Prior authorization codes

McLaren Health Plan

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

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CodeProcedure / ServiceEffectiveRevisedConfidenceSource
78451
Baseline Nuclear Perfusion ( )
2026-07-06Not listed97%
[PDF] PET/CT Order Form - McLaren Health Plan
78459
Myocardial Viability ( )
2026-07-06Not listed97%
[PDF] PET/CT Order Form - McLaren Health Plan
78608
Standard Body ( ) (routine use) Alzheimer’s vs Frontal Temporal Dementia ( )
2026-07-06Not listed97%
[PDF] PET/CT Order Form - McLaren Health Plan
78815
Standard Body ( ) (routine use) Alzheimer’s vs Frontal Temporal Dementia ( )
2026-07-06Not listed97%
[PDF] PET/CT Order Form - McLaren Health Plan
78816
Whole Body ( ) (melanoma or cancer below knee)
2026-07-06Not listed97%
[PDF] PET/CT Order Form - McLaren Health Plan