Please note, in addition to the procedure codes found on Prior Authorization Lists (PAL), other request criteria may impact submission requirements. If you have questions, please reference this contact page for assistance. |
Below is a Prior Authorization List (PAL) for the following services. Please note, in addition to the procedure codes, other request criteria may impact submission requirements.
Beginning March 25, 2024, Medical Mutual contracted providers began submitting prior authorization requests for outpatient services, nursing, and investigational / experimental services through Cohere or through Rhyme’s EMR application. In addition, prior authorization requests for outpatient diagnostic radiology / imaging can be submitted through Rhyme’s EMR application.
Beginning December 16, 2024, prior authorizations for Radiology services must be submitted through the Cohere Health portal or the Rhyme EMR-based application.
Beginning of November 1, 2024, prior authorizations for Physical Therapy, Occupational Therapy, Speech Therapy, and Chiropractic services must be submitted through the Cohere Health Portal.
Beginning March 3, 2025, Cohere Health expanded its partnership with Medical Mutual Health Plans for Cardiology, Gastrointestinal (GI) and Sleep Services. Beginning March 3, 2025, prior authorizations for cardio, sleep and gastrointestinal services must be submitted through the Cohere Health portal or the Rhyme EMR-based application.
Please note, not all commercial plans require prior approval for gastroenterology, cardiology and sleep-related services. To verify benefits and authorization requirements, please use the For Providers number on the back of the Covered Person’s ID card.
Beginning January 28, 2026, prior authorizations for Pain Management and MSK Surgery should be submitted through the Cohere Health portal.
To view the official and most up-to-date Medical Mutual Prior Authorization List (PAL) for these services, please visit Medical Mutual's provider website. Please note, in addition to the procedure codes, other request criteria may impact submission requirements.
Category | Procedure Code |
Advanced Behavioral Analysis | 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, H2019 |
Arthroplasty | 23470, 23472, 27130, 27132, 27134, 27137, 27138, 27438, 27445, 27446, 27447, 27486, 27487, 27703, 23473, 23474, 27125, 27437, 27440, 27441, 27442, 27443, 27700, 27702 |
Arthroscopy | 0707T, 23929, 27299, 27412, 27599, 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29827, 29828, 29855, 29856, 29860, 29861, 29862, 29863, 29866, 29867, 29868, 29871, 29873, 29874, 29875, 29876, 29877, 29879, 29880, 29881, 29882, 29883, 29884, 29885, 29886, 29887, 29888, 29889, 29914, 29915, 29805, 29916, 29999, 29826, 29850, 29851, 29870, G0289, 0737T, C9781, S2112, S2300 |
Cardiology | K0606, K1030, 0417T, 93264, 93745, 0345T, 0408T, 33289, 33340, 33361, 33362, 33363, 33364, 33365, 33366, 33418, 37215, 37216, 37217, 92972, C9772, C9774, C9775, 33206, 33207, 33208, 33210, 33211, 33212, 33213, 33214, 33216, 33217, 33221, 33224, 33230, 33231, 33240, 33249, 33270, 33271, 33273, 33285, 33875, 33877, 33880, 33881, 33883, 33886, 34701, 34702, 34703, 34704, 34705, 34706, 34830, 34831, 34832, 34841, 34842, 34843, 34844, 34845, 34846, 34847, 34848, 35301, 36245, 36246, 36247, 37218, 37220, 37221, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231, 37236, 37238, 92920, 92924, 92928, 92933, 92937, 92943, 93228, 93229, 93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 93580, 93593, 93594, 93595, 93596, 93597, 93600, 93602, 93603, 93610, 93612, 93618, 93619, 93620, 93624, 93631, 93640, 93641, 93642, 93644, 93650, 93653, 93654, 93656, 0234T, 0235T, 0236T, 0237T, 0238T, 0266T, 0267T, 0268T, 0269T, 0270T, 0271T, 0272T, 0273T, 0409T, 0410T, 0411T, 0415T, 0416T, 0418T, 0505T, 0571T, 0572T, 0574T, 0577T, C1721, C1722, C1761, C1777, C1779, C1785, C1786, C1825, C1882, C1895, C1896, C1898, C1899, C1900, C2619, C2620, C2621, C2624, C9600, C9602, C9604, C9607, C9764, C9765, C9766, C9767, C9773, K0607, K0608, K0609, 0412T, 0413T, 0414T, 37254, 37258, 37263, 37271, 37267, 37275, 37280, 37288, 37284, 37292, 37296, 37262, 37256, 37260, 37265, 37273, 37269, 37277, 37282, 37290, 37286, 37294, 37298, 62330, 62331, 63032, 33882, 64654, 64655, 64656, 64657, 64658, 64659, 92945, 93145, 93146 |
Chiropractic Services | 98940, 98941, 98942, 98943 |
Continuous Glucose Monitor | A4239, A9276, A9277, A9278, E2102, E2103 |
Dental | 00170, 20902, 21010, 21073, 21125, 21127, 21141, 21142, 21143, 21145, 21146, 21147, 21154, 21155, 21159, 21160, 21195, 21196, 21199, 21209, 21215, 21240, 21243, 21244, 21245, 21248, 21249, 29800, 29804, 41899 |
Diagnostic Testing | 0072T, 0358T, 78099, 78199, 78299, 78399, 78599, 78699, 78799, 78999, 93998, 61715 |
Durable Medical Equipment (DME) | 0446T, 0447T, 0448T, 20975, 20979, 69711, A4290, A4540, A4541, A4542, A4593, A4594 , A4596, A4600, A4633, A4638, A4649, A6549, A7002, A7025, A7026, A7047, A9274, A9300, A9999, B4034, B4035, B4036, B4081, B4082, B4083, B4087, B4088, B4164, B4168, B4172, B4176, B4178, B4180, B4185, B4187, B4189, B4193, B4197, B4199, B4216, B4220, B4222, B4224, B5000, B5100, B5200, B9000, B9002, B9004, B9006, B9998, B9999, E0193, E0194, E0196, E0197, E0372, E0466, E0467, E0482, E0492, E0493, E0530, E0617, E0637, E0638, E0641, E0642, E0650, E0651, E0652, E0655, E0656, E0657, E0660, E0665, E0666, E0667, E0668, E0669, E0670, E0671, E0672, E0673, E0675, E0676, E0677, E0678, E0679, E0680, E0681, E0682, E0691, E0692, E0693, E0694, E0731, E0732, E0733, E0734, E0735, E0738, E0739 , E0745, E0747, E0748, E0749, E0760, E0762, E0764, E0766, E0770, E0784, E0787, E0830, E0983, E0984, E0986, E0988, E1002, E1004, E1007, E1008, E1010, E1012, E1230, E1231, E1232, E1233, E1235, E1239, E1399, E1699, E2120, E2311, E2312, E2313, E2358, E2359, E2362, E2363, E2368, E2369, E2370, E2373, E2374, E2375, E2376, E2377, E2378, E2381, E2382, E2383, E2384, E2385, E2386, E2387, E2388, E2389, E2390, E2391, E2392, E2394, E2395, E2396, E2397, E2402, E2500, E2502, E2504, E2506, E2508, E2510, E2511, E2512, E2599, K0005, K0010, K0011, K0012, K0013, K0014, K0108, K0733, K0739, E0658, E0659, 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, K0899, K1020, K1022, K1037 , L0999, L1320 , L1499, L1844, L1846, L1860, L2999, L3904, L3999, L5783, L5841, L5856, L5973, L5999, L6880, L6925, L6955, L7499, L8420, L8499, L8614, L8615, L8616, L8617, L8618, L8619, L8625, L8627, L8628, L8629, L8678, L8690, L8691, L8692, L8693, L8694, L8699, L8701, L8702, L9900, Q0480, Q0481, Q0482, Q0483, Q0484, Q0485, Q0486, Q0487, Q0488, Q0489, Q0490, Q0491, Q0492, Q0493, Q0494, Q0495, Q0496, Q0497, Q0498, Q0499, Q0500, Q0501, Q0502, Q0503, Q0504, Q0506, Q0507, Q0508, Q0509, Q4300, S1034, S1040, S9090, A4238, E0446, E2298 |
ENT | 30115, 30117, 30999, 31237, 31253, 31254, 31255, 31256, 31257, 31259, 31267, 31276, 31295, 31296, 31297, 31298, 31299, 31599, 31899, 42299, 42830, 92700 |
Epidural Steroid Injections (ESI) | 62320, 62322, 64480, 64484, 62321, 62323, 64479, 64483, 64999 |
Facet Injection | 22899, 64491, 64492, 64494, 64495, 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 0202T, 0219T, 0220T, 0221T, 0222T, 64490, 64493, 64633, 64634, 64635, 64636 |
Foot Surgery | 28291, 28298, 28299, 26535, 26536, 27870, 28110, 28240, 28285, 28289, 28292, 28295, 28296, 28297, 28306, 28308, 28310, 28740, 28750, L8641 |
Genetic Testing | 0005U, 0009U, 0011M, 0012M, 0013M, 0015M, 0016M, 0016U, 0017M, 0017U, 0018M, 0018U, 0019U, 0020M, 0021U, 0023U, 0026U, 0027U, 0032U, 0034U, 0036U, 0037U, 0040U, 0045U, 0047U, 0048U, 0049U, 0050U, 0055U, 0058U, 0059U, 0066U, 0067U, 0070U, 0071U, 0072U, 0073U, 0074U, 0075U, 0076U, 0080U, 0087U, 0088U, 0089U, 0090U, 0094U, 0102U, 0103U, 0111U, 0113U, 0129U, 0133U, 0134U, 0136U, 0137U, 0138U, 0153U, 0154U, 0155U, 0156U, 0157U, 0158U, 0159U, 0160U, 0161U, 0162U, 0169U, 0171U, 0172U, 0173U, 0174U, 0175U, 0177U, 0179U, 0195U, 0209U, 0211U, 0212U, 0213U, 0214U, 0215U, 0216U, 0217U, 0218U, 0228U, 0229U, 0233U, 0234U, 0235U, 0236U, 0237U, 0238U, 0239U, 0242U, 0244U, 0245U, 0250U, 0251U, 0252U, 0253U, 0254U, 0285U, 0286U, 0287U, 0288U, 0289U, 0290U, 0291U, 0292U, 0293U, 0294U, 0295U, 0296U, 0297U, 0298U, 0299U, 0300U, 0303U, 0304U, 0305U, 0318U , 0346U, 0360U , 0364U, 0365U , 0366U , 0367U , 0378U , 0384U , 0385U , 0387U, 0388U, 0389U, 0390U, 0391U, 0392U, 0393U, 0394U, 0395U, 0398U, 0399U, 0400U, 0401U, 0403U, 0404U, 0405U, 0406U, 0407U, 0409U, 0410U, 0411U, 0412U, 0413U, 0414U, 0415U, 0417U, 0418U, 0419U, 0420U, 0421U, 0422U, 0424U, 0425U, 0426U, 0433U, 0434U, 0435U, 0436U, 0437U, 0438U, 0439U , 0440U , 0444U , 0448U , 0449U , 0450U, 0457U, 0458U, 0459U, 0462U, 0468U, 0472U, 0794T, 80299, 81053, 81105, 81106, 81107, 81108, 81109, 81110, 81111, 81112, 81120, 81121, 81162, 81163, 81165, 81166, 81167, 81168, 81170, 81171, 81172, 81173, 81174, 81176, 81177, 81178, 81179, 81180, 81181, 81182, 81183, 81184, 81186, 81187, 81188, 81189, 81190, 81201, 81202, 81203, 81204, 81206, 81207, 81208, 81210, 81212, 81215, 81216, 81217, 81218, 81219, 81221, 81222, 81223, 81224, 81225, 81226, 81227, 81228, 81229, 81230, 81231, 81232, 81233, 81234, 81235, 81236, 81237, 81238, 81239, 81240, 81241, 81242, 81243, 81244, 81245, 81246, 81247, 81248, 81249, 81250, 81251, 81252, 81253, 81254, 81255, 81256, 81257, 81258, 81259, 81260, 81261, 81262, 81263, 81264, 81265, 81266, 81267, 81268, 81269, 81270, 81271, 81272, 81273, 81274, 81275, 81276, 81277, 81278, 81279, 81283, 81284, 81285, 81286, 81287, 81288, 81289, 81290, 81291, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81301, 81304, 81305, 81306, 81307, 81308, 81309, 81312, 81313, 81314, 81315, 81316, 81317, 81318, 81319, 81320, 81321, 81322, 81323, 81324, 81325, 81326, 81327, 81328, 81329, 81330, 81331, 81332, 81333, 81334, 81335, 81336, 81337, 81338, 81339, 81340, 81341, 81342, 81343, 81344, 81345, 81346, 81347, 81348, 81349, 81350, 81351, 81352, 81353, 81357, 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, 81413, 81414, 81415, 81416, 81417, 81418, 81419, 81422, 81425, 81426, 81427, 81430, 81431, 81432, 81434, 81437, 81439, 81440, 81441, 81442, 81443, 81445, 81448, 81449, 81450, 81451, 81455, 81456, 81457, 81458, 81459, 81460, 81462, 81463, 81464, 81465, 81470, 81471, 81479, 81493, 81504, 81506, 81507, 81518, 81519, 81520, 81521, 81522, 81523, 81525, 81529, 81538, 81540, 81541, 81542, 81546, 81551, 81552, 81554, 81560, 81595, 81599, 84112, 84433, 84999, 85999, 86343, 86849, 88235, 88241, 88245, 88248, 88249, 88269, 88271, 88272, 88273, 88274, 88275, 88283, 88299, 89335, 89344, S3800, S3841, S3842, S3850, S3853, S3861, S3865, S3870, 0532U, 0533U, 0534U, 0536U, 0537U, 0538U, 0539U, 0540U, 0543U, 0549U, 88261, 88262, 88263, 88289 |
Genicular Nerve Procedure | 64454, 64624 |
Gastrointestinal (GI) | 0651T, 91110, 43284, 43647, 43648, 43881, 43882, 43237, 43238, 43239, 43242, 43252, 43253, 43259, 43280, 43281, 43282, 43235, 91111, 91113 |
Lab | 0082U, 0093U, 0306U, 0307U, 0308U, 0309U, 0310U, 0311U, 0312U, 0313U, 0314U, 0315U, 0316U, 0317U, 0319U, 0320U, 0321U, 0322U, 0326U, 0327U, 0328U, 0329U, 0331U, 0332U, 0333U, 0334U, 0335U, 0569U, 0336U, 0337U, 0338U, 0339U, 0340U, 0341U, 0342U, 0343U, 0344U, 0345U, 0347U, 0348U, 0349U, 0350U, 0356U, 0359U, 0362U, 0363U, 0368U, 0375U, 0376U, 0377U, 0381U, 0451U, 0452U, 0453U, 0454U, 0460U, 0461U, 0463U, 0465U, 0466U, 0467U, 0469U, 0470U, 0471U, 0473U, 0474U, 0475U, 81099, 81517, 86486, 87999, 88199, 88399, 88749, 89398, 95065, 95199, 0476U, 0477U, 0478U, 0481U, 0485U, 0486U, 0487U, 0488U, 0489U, 0490U, 0491U, 0492U, 0493U, 0494U, 0495U, 0496U, 0497U, 0498U, 0499U, 0500U, 0501U, 0506U, 0507U, 0510U, 0511U, 0512U, 0513U, 0516U, 0108U, 0552U, 0553U, 0554U, 0555U, 0560U, 0561U, 0562U, 0565U, 0566U, 0567U, 0571U, 0572U, 0575U, 0576U, 0578U, 0582U, 0583U, 0585U, 0586U, 0591U, 0592U, 0597U, 0605U, 0607U, 0608U, 0609U, 0611U, 0612U, 0613U, 81354, 81524 |
OB/GYN | 0664T, 0665T, 0666T, 58140, 58145, 58146, 58150, 58180, 58210, 58260, 58262, 58263, 58270, 58290, 58291, 58292, 58541, 58542, 58544, 58545, 58546, 58548, 58550, 58552, 58553, 58554, 58558, 58563, 58565, 58570, 58571, 58572, 58573, 58578, 58579, 58661, 58662, 58670, 58679, 58720, 58953, 58954, 59898, 59899 |
Orthopedics | 24362, 24363, 24999, 25999, 26989, 27415, 27416, 27899, 28446, 28899, 29834, 29835, 29837, 29838, 29844, 29846, 29847, 29891, 29892, 29894, 29895, 29897, 29898, 29899, G0428, J7330, C8003 |
Other Joint Procedures | 27036, 27071, 27170, 27405, 27407, 27409, 27418, 27420, 27422, 27424, 27427, 27455, 27457, 27488, 27570 |
Pain Infusion Pump | 62325, 62327, 62350, 62351, 62355, 62361, 62362, 62365, 62367, 62368, 62369, 62370, 95990, 95991, C1772, C1891, C2626, E0782, E0783, E0785, E0786, 62324, 62326, 62360 |
Physical Therapy/Occupational Therapy | 97010, 97012, 97014, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036, 97039, 97113, 97124, 97129, 97139, 97140, 97150, 97165, 97166, 97167, 97168, 97542, 97545, 97546, 97602, 97750, 97755, 97760, 97761, 97763, 97799, 97110, 97112, 97116, 97530, 97533, 97535, 97537 |
Plastics/Reconstructive | 11920, 11921, 11922, 11970, 11971, 15769, 15771, 15786, 15787, 15788, 15789, 15792, 15793, 15819, 15820, 15821, 15822, 15823, 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879, 17106, 17107, 17108, 17999, 19300, 19303, 19316, 19318, 19325, 19328, 19330, 19340, 19342, 19350, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380, 19396, 19499, 21089, 21122, 21123, 21280, 21282, 21295, 21296, 21299, 30400, 30410, 30420, 30430, 30435, 30450, 30460, 30462, 30465, 30468, 30469, 30520, 30620, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909, 67911, 67916, 67917, 67950, 67961, 69300, S2066, S2067, S2068, 15770 |
Private Duty Nursing | S9123, S9124 |
Procedure Other | 0101T, 0102T, 0278T, 0512T, 0513T, 0528T, 0529T, 0547T, 0552T, 0554T, 0555T, 0556T, 0557T, 0587T, 0588T, 0720T, 0780T, 0791T, 0792T, 0807T, 0808T, 0810T, 0867T, 0868T, 0870T, 0871T, 0872T, 0873T, 0874T, 0875T, 0876T, 0877T, 0878T, 0879T, 0880T, 92065, 0881T, 0882T, 0883T, 0884T, 0885T, 0886T, 0887T, 0888T, 0889T, 0890T, 0891T, 0892T, 0893T, 0894T, 0895T, 0896T, 0897T, 0898T, 0899T, 0900T, 15772, 20560, 20561, 21499, 22505, 27275, 28890, 29799, 31242, 31243, 36299, 37243, 37501, 43201, 43210, 43236, 43257, 44705, 62263, 62264, 63661, 63662, 67299, 76496, 76981, 76982, 76983, 76999, 77299, 77399, 77499, 77799, 92605, 92066, 79999, 86999, 88099, 90399, 90749, 90899, 90999, 91112, 91299, 92499, 92548, 92549, 93702, 93799, 94799, 95803, 95999, 96003, 96127, 96379, 96549, 96904, 96920, 96921, 96922, 96931, 96932, 96933, 96934, 96935, 96936, 99199, 99429, 99499, 99600, A0430, A0431, A0435, A0436, A4560, A9268, A9269, E0483, E0490, E0491, G0281, G0455, J0600, L8605, L8610, M0076, M0300, S8130, S8131, S8948, S9960, S9961, 64567, Q4398, Q4399, Q4400, Q4401, Q4402, Q4403, Q4404, Q4405, Q4406, Q4407, Q4408, Q4409, Q4410, Q4411, Q4412, Q4413, Q4414, Q4415, Q4416, Q4417, Q4420, Q4431, Q4432, Q4433, A2040, A2041, A2042, A2045, G0681, G0682, G0683, G0684, Q4418, Q4419, Q4421, Q4422, Q4423, Q4424, Q4425, Q4426, Q4427, Q4428, Q4429, Q4435, Q4436, Q4437, Q4438, Q4439, Q4440, 0616U, 0617U, 0618U, 0619U, 0620U, 0621U, 0622U, 0623U, 0624U, 0625U, 0626U, 0627U, 0628U, 0629U, 0630U |
Radiology | 70336, 70450, 70460, 70470, 70480, 70481, 70482, 70486, 70487, 70488, 70490, 70491, 70492, 70496, 70498, 70540, 70542, 70543, 70544, 70545, 70546, 70547, 70548, 70549, 70551, 70552, 70553, 70554, 70555, 71250, 71260, 71270, 71271, 71275, 71550, 71551, 71552, 71555, 72125, 72126, 72127, 72128, 72129, 72130, 72131, 72132, 72133, 72141, 72142, 72146, 72147, 72148, 72149, 72156, 72157, 72158, 72159, 72191, 72192, 72193, 72194, 72195, 72196, 72197, 72198, 73200, 73201, 73202, 73206, 73218, 73219, 73220, 73221, 73222, 73223, 73225, 73700, 73701, 73702, 73706, 73718, 73719, 73720, 73721, 73722, 73723, 73725, 74150, 74160, 74170, 74174, 74175, 74176, 74177, 74178, 74181, 74182, 74183, 74185, 74261, 74262, 74263, 74712, 74713, 75557, 75559, 75561, 75563, 75571, 75572, 75573, 75574, 75580, 75635, 76380, 76390, 76391, 77046, 77047, 77048, 77049, 77078, 77084, 78429, 78430, 78431, 78432, 78433, 78451, 78452, 78453, 78454, 78459, 78466, 78468, 78469, 78472, 78473, 78481, 78483, 78491, 78492, 78494, 78608, 78609, 78811, 78812, 78813, 78814, 78815, 78816, C8900, C8901, C8902, C8903, C8905, C8906, C8908, C8909, C8910, C8911, C8912, C8913, C8914, C8918, C8919, C8920, C8931, C8932, C8933, C8934, C8935, C8936, C9762, C9763, C9791, G0235, G0252, G0219, S8037, S8042, S8092, 70471, 70472, 70473, 75577 |
Shoulder Surgery | 23120, 23125, 23130, 23334, 23335, 23410, 23412, 23420, 23430, 23440, 23450, 23455, 23460, 23462, 23465, 23466 |
SI Joint Injections | 27096, 64451, 64625, G0260 |
Sleep | E0601, 95782, 95783, 95800, 95801, 95805, 95806, 95807, 95808, 95810, 95811, E0486, 41530, 42145, 64582, 64583, 64584, E0485, 21685, 33277, 33279, 33280, 33281, 33287, 33288, 93150, 93151, 93152, 93153, 41512, 42140, 42950, C9727, S2080, E0470, E0471, E0561, E0562 |
Speech Therapy | 92507, 92508, 92521, 92522, 92523, 92524, 92526, 92610, 92611, 96105 |
Spinal Allogeneic Tissue-Based Injections | 0627T, 0628T, 0629T, 0630T |
Spinal Cord Stimulators | 64590, C1816, C1820, C1822, 63650, 63655, 63663, 63664, 63685, 63688, 64555, 64575, L8679, L8680, L8682, L8685, L8686, L8687, L8688 |
Spine Surgery | 0095T, 0098T, 0164T, 0165T, 0274T, 0275T, 0656T, 0657T, 0790T, 20999, 22100, 22214, 22224, 22510, 22511, 22512, 22513, 22514, 22515, 22533, 22534, 22551, 22552, 22554, 22558, 22585, 22586, 22610, 22612, 22614, 22630, 22632, 22633, 22634, 22800, 22802, 22804, 22808, 22830, 22836, 20930, 20931, 22837, 22838, 22840, 22842, 22843, 22844, 22845, 22846, 22849, 22850, 22853, 22856, 22857, 22858, 22860, 22861, 22862, 22867, 22868, 22869, 22852, 22870, 22855, 27278, 27279, 27280, 62287, 63001, 63003, 63005, 63012, 63015, 63016, 63017, 63020, 63030, 63035, 63040, 63042, 63044, 63045, 63046, 63047, 63048, 22101, 22102, 22103, 22116, 22206, 22207, 22210, 22212, 63050, 22220, 22222, 63051, 63055, 63056, 22526, 22527, 22532, 63075, 22548, 63081, 63085, 22556, 63090, 22590, 22595, 22600, 63172, 63185, 63190, 63265, 63266, 63267, 22810, 22812, 22818, 22819, 63277, 22841, 22847, 22848, 22854, 22859, 22864, 22865, C9757, 63011, 63043, 63052, 63053, 63057, 63064, 63066, 63076, 63077, 63078, 63082, 63086, 63087, 63088, 63091, 63101, 63102, 63103, S2350, S2351, 63170, 63173, 63191, 63197, 63200, 63250, 63251, 63252, 63268, 63270, 63271, 63272, 63273, 63275, 63276, S2348, 63278, 63280, 63281, 63282, 63283, 63285, 63286, 63287, 63290, 63295, 63300, 63301, 63302, 63303, 63304, 63305, 63306, 63307, 63308, C1821, C2614 |
Surgery Other | 0054T, 0055T, 0071T, 0075T, 0076T, 0232T , 0253T, 0308T, 0444T, 0445T, 0449T, 0450T, 0474T, 0483T, 0484T, 0584T, 0585T, 0586T, 0600T, 0601T, 0621T, 0622T, 0644T, 0645T, 0660T, 0661T, 0671T, 0730T, 0784T, 0785T, 0786T, 0787T, 0788T, 0789T, 0793T, 0795T, 0796T, 0797T, 0798T, 0799T, 0800T, 0801T, 0802T, 0803T, 0804T, 0805T, 0806T, 0869T, 11960, 15756, 15780, 15781, 15783, 15824, 15826, 15828, 15829, 15999, 17380, 20983, 20985, 21087, 21121, 21137, 21138, 21139, 21172, 21175, 21179, 21180, 21182, 21183, 21184, 21188, 21210, 21230, 21235, 21256, 21270, 21740, 21742, 21743, 21899, 22110, 22999, 32491, 32664, 32672, 32851, 32852, 32853, 32999, 33274, 33275, 33276, 33278, 33419, 33477, 33927, 33928, 33929, 33935, 33945, 33975, 33976, 33979, 33981, 33982, 33983, 33990, 33991, 33993, 33995, 33999, 35206, 35226, 35236, 35266, 36465, 36466, 36468, 36470, 36471, 36475, 36476, 36478, 36479, 36482, 36483, 37718, 37722, 37780, 37799, 38129, 38206, 38230, 38232, 38240, 38241, 38242, 38308, 38589, 38999, 39499, 39599, 40799, 40899, 41599, 42699, 42999, 43289, 43290, 43497, 43499, 43644, 43645, 43659, 43770, 43771, 43772, 43773, 43774, 43775, 43842, 43843, 43845, 43846, 43847, 43848, 43886, 43888, 43999, 44132, 44133, 44135, 44136, 44238, 44715, 44720, 44721, 44799, 44899, 44979, 45399, 45499, 45999, 46707, 46999, 47133, 47135, 47136, 47140, 47141, 47142, 47143, 47144, 47145, 47146, 47147, 47370, 47379, 47380, 47382, 47399, 47579, 47999, 48160, 48550, 48551, 48552, 48554, 48999, 49329, 49659, 49904, 49906, 49999, 50250, 50360, 50549, 50592, 50593, 50949, 51999, 54699, 55559, 55899, 56625, 56800, 56810, 57106, 57295, 57335, 58580, 58999, 59070, 59076, 59897, 60659, 60699, 61736, 61737, 61888, 62380, 64553, 64561, 64566, 64568, 64569, 64570, 64580, 64581, 64585, 64595, 64596, 64597, 64598, 64640, 64721, 64910, 64912, 64913, 65785, 66989, 66991, 66999, 67311, 67312, 67314, 67316, 67318, 67320, 67331, 67332, 67334, 67335, 67340, 67399, 67599, 67999, 68399, 68899, 69399, 69705, 69706, 69710, 69714, 69716, 69717, 69719, 69729, 69730, 69799, 69930, 69949, 69979, 76499, 86813, 93740, 96999, A2022, A2023, A2024, A2025, A4100, C1783, C9752, C9753, C9785, G0341, G0342, G0343, G0429, G0460, G0465, L8600, L8612, L8681, L8683, L8689, L8695, P9020, Q4101, Q4103, Q4104, Q4105, Q4108, 15773, 15774, 15825, Q4110, Q4111, Q4112, Q4113, Q4114, Q4115, Q4116, Q4117, Q4118, Q4122, Q4123, Q4124, Q4125, Q4126, Q4127, Q4130, Q4134, Q4135, Q4136, Q4137, Q4138, Q4139, Q4140, Q4142, Q4143, Q4145, Q4146, Q4147, Q4148, Q4149, Q4150, Q4151, Q4152, Q4153, Q4154, Q4155, Q4156, Q4157, Q4158, Q4159, Q4160, Q4161, Q4162, Q4163, Q4164, Q4166, Q4167, Q4169, Q4170, Q4171, Q4173, Q4174, Q4175, Q4176, Q4177, Q4178, Q4179, Q4180, Q4181, Q4182, Q4183, Q4184, Q4185, Q4186, Q4187, Q4188, Q4189, Q4190, Q4191, Q4192, Q4193, Q4194, Q4195, Q4196, Q4197, Q4199, Q4201, Q4203, Q4224, Q4225, Q4256, Q4257, Q4258, Q4259, Q4260, Q4261, Q4262, Q4263, Q4264, Q4272, Q4273, Q4274, Q4275, Q4276, Q4278, Q4279, Q4280, Q4281, Q4282, Q4283, Q4285, Q4286, Q4287, Q4288, Q4289, Q4290, Q4291, Q4292, Q4293, Q4294, Q4295, Q4296, Q4297, Q4298, Q4299, Q4301, Q4302, Q4303, Q4304, 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, S0515, S2053, S2054, S2055, S2065, S2083, S2102, S2152, S2230, S2235, S2400, S2401, S2402, S2403, S2405, S2409, 61885, A2036, A2037, A2038, A2039, Q4383, Q4384, Q4385, Q4386, Q4387, Q4388, Q4389, Q4390, Q4391, Q4392, Q4393, Q4394, Q4395, Q4396, Q4397, 44145, 53400, 53405, 53410, 53415, 53420, 53425, 53430, 54125, 54400, 54401, 54405, 54406, 54408, 54410, 54411, 54415, 54416, 54417, 54520, 54660, 54690, 55175, 55180, 55866, 55970, 55980, 56805, 57107, 57110, 57111, 57291, 57292, 57296, 57426, 58275, 58280, 58285, 58543, 58700, 58940, 47384, 55877, 43889, 11950, 11951, 11952, 11954, 15775, 15776, 21120, 33140, 33141, 61867, 61868, 61880 |
Thermal Ablation of the Intraosseous Basivertebral Nerve (BVN) | 64628, 64629 |
Transcranial Magnetic Stimulation | 90867, 90868, 90869 |
Urology | 37241, 37242, 53855, 53899, 51715, 53445, 53448, 53860 |
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