Prior Auth Required

15823 - CPT/HCPCS Codes # – # Continued on page 3

This procedure appears on the selected insurer prior authorization source.

Prior authorizationPrior Auth Required
Procedure / ServiceCPT/HCPCS Codes # – # Continued on page 3
Procedure / Service Description

Pre-Authorization List 2018 - Clover Pre-Authorization List 2018 CPT/HCPCS Codes #15823 – #93970 Continued on page 3 15823 22630 29822 31255 33263 43244 49656 54410 58661 63664 67039 72146 73723 78452 91110

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.