Prior authorization codes
PacificSource Health Plans
Active CPT codes that appear on the extracted prior authorization list for this health plan.
| Code | Procedure / Service | Effective | Revised | Confidence | Source |
|---|---|---|---|---|---|
| 33254 | (CPT®) codes , , , , and , which are considered experimental | 2022-08-13 | Not listed | 97% | [PDF] June 2022 - IPN |
| 33255 | (CPT®) codes , , , , and , which are considered experimental | 2022-08-13 | Not listed | 97% | [PDF] June 2022 - IPN |
| 33258 | (CPT®) codes , , , , and , which are considered experimental | 2022-08-13 | Not listed | 97% | [PDF] June 2022 - IPN |
| 33265 | (CPT®) codes , , , , and , which are considered experimental | 2022-08-13 | Not listed | 97% | [PDF] June 2022 - IPN |
| 33266 | (CPT®) codes , , , , and , which are considered experimental | 2022-08-13 | Not listed | 97% | [PDF] June 2022 - IPN |
| 99212 | Terminology (CPT®) codes , , , and and modifier 25 when a minor | 2022-08-13 | Not listed | 97% | [PDF] June 2022 - IPN |
| 99213 | Terminology (CPT®) codes , , , and and modifier 25 when a minor | 2022-08-13 | Not listed | 97% | [PDF] June 2022 - IPN |
| 99214 | Terminology (CPT®) codes , , , and and modifier 25 when a minor | 2022-08-13 | Not listed | 97% | [PDF] June 2022 - IPN |
| 99215 | Terminology (CPT®) codes , , , and and modifier 25 when a minor | 2022-08-13 | Not listed | 97% | [PDF] June 2022 - IPN |