Prior authorization codes
UPMC Health Plan
Active CPT codes that appear on the extracted prior authorization list for this health plan.
| Code | Procedure / Service | Effective | Revised | Confidence | Source |
|---|---|---|---|---|---|
| 15004 | Cntrctr=236&name=CGS+Administrators%2c+LLC+( %2c+HHH+MAC)&s=45&Doc | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 27513 | details.aspx?LCDId= &ContrId=170&ver=113&ContrVer=2&Date=06%2f01%2f2013 | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 32016 | details.aspx?LCDId= &ContrId=236&ver=13&ContrVer=2&CntrctrSelected=236*2& | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 33942 | details.aspx?LCDId= &ContrId=236&ver=2&ContrVer=2&CntrctrSelected=236*2&C | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 64550 | Application of surface (transcutaneous) | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 97001 | (No Prior Authorization Required in Home | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 97002 | Physical Therapy Re-evaluation | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 97010 | Application of a modality to 1 or more areas; hot | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 97014 | Application of a modality to 1 or more areas | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 97016 | Application of a modality to 1 or more areas | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 97024 | Application of a modality to 1 or more areas | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 97026 | Application of a modality to 1 or more areas | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 97028 | Application of a modality to 1 or more areas | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 97032 | Application of a modality to 1 or more areas | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 97033 | Application of a modality to 1 or more areas | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 97034 | Application of a modality to 1 or more areas | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 97035 | Application of a modality to 1 or more areas | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 97110 | Therapeutic procedure, 1 or more areas, each 15 | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 97112 | Therapeutic procedure, 1 or more areas, each 15 | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 97116 | Therapeutic procedure, 1 or more areas, each 15 | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 97124 | Therapeutic procedure, 1 or more areas, each 15 | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 97140 | Manual therapy techiques (eg | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 97150 | Therapeutic procedures 2 or more individuals | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 97530 | Therapeutic activities, direct (one-on-one) patient | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 97542 | Wheelchair management (eg assessment, fitting | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 97750 | Physical performance test or measurement (eg | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 97760 | Orthotic(s) management and training (including | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 97761 | Prosthetic training upper and/or lower extremity(s) | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| 97762 | Checkout for orthotic/prosthetic use, established | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| G0151 | Therapist in the home health or hospice setting | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| G0157 | Therapist Assistant in the home health or | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| G0159 | establishment or delivery of a safe and effective | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| G0283 | Electronic stimulation (unattended) to one or more | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| G8990 | Other physical or occupational therapy primary | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| G8991 | Other physical or occupational therapy primary | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| G8992 | Other physical or occupational therapy primary | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| G8993 | Other physical or occupational therapy | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| G8994 | Other physical or occupational therapy subsequent | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |
| G8995 | Other physical or occupational therapy subsequent | 2013-06-13 | 2013-06-13 | 97% | [PDF] UPMC Health Plan |