Prior authorization codes
Independent Care Health Plan (iCare)
Active CPT codes that appear on the extracted prior authorization list for this health plan.
| Code | Procedure / Service | Effective | Revised | Confidence | Source |
|---|---|---|---|---|---|
| 02717 | F- ), when applicable | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| 11133 | o Personal care screening tool (PCST) (Form F- ) completed per | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| 11136 | o Personal Care Addendum (Form F- ) when applicable | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| 1128B | The Social Security Act, Section . (d)(1), [42 U.S.C. 1320a-7b], also provides that | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| 11695 | payer ID code is | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| 21060 | Glen Burnie MD - 0280 | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| 2310A | submission: Loop Number | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| 53212 | Milwaukee, WI | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| 99211 | EP Service provided as part of , , HealthCheck nursing | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| 99212 | EP Service provided as part of , , HealthCheck nursing | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| 99213 | EP Service provided as part of , , HealthCheck nursing | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| 99214 | EP Service provided as part of , , HealthCheck nursing | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| 99215 | EP Service provided as part of , , HealthCheck nursing | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| 99381 | UA * Comprehensive HealthCheck and All HealthCheck providers | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| 99382 | UA * Comprehensive HealthCheck and All HealthCheck providers | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| 99383 | UA * Comprehensive HealthCheck and All HealthCheck providers | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| 99384 | UA * Comprehensive HealthCheck and All HealthCheck providers | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| 99385 | UA * Comprehensive HealthCheck and All HealthCheck providers | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| 99391 | screen results in a referral or including HealthCheck | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| 99392 | screen results in a referral or including HealthCheck | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| 99393 | screen results in a referral or including HealthCheck | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| 99394 | screen results in a referral or including HealthCheck | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| 99395 | screen results in a referral or including HealthCheck | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| T1002 | EP Service provided as part of , , HealthCheck nursing | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| T1016 | periodic screening diagnosis | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| T1017 | [follow-up to] Medicaid early , , and agencies only | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |
| T1029 | [follow-up to] Medicaid early , , and agencies only | 2026-07-06 | 2016-11-08 | 97% | [PDF] Provider Reference Manual - Independent Care Health Plan |