Prior Auth Required

79999 - C2638; C2639; C2640; C2641; C2642; C2643; C2644; C2645; C2698; C2699;

This procedure appears on the selected insurer prior authorization source.

Prior authorizationPrior Auth Required
Procedure / ServiceC2638; C2639; C2640; C2641; C2642; C2643; C2644; C2645; C2698; C2699;
Procedure / Service Description

Prior Authorization List - Therapy 77525; 77761; 77762; 77763; 77767; 77768; 77770; 77771; 77772; 77778;77790; Please complete the Case / Disease Management Referral Form for the member. 77799; 79999; C1716; C1717; C1719; C2616; C2634; C2635; C2636; C2637; C2638; C2639; C2640; C2641; C2642; C2643; C2644; C2645; C2698; C2699; (Proton Beam Therapy, Brachytherapy, C9725; C9726; C9727; C9739; C9740; G0173; G0251; G0339; G0340; G0458;

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.