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Medicaid Prior Authorization

Date: 12/31/25

Michigan Meridian Medicaid requires prior authorization (PA) as a condition of payment for many services.  This Notice contains information regarding such prior authorization requirements and is applicable to all Medicaid products offered by Michigan Meridian Medicaid.

Michigan Meridian Medicaid is committed to delivering cost effective quality care to our members.  This effort requires us to ensure that our members receive only treatment that is medically necessary according to current standards of practice.  Prior authorization is a process initiated by the physician in which we verify the medical necessity of a treatment in advance using independent objective medical criteria and/or in network utilization, where applicable.

It is the ordering/prescribing provider’s responsibility to determine which specific codes require prior authorization.  

Please verify eligibility and benefits prior to rendering services for all members. Payment, regardless of authorization, is contingent on the member’s eligibility at the time service is rendered. NON-PAR PROVIDERS & FACILITIES REQUIRE AUTHORIZATION FOR ALL HMO SERVICES EXCEPT WHERE INDICATED.        

For complete CPT/HCPCS code listing, please see the Medicaid Online Prior Authorization Tool.

The following procedure codes required prior authorization as of 12/31/2025:
Service CategoryServiceProcedure Codes
Administrative & QualityQuality Reporting & Performance MeasuresG9477
Anesthesia ServicesInterventional Pain Management (Nerve Blocks)0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 0628T, 0630T, 0777T, 64400, 64405, 64408, 64415, 64416, 64417, 64418, 64420, 64421, 64430, 64445, 64446, 64447, 64448, 64449, 64450, 64451, 64454, 64461, 64462, 64463, 64466, 64467, 64468, 64469, 64473, 64474, 64479, 64483, 64486, 64487, 64488, 64489, 64490, 64493, 64505, 64510, 64517, 64520, 64530, 64624, 64625, 64628, 64629, 64633, 64635, G0260
Behavioral Health & Substance UseAlcohol and drug management, treatment, and rehabilitationH0004, H0036, H2014, H2017, H2019, H2022, H2027
Psychological and psychiatric evaluation and therapy0889T, 0890T, 0891T, 0892T, 90847, 90853, 90867, 90868, 90899
Cardiovascular & Thoracic ProceduresConversion of cardiac rhythm92960, 92961, 93609, 93613, 93619, 93620, 93621, 93622, 93623, 93650, 93653, 93654, 93655, 93656, 93657, 93662, C9784
Coronary artery bypass graft (CABG)33510, 33511, 33512, 33513, 33514, 33516, 33517, 33518, 33519, 33521, 33522, 33523, 33530, 33533, 33534, 33535, 33536, 33542, 33548, 33768, S2205, S2206, S2207, S2208, S2209
Embolectomy and Endarterectomy35301, 35302, 35303, 35304, 35305, 35306, 35351, 35355, 35371, 35372, 35390
Heart valve procedures0643T, 0644T, 0645T, 0646T, 33340, 33361, 33362, 33363, 33364, 33365, 33366, 33367, 33368, 33369, 33405, 33406, 33410, 33411, 33412, 33413, 33418, 33419, 33425, 33426, 33427, 33430, 33440, 33465, 33475, 33477, 33572, 33641, 33820, 33840, 33917, 33924, 33930, 33933, 33935, 33940, 33944, 33945
Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator0682T, 33202, 33203, 33206, 33207, 33208, 33210, 33211, 33212, 33213, 33214, 33215, 33216, 33217, 33218, 33220, 33221, 33222, 33223, 33224, 33225, 33226, 33227, 33228, 33229, 33230, 33231, 33233, 33234, 33235, 33236, 33237, 33240, 33241, 33243, 33244, 33249, 33254, 33255, 33256, 33262, 33263, 33264, 33265, 33266, 33270, 33271, 33272, 33273, 33274, 33275, 33285, 33286, 33289
Lobectomy, Pneumonectomy, and Mediastinal Procedures0681T, 31599, 31899, 32491, 32672, 32850, 32851, 32852, 32853, 32854, 32855, 32856, 32999, 39499
Mechanical Circulatory Support and Transplantation33999
Percutaneous transluminal coronary angioplasty (PTCA)0235T, 92920, 92921, 92924, 92925, 92928, 92929, 92933, 92934, 92937, 92938, 92943, 92944, 92973, 92974, 92978, 92979, 92986, 92987, 92997, 92998, C9600, C9601, C9602, C9603, C9604, C9605, C9606, C9607, C9608
Peripheral vascular bypass35001, 35011, 35141, 35151, 35400, 35500, 35556, 35558, 35566, 35571, 35572, 35583, 35585, 35587, 35600, 35621, 35646, 35654, 35656, 35661, 35665, 35666, 35671, 35700, 35881, 35883, 35884, 37215, 37220, 37221, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231, 37232, 37233, 37234, 37235, 37236, 37237, 37238, 37239, 37243, 37246, 37247, 37248, 37249
Varicose vein stripping, lower limb36465, 36466, 36468, 36470, 36473, 36474, 36475, 36476, 36478, 36479, 36482, 36483, 37501, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780, 37785
Vascular Repairs, Open Trauma, and Ligation37799
Consultation & Evaluation ServicesConsultation, evaluation, and preventative care0893T, 99078, 99183, 99199, G0182, G0302, G0303, G0304, G0305, G3002, S0255, S0271, S9975, S9976, S9977
Dental ServicesOral and Dental Services0964T, 0965T, 0966T, D0120, D0140, D0145, D0150, D0160, D0170, D0171, D0180, D0190, D0191, D0210, D0220, D0230, D0240, D0250, D0251, D0270, D0272, D0273, D0274, D0277, D0310, D0320, D0321, D0322, D0330, D0340, D0350, D0360, D0362, D0364, D0365, D0366, D0367, D0368, D0369, D0370, D0371, D0372, D0373, D0374, D0380, D0381, D0382, D0383, D0384, D0385, D0386, D0387, D0388, D0389, D0391, D0393, D0394, D0395, D0396, D0411, D0412, D0414, D0415, D0416, D0417, D0418, D0419, D0422, D0423, D0425, D0431, D0460, D0470, D0472, D0473, D0474, D0475, D0476, D0477, D0478, D0479, D0480, D0481, D0482, D0483, D0484, D0485, D0486, D0600, D0601, D0602, D0603, D0605, D0606, D0706, D0707, D0708, D0709, D0999, D1110, D1120, D1203, D1204, D1206, D1208, D1310, D1320, D1321, D1330, D1351, D1352, D1353, D1354, D1355, D1510, D1516, D1517, D1520, D1526, D1527, D1551, D1552, D1553, D1556, D1557, D1558, D1575, D1706, D1707, D1708, D1709, D1710, D1711, D1712, D1713, D1714, D1781, D1782, D1783, D1999, D2140, D2150, D2160, D2161, D2330, D2331, D2332, D2335, D2390, D2391, D2392, D2393, D2394, D2410, D2420, D2430, D2510, D2520, D2530, D2542, D2543, D2544, D2610, D2620, D2630, D2642, D2643, D2644, D2650, D2651, D2652, D2662, D2663, D2664, D2710, D2712, D2720, D2721, D2722, D2740, D2750, D2751, D2752, D2753, D2780, D2781, D2782, D2783, D2790, D2791, D2792, D2794, D2799, D2910, D2915, D2920, D2921, D2928, D2929, D2930, D2931, D2932, D2933, D2934, D2940, D2949, D2950, D2951, D2952, D2953, D2954, D2955, D2956, D2957, D2960, D2961, D2962, D2971, D2975, D2976, D2980, D2981, D2982, D2983, D2989, D2990, D2991, D2999, D3110, D3120, D3220, D3221, D3222, D3230, D3240, D3310, D3320, D3330, D3331, D3332, D3333, D3346, D3347, D3348, D3351, D3352, D3353, D3355, D3356, D3357, D3410, D3421, D3425, D3426, D3428, D3429, D3430, D3431, D3432, D3450, D3460, D3470, D3471, D3472, D3473, D3501, D3502, D3503, D3910, D3911, D3920, D3921, D3950, D3999, D4210, D4211, D4212, D4230, D4231, D4240, D4241, D4245, D4249, D4260, D4261, D4263, D4264, D4265, D4266, D4267, D4268, D4270, D4271, D4273, D4274, D4275, D4276, D4277, D4278, D4283, D4285, D4286, D4322, D4323, D4341, D4342, D4346, D4355, D4381, D4910, D4920, D4921, D4999, D5110, D5120, D5130, D5140, D5211, D5212, D5213, D5214, D5221, D5222, D5223, D5224, D5225, D5226, D5227, D5228, D5282, D5283, D5284, D5286, D5410, D5411, D5421, D5422, D5511, D5512, D5520, D5611, D5612, D5621, D5622, D5630, D5640, D5650, D5660, D5670, D5671, D5710, D5711, D5720, D5721, D5725, D5730, D5731, D5740, D5741, D5750, D5751, D5760, D5761, D5765, D5810, D5811, D5820, D5821, D5850, D5851, D5862, D5863, D5864, D5865, D5866, D5867, D5875, D5876, D5899, D5911, D5912, D5913, D5914, D5915, D5916, D5919, D5922, D5923, D5924, D5925, D5926, D5927, D5928, D5929, D5931, D5932, D5933, D5934, D5935, D5936, D5937, D5951, D5952, D5953, D5954, D5955, D5958, D5959, D5960, D5982, D5983, D5984, D5985, D5986, D5987, D5988, D5991, D5992, D5993, D5995, D5996, D5999, D6010, D6011, D6012, D6013, D6040, D6050, D6051, D6055, D6056, D6057, D6058, D6059, D6060, D6061, D6062, D6063, D6064, D6065, D6066, D6067, D6068, D6069, D6070, D6071, D6072, D6073, D6074, D6075, D6076, D6077, D6080, D6081, D6082, D6083, D6084, D6085, D6086, D6087, D6088, D6089, D6090, D6091, D6092, D6093, D6094, D6096, D6097, D6098, D6099, D6100, D6101, D6102, D6103, D6104, D6105, D6106, D6107, D6110, D6111, D6112, D6113, D6114, D6115, D6116, D6117, D6118, D6119, D6120, D6121, D6122, D6123, D6180, D6190, D6191, D6192, D6193, D6194, D6195, D6197, D6198, D6199, D6205, D6210, D6211, D6212, D6214, D6240, D6241, D6242, D6243, D6245, D6250, D6251, D6252, D6253, D6254, D6545, D6548, D6549, D6600, D6601, D6602, D6603, D6604, D6605, D6606, D6607, D6608, D6609, D6610, D6611, D6612, D6613, D6614, D6615, D6624, D6634, D6710, D6720, D6721, D6722, D6740, D6750, D6751, D6752, D6753, D6780, D6781, D6782, D6783, D6784, D6790, D6791, D6792, D6793, D6794, D6795, D6920, D6930, D6940, D6950, D6970, D6972, D6973, D6976, D6977, D6980, D6985, D6999, D7111, D7140, D7210, D7220, D7230, D7240, D7241, D7250, D7251, D7252, D7259, D7260, D7261, D7270, D7272, D7280, D7282, D7283, D7284, D7285, D7286, D7287, D7288, D7290, D7291, D7292, D7293, D7294, D7295, D7296, D7297, D7298, D7299, D7300, D7310, D7311, D7320, D7321, D7340, D7350, D7410, D7411, D7412, D7413, D7414, D7415, D7440, D7441, D7450, D7451, D7460, D7461, D7465, D7471, D7472, D7473, D7485, D7490, D7509, D7510, D7511, D7520, D7521, D7530, D7540, D7550, D7560, D7610, D7620, D7630, D7640, D7650, D7660, D7670, D7671, D7680, D7710, D7720, D7730, D7740, D7750, D7760, D7770, D7771, D7780, D7810, D7820, D7830, D7840, D7850, D7852, D7854, D7856, D7858, D7860, D7865, D7870, D7871, D7872, D7873, D7874, D7875, D7876, D7877, D7880, D7881, D7899, D7910, D7911, D7912, D7920, D7921, D7922, D7939, D7940, D7941, D7943, D7944, D7945, D7946, D7947, D7948, D7949, D7950, D7951, D7952, D7953, D7955, D7956, D7957, D7961, D7962, D7963, D7970, D7971, D7972, D7979, D7980, D7981, D7982, D7983, D7990, D7991, D7993, D7994, D7995, D7996, D7997, D7998, D7999, D8010, D8020, D8030, D8040, D8070, D8080, D8090, D8091, D8210, D8220, D8660, D8670, D8671, D8680, D8681, D8695, D8696, D8697, D8698, D8699, D8701, D8702, D8703, D8704, D8999, D9110, D9120, D9130, D9210, D9211, D9212, D9215, D9219, D9222, D9223, D9230, D9239, D9243, D9248, D9310, D9311, D9410, D9420, D9430, D9440, D9450, D9610, D9612, D9613, D9630, D9910, D9911, D9912, D9913, D9914, D9920, D9930, D9932, D9933, D9934, D9935, D9938, D9939, D9941, D9942, D9943, D9944, D9945, D9946, D9947, D9948, D9949, D9950, D9951, D9952, D9953, D9954, D9955, D9956, D9957, D9959, D9961, D9970, D9971, D9972, D9973, D9974, D9975, D9985, D9986, D9987, D9990, D9991, D9992, D9993, D9994, D9995, D9996, D9997, D9999
Diagnostic CardiologyDiagnostic cardiac catheterization, coronary arteriography93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 93462, 93463, 93464, 93505, 93563, 93564, 93565, 93566, 93567, 93568, 93571, 93572, 93580, 93581, 93582, 93583, 93590, 93591, 93592, C7504, C7505, C7507, C7508
Diagnostic ultrasound of heart (echocardiogram)93303, 93304, 93306, 93307, 93308, 93312, 93313, 93314, 93315, 93316, 93317, 93318, 93350, 93351
Electroencephalogram (EEG), Sleep Studies, and Neurodiagnostics95782, 95783
Electrographic cardiac monitoring0695T, 0696T, 0716T, 0897T, 0949T, 0962T, 93292
Diagnostic NeurologyElectroencephalogram (EEG) and Sleep Studies95803, 95805, 95807, 95808, 95810, 95811, 95851, 95852
Diagnostic Radiology & ImagingArterio- or Venogram (Including Aortography)36005, 36140, 36200, 36215, 36216, 36217, 36218, 36221, 36245, 36246, 36247, 36251, 36252, 36253, 36254, 36299, 75625, 75630, 75635, 75710, 75716, 75726, 75736
Computerized axial tomography (CT) Imaging0042T, 0174T, 0624T, 0691T, 0710T, 0711T, 0712T, 0713T, 0721T, 0877T, 0878T, 0879T, 0880T, 70450, 70460, 70470, 70480, 70481, 70482, 70486, 70487, 70488, 70490, 70491, 70492, 70496, 70498, 71250, 71260, 71270, 71271, 71275, 72125, 72126, 72127, 72128, 72129, 72130, 72131, 72132, 72133, 72191, 72192, 72193, 72194, 72198, 73200, 73201, 73202, 73206, 73700, 73701, 73702, 73706, 73718, 73719, 73720, 73721, 73722, 73723, 73725, 74150, 74160, 74170, 74174, 74175, 74176, 74177, 74178, 74261, 74262, 74263, 75571, 75572, 75573, 75574, G0288
Magnetic resonance imaging (MRI/MRA)0648T, 0649T, 0723T, 0898T, 0899T, 0900T, 70540, 70542, 70543, 70544, 70545, 70546, 70547, 70548, 70549, 70551, 70552, 70553, 70554, 70555, 71550, 71551, 71552, 71555, 72141, 72142, 72146, 72147, 72148, 72149, 72156, 72157, 72158, 72159, 72195, 72196, 72197, 73218, 73219, 73220, 73221, 73222, 73223, 73225, 74181, 74182, 74183, 74185, 74712, 74713, 75557, 75559, 75561, 75563, 77046, 77047, 77048, 77049, C8900, C8901, C8902, C8903, C8905, C8906, C8908, C8909, C8910, C8911, C8912, C8913, C8914, C8918, C8919, C8920, C8931, C8932, C8933, C8934, C8935, C8936, S8037, S8042
Mammography0351T, 0353T, 0694T
Other diagnostic ultrasound0690T, 0876T, 76937, 76999
Radioisotope scan, PET, and Nuclear Medicine0742T, 78099, 78199, 78299, 78399, 78429, 78430, 78431, 78432, 78433, 78451, 78452, 78453, 78454, 78459, 78466, 78468, 78469, 78472, 78473, 78481, 78483, 78491, 78492, 78494, 78499, 78599, 78608, 78609, 78699, 78799, 78811, 78812, 78813, 78814, 78815, 78816, 78999, G0341, G0342, G0343
Standard X-Ray and Radiography70336, 76380, 76390, 76496, 76497, 76498, 76499, 77078, 77084
Dialysis & Nephrology ServicesHemodialysis and Peritoneal Dialysis0692T, G0495, G0496
Durable Medical Equipment (DME)DME and suppliesA4100, A4238, A4239, A4271, A4421, A4438, A4564, A4593, A4594, A4615, A4619, A4649, A6501, A6502, A6503, A6504, A6505, A6506, A6507, A6508, A6509, A6510, A6511, A6512, A6513, A6545, A6576, A6577, A6579, A6580, A8003, E0152, E0194, E0241, E0242, E0243, E0260, E0261, E0265, E0266, E0294, E0295, E0296, E0297, E0301, E0302, E0303, E0304, E0316, E0328, E0329, E0434, E0445, E0457, E0465, E0466, E0468, E0469, E0470, E0471, E0482, E0483, E0490, E0491, E0616, E0625, E0630, E0635, E0636, E0637, E0638, E0639, E0641, E0642, E0650, E0651, E0652, E0655, E0656, E0657, E0658, E0659, E0660, E0665, E0666, E0667, E0668, E0669, E0670, E0671, E0672, E0673, E0683, E0715, E0721, E0736, E0737, E0738, E0739, E0743, E0745, E0747, E0748, E0760, E0766, E0767, E0783, E0784, E0954, E0983, E0984, E0986, E1002, E1004, E1007, E1012, E1017, E1018, E1032, E1033, E1034, E1050, E1161, E1229, E1230, E1231, E1232, E1233, E1234, E1235, E1236, E1237, E1238, E1239, E1391, E1399, E1639, E1832, E2102, E2103, E2104, E2230, E2291, E2292, E2293, E2294, E2295, E2298, E2301, E2311, E2313, E2321, E2323, E2324, E2326, E2327, E2328, E2329, E2330, E2331, E2370, E2375, E2378, E2386, E2392, E2402, E2500, E2502, E2504, E2506, E2508, E2510, E2511, E2512, E2599, E2609, E2617, E8000, E8001, E8002, K0003, K0004, K0005, K0006, K0007, K0009, K0015, K0017, K0018, K0020, K0037, K0040, K0041, K0042, K0044, K0045, K0046, K0047, K0050, K0051, K0052, K0053, K0056, K0108, K0606, K0607, K0608, K0609, K0800, K0801, K0802, K0806, K0807, K0808, K0812, K0813, K0814, K0815, K0816, K0820, K0821, K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0890, K0891, K0898, K1036, Q0477, Q0515, Q3031, Q4025, Q4050, Q4051, S1040, S8092, S8422, S8423, S8425, S8426, T4521, T4522, T4523, T4524
Enteral & Parenteral Therapy (Formula/Pumps)B4100, B4103, B4105, B4155, B4158, B4159, B4160, B4161, B4162, B4187, B9998, B9999
Orthotics, Prosthetics, and OPPS DevicesC1730, C1731, C1732, C1733, C1735, C1736, C1737, C1742, C1753, C1759, C1760, C1764, C1768, C1777, C1779, C1785, C1786, C1826, C1827, C1832, C1876, C1877, C1882, C1895, C1896, C1898, C1899, L0112, L0464, L0480, L0482, L0484, L0486, L0632, L0634, L0637, L0648, L0650, L0700, L0710, L0720, L0999, L1000, L1001, L1005, L1006, L1007, L1200, L1300, L1320, L1499, L1653, L1681, L1690, L1700, L1710, L1755, L1833, L1844, L1846, L1932, L1933, L1952, L2034, L2036, L2037, L2128, L2627, L2628, L2861, L2999, L3160, L3170, L3201, L3202, L3203, L3204, L3206, L3207, L3224, L3225, L3230, L3250, L3251, L3252, L3253, L3254, L3255, L3257, L3265, L3300, L3310, L3320, L3330, L3332, L3334, L3340, L3350, L3360, L3370, L3380, L3400, L3430, L3440, L3450, L3455, L3460, L3465, L3470, L3808, L3891, L3904, L3927, L3999, L4631, L4645, L5000, L5010, L5020, L5050, L5060, L5100, L5105, L5150, L5160, L5200, L5210, L5220, L5230, L5250, L5270, L5280, L5301, L5312, L5321, L5331, L5341, L5500, L5505, L5510, L5520, L5530, L5535, L5540, L5560, L5570, L5580, L5590, L5595, L5600, L5610, L5611, L5613, L5616, L5618, L5620, L5622, L5624, L5626, L5628, L5629, L5630, L5631, L5632, L5634, L5636, L5637, L5638, L5639, L5640, L5642, L5644, L5645, L5646, L5648, L5650, L5651, L5652, L5653, L5654, L5655, L5656, L5657, L5658, L5666, L5668, L5670, L5671, L5672, L5673, L5676, L5678, L5679, L5680, L5681, L5682, L5683, L5684, L5685, L5686, L5688, L5690, L5692, L5694, L5695, L5696, L5697, L5698, L5699, L5700, L5701, L5702, L5703, L5704, L5705, L5706, L5707, L5710, L5712, L5714, L5716, L5718, L5722, L5724, L5726, L5728, L5780, L5783, L5810, L5812, L5816, L5818, L5822, L5824, L5827, L5828, L5830, L5840, L5841, L5845, L5850, L5855, L5856, L5859, L5920, L5925, L5950, L5962, L5964, L5966, L5970, L5971, L5972, L5974, L5975, L5976, L5978, L5979, L5980, L5981, L5982, L5984, L5987, L5990, L5991, L5999, L6000, L6010, L6020, L6028, L6029, L6031, L6032, L6033, L6034, L6035, L6036, L6038, L6039, L6050, L6055, L6100, L6110, L6120, L6130, L6200, L6205, L6250, L6300, L6350, L6400, L6450, L6500, L6550, L6570, L6600, L6605, L6610, L6615, L6616, L6620, L6625, L6628, L6629, L6630, L6635, L6637, L6640, L6641, L6642, L6645, L6646, L6647, L6650, L6655, L6660, L6665, L6670, L6672, L6675, L6676, L6677, L6680, L6682, L6684, L6686, L6687, L6688, L6689, L6690, L6691, L6692, L6693, L6694, L6695, L6696, L6697, L6698, L6700, L6706, L6707, L6708, L6709, L6711, L6712, L6713, L6714, L6721, L6722, L6805, L6810, L6881, L6883, L6884, L6885, L6890, L6895, L6935, L7186, L7400, L7401, L7402, L7403, L7404, L7405, L7406, L7499, L7510, L7520, L7600, L7700, L8000, L8001, L8002, L8015, L8020, L8030, L8499, L8500, L8501, L8509, L8510, L8515, L8607, L8608, L8614, L8615, L8616, L8617, L8618, L8619, L8624, L8629, L8691, L8692, L8693, L8698, L8720
Ear, Nose & Throat (ENT) SurgeryDiagnostic procedures on nose, mouth, pharynx, and ear0881T, 0955T, 0978T, 0979T, 0980T, 30520, 30620, 30630, 30999, 31276, 31295, 31296, 31298, 31299, 40899, 41599, 41899, 42145, 42299, 42699, 42820, 42825, 42826, 42830, 42831, 42835, 42836, 42999, 69399, 69716, 69799, 69930, 69949, 69979
Gastroenterology ProceduresColonoscopy and biopsyS2142
Gastrostomy, temporary and permanent0647T
Sigmoidoscopy, proctoscopy, and anoscopy0963T, 0967T, 45399, 45999, 46999, S2140
Upper gastrointestinal endoscopy (and Diagnostics)0651T, 0652T, 0653T, 0654T, 0736T, 0977T
Upper gastrointestinal endoscopy (and Diagnostics) (and Diagnostics)0868T, 91299
General & Abdominal SurgeryAppendectomy44979
Cholecystectomy and common duct exploration47579, 47999
Exploratory laparotomy (and Major Open Abdominal)45499, 47133, 47135, 47140, 47141, 47142, 47143, 47144, 47145, 47146, 47147, 47379, 47380, 47381, 47399, 48551, 48552, 48554, 48556, 48999, 49999, 60659, 60699, S2102
Gastric bypass and volume reduction (Bariatric)43289, 43290, 43291, 43499, 43644, 43645, 43647, 43648, 43659, 43770, 43771, 43772, 43773, 43775, 43842, 43843, 43845, 43846, 43847, 43848
Gastric, Esophageal, and Bariatric Structural Surgery43881, 43882, 43888, 43999
Laparoscopy44238, 49329
Other hernia repair39599, 49505, 49591, 49593, 49595, 49650, 49659
Small bowel resection/ Resection & Stoma44132, 44133, 44135, 44136, 44137, 44715, 44720, 44721, 44799, 44899
Gynecological SurgeryHysterectomy, abdominal and vaginal0664T, 0665T, 0666T, 0667T, 0668T, 0669T, 0670T, 58150, 58180, 58260, 58262, 58290, 58291, 58541, 58542, 58543, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573
Minor Gyn, Non-Hysterectomy & Maternity56625, 56800, 56805, 57110, 57291, 57292, 57335, 58350, 58578, 58579, 58999, 59840, 59841, 59850, 59851, 59852, 59855, 59856, 59857, 59866, 59897, 59898, 59899, S9002
Other gynecological surgery (Ovary/Tubal)58661, 58662, 58679, 58720
Hematology & Oncology ProceduresBone marrow transplant38204, 38240, 38241, 38242, S2150
Lymph Node and Hemic System Surgery38129, 38589, 38999
Therapeutic radiology (Radiation Oncology)0659T, 77299, 77399, 77499, 77799, 79999, C1721, C1722, C2617, C2619, C2620, C2621, C2623, C2624, C2630
Home Health & Community ServicesHome Infusion Services99601, 99602, S9562
Private Duty Nursing/Aide (T-Codes)T1002, T1003, T1025
Supplemental & State-Waiver Services0731T, A9156, A9268, A9269, A9274, A9276, A9277, A9291, A9999, C1062, S5165, T5001
Integumentary ProceduresBlepharoplasty and Brow Procedures15820, 15821, 15822, 15823, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909, 67911, 67914, 67915, 67916, 67917, 67921, 67922, 67923, 67924, 67950, 67999
Breast Reconstruction and Mastectomy19300, 19301, 19303, 19316, 19318, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19370, 19371, 19396, 19499, S2053, S2054, S2055
Complex Reconstruction & Grafts (Skin Substitutes)Q4101, Q4107, Q4110, Q4113, Q4115, Q4121, Q4132, Q4133, Q4160, Q4173, Q4186, Q4195, Q4196, Q4199, Q4204, Q4205, Q4224, Q4225, Q4234, Q4236, Q4248, Q4250, Q4256, Q4257, Q4258, Q4259, Q4260, Q4261, Q4262, Q4263, Q4264, Q4265, Q4274, Q4281, Q4285, Q4286, Q4305, Q4306, Q4307, Q4308, Q4309, Q4310, Q4311, Q4312, Q4313, Q4314, Q4315, Q4316, Q4317, Q4318, Q4319, Q4320, Q4321, Q4322, Q4323, Q4324, Q4325, Q4326, Q4327, Q4328, Q4329, Q4330, Q4331, Q4332, Q4333, Q4336, Q4337, Q4338, Q4339, Q4340, Q4341, Q4342, Q4343, Q4344, Q4345, Q4346, Q4347, Q4348, Q4349, Q4350, Q4351, Q4352, Q4353, Q4354, Q4355, Q4356, Q4357, Q4358, Q4359, Q4360, Q4361, Q4362, Q4363, Q4364, Q4365, Q4366, Q4367, Q4368, Q4369, Q4370, Q4371, Q4372, Q4373, Q4375, Q4376, Q4377, Q4378, Q4379, Q4380, Q4381, Q4382, Q4383, Q4384, Q4385, Q4386, Q4387, Q4388, Q4389, Q4390, Q4391, Q4392, Q4393, Q4394, Q4395, Q4396, Q4397
Debridement of wound, infection or burn0640T, 0658T, 0859T, 0860T, 0972T, 0973T, 0974T, 0975T, 11042, 15999, 96931, 96932, 96933, 96934, 96935, 96936
Excision of skin lesion0970T
Skin graft15271, 15272, 15273, 15274, 15275, 15276, 15277, 15278, 15734, 15736, 15738, 15771, 15772, 15773, 15774, 15775, 15776, A2003, A2011, A2012, A2013, A2014, A2015, A2016, A2017, A2018, A2022, A2023, A2024, A2025, A2026, A2027, A2028, A2029, A2030, A2031, A2032, A2033, A2034, A2035, A2036, A2037, A2038, A2039
Wound Repair & Destruction of Lesions17340, 17360, 17380, 17999
Laboratory & Pathology ServicesGenetic and Molecular Testing0006M, 0011M, 0012M, 0013M, 0015M, 0016M, 0017M, 0020M, 81105, 81106, 81107, 81108, 81109, 81110, 81111, 81112, 81120, 81121, 81161, 81162, 81163, 81164, 81165, 81166, 81167, 81168, 81170, 81171, 81172, 81173, 81174, 81175, 81176, 81177, 81178, 81179, 81180, 81181, 81182, 81183, 81184, 81185, 81186, 81187, 81188, 81189, 81190, 81191, 81192, 81193, 81194, 81200, 81201, 81202, 81203, 81204, 81205, 81206, 81207, 81208, 81209, 81210, 81212, 81215, 81216, 81217, 81218, 81219, 81221, 81222, 81223, 81224, 81225, 81226, 81227, 81228, 81229, 81230, 81231, 81232, 81233, 81234, 81236, 81237, 81238, 81239, 81240, 81241, 81242, 81243, 81247, 81248, 81249, 81250, 81251, 81252, 81253, 81254, 81255, 81256, 81257, 81258, 81259, 81260, 81269, 81271, 81272, 81273, 81274, 81276, 81277, 81278, 81279, 81283, 81284, 81285, 81286, 81287, 81288, 81289, 81290, 81291, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81301, 81302, 81303, 81304, 81305, 81306, 81307, 81308, 81309, 81311, 81312, 81313, 81314, 81317, 81318, 81319, 81320, 81321, 81322, 81323, 81324, 81325, 81326, 81327, 81328, 81329, 81330, 81332, 81333, 81334, 81335, 81336, 81337, 81338, 81339, 81343, 81344, 81345, 81346, 81347, 81348, 81350, 81351, 81352, 81353, 81355, 81357, 81360, 81361, 81362, 81363, 81364, 81370, 81371, 81372, 81373, 81374, 81375, 81376, 81377, 81378, 81379, 81380, 81381, 81382, 81383, 81400, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408, 81410, 81411, 81412, 81413, 81414, 81415, 81416, 81417, 81418, 81419, 81422, 81425, 81426, 81427, 81430, 81431, 81434, 81435, 81437, 81439, 81440, 81441, 81442, 81443, 81445, 81448, 81449, 81450, 81451, 81455, 81456, 81457, 81458, 81459, 81460, 81462, 81463, 81464, 81465, 81470, 81471, 81479, 81490, 81493, 81500, 81503, 81504, 81506, 81517, 81518, 81520, 81521, 81522, 81523, 81525, 81529, 81538, 81539, 81540, 81541, 81542, 81546, 81551, 81552, 81554, 81595, 81599, S3800, S3840, S3841, S3842, S3844, S3845, S3846, S3849, S3850, S3852, S3853, S3861, S3865, S3866, S3870
Immunology86812, 86813, 86816, 86817, 86821, 86849, 86999
Laboratory - Chemistry, Hematology, and Blood Bank81099, 84999, 85999, 89240, 89398
Laboratory - Chemistry, Hematology, and Specimen CollectionC8000, C8005
Microscopic examination (bacterial, toxicology, COVID-19)87483, 87593, 87999, G0480, G0481, G0482, G0483
Pathology0751T, 0752T, 0753T, 0754T, 0755T, 0756T, 0757T, 0758T, 0759T, 0760T, 0761T, 0762T, 0763T, 88099, 88199, 88230, 88233, 88235, 88240, 88241, 88245, 88248, 88249, 88261, 88262, 88263, 88264, 88267, 88269, 88271, 88272, 88273, 88274, 88275, 88280, 88283, 88285, 88289, 88291, 88299, 88364, 88365, 88366, 88369, 88373, 88374, 88377, 88399
Proprietary Lab Analyses (PLA Codes)0002U, 0003U, 0005U, 0009U, 0010U, 0016U, 0017U, 0018U, 0019U, 0021U, 0023U, 0026U, 0027U, 0031U, 0032U, 0033U, 0034U, 0036U, 0040U, 0045U, 0046U, 0047U, 0049U, 0060U, 0063U, 0080U, 0083U, 0090U, 0092U, 0101U, 0163U, 0169U, 0170U, 0171U, 0173U, 0174U, 0175U, 0177U, 0179U, 0180U, 0181U, 0182U, 0183U, 0184U, 0185U, 0186U, 0187U, 0188U, 0189U, 0190U, 0191U, 0192U, 0193U, 0194U, 0195U, 0196U, 0197U, 0198U, 0199U, 0200U, 0201U, 0203U, 0205U, 0209U, 0211U, 0212U, 0213U, 0214U, 0215U, 0216U, 0217U, 0218U, 0219U, 0220U, 0221U, 0222U, 0239U, 0242U, 0243U, 0244U, 0245U, 0246U, 0247U, 0248U, 0249U, 0250U, 0252U, 0253U, 0254U, 0256U, 0258U, 0260U, 0261U, 0262U, 0263U, 0264U, 0265U, 0266U, 0267U, 0268U, 0269U, 0270U, 0271U, 0272U, 0273U, 0274U, 0276U, 0277U, 0278U, 0282U, 0285U, 0286U, 0287U, 0288U, 0289U, 0290U, 0291U, 0292U, 0293U, 0294U, 0295U, 0296U, 0297U, 0298U, 0299U, 0300U, 0306U, 0307U, 0308U, 0309U, 0310U, 0313U, 0314U, 0315U, 0317U, 0318U, 0319U, 0320U, 0322U, 0327U, 0329U, 0331U, 0333U, 0334U, 0335U, 0336U, 0339U, 0341U, 0343U, 0345U, 0347U, 0348U, 0349U, 0350U, 0420U, 0421U, 0422U, 0423U, 0424U, 0425U, 0426U, 0433U, 0434U, 0436U, 0437U, 0438U, 0439U, 0440U, 0443U, 0444U, 0449U, 0452U, 0453U, 0454U, 0457U, 0458U, 0459U, 0460U, 0461U, 0462U, 0463U, 0465U, 0466U, 0467U, 0468U, 0469U, 0470U, 0472U, 0473U, 0474U, 0475U, 0476U, 0477U, 0478U, 0479U, 0480U, 0481U, 0485U, 0486U, 0487U, 0488U, 0489U, 0493U, 0494U, 0495U, 0496U, 0497U, 0498U, 0499U, 0500U, 0501U, 0502U, 0503U, 0506U, 0507U, 0508U, 0509U, 0510U, 0511U, 0516U, 0531U, 0532U, 0533U, 0534U, 0536U, 0537U, 0538U, 0539U, 0540U, 0543U, 0544U, 0549U, 0552U, 0553U, 0554U, 0555U, 0560U, 0561U, 0562U, 0565U, 0566U, 0567U, 0568U, 0569U, 0571U, 0575U, 0576U, 0577U, 0578U, 0579U, 0582U, 0583U, 0585U, 0586U, 0591U, 0592U, 0596U, 0597U, 0598U, 0599U
Medication & PharmacyMedications (Injections, infusions and other forms)0708T, 0709T, 0732T, A9607, C1605, C1606, C1900, C9047, C9089, C9257, C9305, C9399, J0121, J0122, J0129, J0172, J0174, J0175, J0177, J0178, J0179, J0180, J0185, J0202, J0208, J0210, J0215, J0218, J0219, J0220, J0221, J0222, J0223, J0225, J0256, J0257, J0287, J0289, J0291, J0348, J0364, J0480, J0485, J0490, J0491, J0517, J0565, J0567, J0577, J0578, J0584, J0585, J0586, J0587, J0588, J0589, J0593, J0596, J0597, J0598, J0599, J0601, J0602, J0603, J0604, J0605, J0606, J0607, J0608, J0609, J0630, J0637, J0638, J0668, J0691, J0717, J0738, J0743, J0752, J0775, J0791, J0801, J0802, J0879, J0881, J0885, J0888, J0889, J0895, J0896, J0897, J1072, J1096, J1202, J1203, J1260, J1267, J1290, J1299, J1301, J1302, J1303, J1306, J1307, J1324, J1325, J1412, J1414, J1434, J1437, J1438, J1439, J1440, J1442, J1447, J1453, J1454, J1455, J1456, J1458, J1459, J1460, J1551, J1552, J1554, J1555, J1556, J1557, J1558, J1559, J1560, J1561, J1562, J1566, J1568, J1569, J1570, J1572, J1575, J1576, J1599, J1602, J1626, J1627, J1628, J1632, J1640, J1645, J1650, J1652, J1655, J1726, J1738, J1740, J1743, J1744, J1745, J1748, J1786, J1809, J1823, J1826, J1830, J1930, J1931, J1932, J1943, J1944, J1954, J2020, J2062, J2170, J2182, J2212, J2248, J2260, J2267, J2277, J2278, J2280, J2315, J2320, J2323, J2325, J2327, J2329, J2350, J2351, J2353, J2354, J2355, J2356, J2357, J2358, J2407, J2410, J2426, J2427, J2428, J2430, J2468, J2501, J2504, J2506, J2507, J2513, J2545, J2562, J2680, J2700, J2724, J2770, J2777, J2778, J2779, J2781, J2782, J2786, J2787, J2793, J2797, J2798, J2801, J2802, J2820, J2840, J2860, J2910, J2941, J2993, J2995, J2998, J3000, J3030, J3031, J3032, J3060, J3070, J3090, J3095, J3111, J3240, J3241, J3243, J3245, J3246, J3247, J3262, J3280, J3285, J3299, J3305, J3320, J3357, J3358, J3364, J3380, J3385, J3391, J3396, J3397, J3402, J3403, J3465, J3471, J3472, J3473, J3490, J3590, J3591, J7170, J7171, J7172, J7173, J7174, J7175, J7177, J7179, J7180, J7181, J7182, J7183, J7185, J7186, J7187, J7188, J7189, J7190, J7191, J7192, J7193, J7194, J7195, J7196, J7197, J7198, J7199, J7200, J7201, J7202, J7203, J7204, J7205, J7207, J7208, J7209, J7210, J7211, J7212, J7213, J7214, J7308, J7309, J7310, J7311, J7312, J7313, J7314, J7318, J7320, J7321, J7322, J7323, J7324, J7325, J7326, J7327, J7328, J7329, J7331, J7332, J7345, J7351, J7352, J7354, J7356, J7501, J7504, J7511, J7513, J7521, J7525, J7599, J7648, J7649, J7658, J7659, J8499, J8541, J8655, J8999, J9024, J9038, J9054, J9161, J9210, J9212, J9213, J9226, J9314, J9332, J9361, J9376, J9381, J9999, M0224, Q0138, Q0139, Q0162, Q0166, Q0180, Q0224, Q2026, Q3027, Q5101, Q5103, Q5104, Q5106, Q5108, Q5109, Q5110, Q5111, Q5120, Q5121, Q5122, Q5124, Q5125, Q5128, Q5130, Q5133, Q5134, Q5135, Q5136, Q5147, Q5148, Q5149, Q5150, Q5151, Q5152, Q5153, Q5154, Q5155, Q5156, Q5157, Q5158, Q5159, Q9991, Q9992, Q9996, Q9997, Q9998, Q9999, S0013, S0080, S0189, S0190, S0191, S0199
NeurosurgeryIncision and excision of CNS0662T, 0663T, 0735T, 61736, 61737, 63620, 64999
Insertion of catheter or spinal stimulator0674T, 0675T, 0676T, 0677T, 0678T, 0679T, 0680T, 0767T, 0969T, 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327, 62350, 62351, 62360, 62361, 62362, 62380, 63650, 63655, 63661, 63662, 63663, 63664, 63685, 63688, 64555, 64561, 64566, 64568, 64590
Non-Hospital & Outpatient ServicesNonhospital-based care (e.g., home health care, hospice)G0151, G0152, G0156, G0157, G0158, G0159, G0160, G0299, G0300, G0493, G0494, G0529, G0530, G0531, Q5001, Q5002, Q5003, Q5004, Q5005, Q5006, Q5007, Q5008, Q5009, Q5010, Q5098, Q5099, Q5100, S9126, S9129, S9131
Ophthalmology & Vision CareGeneral Eye Exams & Diagnostics0333T, 0687T, 0688T, 0704T, 0705T, 0706T, 92065
Glaucoma & Eyeball Procedures0253T, 0308T, 0329T, 0660T, 0661T, 0730T, 67299, 67399, 67599, 68399, 68899
Lens and cataract procedures66999
Visual aids and other optical supplies92310, 92311, 92312, 92313, 92326, 92499, V2500, V2501, V2510, V2511, V2513, V2520, V2521, V2523, V2526, V2531, V2599, V2629
Orthopedic & Spine SurgeryFoot & Ankle Surgery28899
General Orthopedics, Trauma, & Fracture Treatment0200T, 0201T, 0232T, 0717T, 0718T, 0869T, 20560, 20561, 20999, 21089, 21120, 21121, 21122, 21123, 21125, 21127, 21137, 21138, 21139, 21141, 21142, 21143, 21145, 21146, 21147, 21150, 21151, 21154, 21155, 21159, 21160, 21172, 21175, 21179, 21180, 21181, 21182, 21183, 21184, 21188, 21193, 21194, 21195, 21196, 21198, 21199, 21206, 21208, 21209, 21210, 21215, 21230, 21235, 21240, 21242, 21243, 21244, 21245, 21246, 21247, 21248, 21249, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21270, 21275, 21280, 21282, 21295, 21296, 21299, 21499, 21899, 22101, 22102, 22103, 22110, 22112, 22114, 22116, 22220, 22222, 22224, 22532, 22856, 22857, 22858, 22861, 22862, 22864, 22865, 22867, 22869, 22899, 22999, 23120, 23125, 23130, 23700, 23929, 24363, 24366, 24370, 24371, 24999, 25332, 25441, 25442, 25443, 25444, 25445, 25446, 25999, 26989, 27096, 27125, 27278, 27279, 27299, 27403, 27405, 27407, 27409, 27412, 27415, 27416, 27418, 27420, 27422, 27424, 27425, 27427, 27428, 27429, 27438, 27570, 27599, 27702, 27899
Major Joint Reconstruction & Arthroscopy23405, 23410, 23412, 23415, 23420, 23430, 23450, 23455, 23460, 23462, 23465, 23466, 23470, 23472, 23473, 23474, 27130, 27132, 27134, 27137, 27138, 27332, 27333, 27446, 27447, 27486, 27487, 29805, 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29826, 29827, 29828, 29860, 29861, 29862, 29863, 29866, 29867, 29868, 29870, 29873, 29874, 29875, 29876, 29877, 29879, 29880, 29881, 29882, 29883, 29884, 29885, 29886, 29887, 29888, 29889, 29899, 29914, 29915, 29916, 29999, G0289, S2118
Orthopedic Supplies, Casting, & Wound Care29799
Spine Surgery (Fusion, Laminectomy, & Deformity)0202T, 0219T, 0220T, 0221T, 0222T, 0656T, 0657T, 0719T, 0790T, 22533, 22548, 22551, 22552, 22554, 22558, 22590, 22595, 22600, 22612, 22614, 22630, 22633, 22830, 22836, 22837, 22847, 22848, 22849, 63001, 63003, 63005, 63011, 63012, 63015, 63016, 63017, 63020, 63030, 63040, 63042, 63045, 63046, 63047, 63050, 63051, 63055, 63056, 63064, 63066, 63075, 63077, 63078, 63085, 63086, 63185, 63190, 63191, C9757, G0277, G0278
Physical, Occupational, and Speech TherapyChiropractic Services98940, 98941, 98942
PT/OT/Speech therapy0693T, 0733T, 0734T, 97110, 97112, 97113, 97116, 97124, 97129, 97130, 97139, 97140, 97150, 97153, 97155, 97530, 97533, 97535, 97537, 97542, 97545, 97546, 97550, 97551, 97552, S8948, S9090
Therapy Modalities (Ultrasound, Traction, Stim)97010, 97012, 97014, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036, 97039, 97750, 97755, 97760, 97761, 97763, 97799, G0283
Plastic & Reconstructive SurgeryCosmetic & Functional Reconstructive Surgery15780, 15781, 15782, 15783, 15786, 15788, 15789, 15792, 15793, 15824, 15825, 15826, 15828, 15829, 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15876, 15877, 15878, 15879, 40799
Plastic procedures on nose (Rhinoplasty)30400, 30410, 30420, 30430, 30435, 30450, 30460, 30462
Speech, Language, and Hearing ServicesHearing and Speech Evaluations0725T, 0726T, 0727T, 0728T, 0729T, 92507, 92508, 92526, 92700
Hearing devices and audiology suppliesV5030, V5040, V5050, V5060, V5100, V5120, V5130, V5140, V5171, V5172, V5181, V5200, V5211, V5212, V5213, V5214, V5215, V5240, V5242, V5243, V5244, V5245, V5246, V5247, V5248, V5249, V5250, V5251, V5252, V5253, V5254, V5255, V5258, V5259, V5274, V5298, V5299
Telehealth ServicesTelehealth (calls, online communication, remote monitoring)0175T, 0650T
Therapeutic Injections & InfusionsInjections: muscles, tendons, bursa, joints, soft tissue11950, 11951, 11952, 11954, 11960
Prophylactic vaccinations and inoculations admin90749
Vaccine and Immune Globulin Products90378, 90399
Transportation ServicesTransportation - patient, provider, equipmentA0170, A0426, A0428, A0430, A0431, A0435, A0436, A0999
UncategorizedGeneral01966, 01999
Urological & Kidney SurgeryDiagnostic procedures, male genital0864T, 54125, 55899
Diagnostic procedures, male genital (includes minor surgery)54520, 54660, 54690, 54699, 55175, 55180, 55559
Kidney transplant50300, 50320, 50323, 50325, 50327, 50328, 50329, 50340, 50360, 50365, 50370, 50380, S2065
Nephrectomy and Major Urinary Tract Reconstruction0672T, 50547, 50548, 50549, 50949, 51999, 53430, 54360, 54400, 54401
Other diagnostic procedures of urinary tract53899
Transurethral resection of prostate (TURP)0655T, 0714T, 0950T


Last Updated: 02/10/2026