L8609 Q0496 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L8609 | L5150 L5580 L5724 L5970 L6100 L6588 L6883 L7170 L8614 Q0503 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L8614 | L5160 L5585 L5726 L5971 L6110 L6590 L6884 L7180 L8619 Q5001 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L8619 | L5200 L5590 L5728 L5972 L6120 L6611 L6885 L7181 L8627 Q5002 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L8627 | L5210 L5595 L5780 L5973 L6130 L6621 L6890 L7185 L8628 Q5009 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L8628 | L5220 L5600 L5781 L5974 L6200 L6624 L6895 L7186 L8631 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L8631 | L5230 L5610 L5782 L5975 L6205 L6638 L6900 L7190 L8659 V2623 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L8659 | L5250 L5611 L5795 L5976 L6250 L6646 L6905 L7191 L8679 V2627 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L8679 | L5270 L5613 L5814 L5978 L6300 L6648 L6910 L7259 L8681 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L8681 | L5280 L5614 L5822 L5979 L6310 L6693 L6920 L7400 L8682 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L8682 | L5301 L5616 L5824 L5980 L6320 L6694 L6925 L7401 L8683 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L8683 | L5312 L5639 L5826 L5981 L6350 L6695 L6930 L7402 L8689 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L8689 | Pre-Authorization List 2018 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L8690 | L3973 L5331 L5649 L5830 L5984 L6370 L6697 L6940 L7404 L8691 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L8691 | L3975 L5341 L5651 L5840 L5985 L6380 L6698 L6945 L7405 L8693 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| L8693 | L3976 L5400 L5673 L5845 L5986 L6382 L6707 L6950 L7499 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| Q0479 | L3978 L5500 L5683 L5856 L5988 L6400 L6712 L6960 L8040 Q0480 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| Q0480 | L4000 L5505 L5685 L5857 L5990 L6450 L6713 L6965 L8041 Q0481 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| Q0481 | L4631 L5510 L5699 L5858 L5999 L6500 L6714 L6970 L8042 Q0482 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| Q0482 | L5010 L5520 L5700 L5859 L6000 L6550 L6715 L6975 L8043 Q0483 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| Q0483 | L5020 L5530 L5701 L5930 L6010 L6570 L6721 L7007 L8044 Q0484 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| Q0484 | L5050 L5535 L5702 L5960 L6020 L6580 L6722 L7008 L8045 Q0489 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| Q0489 | L5060 L5540 L5703 L5961 L6026 L6582 L6880 L7009 L8046 Q0491 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| Q0491 | L5100 L5560 L5705 L5966 L6050 L6584 L6881 L7040 L8047 Q0495 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| Q0495 | L5105 L5570 L5707 L5968 L6055 L6586 L6882 L7045 L8609 Q0496 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| Q0496 | L5150 L5580 L5724 L5970 L6100 L6588 L6883 L7170 L8614 Q0503 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| Q0503 | L5160 L5585 L5726 L5971 L6110 L6590 L6884 L7180 L8619 Q5001 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| Q5001 | L5200 L5590 L5728 L5972 L6120 L6611 L6885 L7181 L8627 Q5002 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| Q5002 | L5210 L5595 L5780 L5973 L6130 L6621 L6890 L7185 L8628 Q5009 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| Q5009 | L5220 L5600 L5781 L5974 L6200 L6624 L6895 L7186 L8631 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| V2623 | L5250 L5611 L5795 L5976 L6250 L6646 L6905 L7191 L8679 V2627 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |
| V2627 | CPT/HCPCS Codes # - # Continued from page 3 | 2018-01-01 | Not listed | 97% | [PDF] Pre-Authorization Request - Clover Health |