Cohere Health’s Scope of Management - Codes Under Management
Oak Street Health (Humana) Prior Authorization List
Effective October 1, 2024
Overview
Starting October 1, 2024, Cohere Health, a patient journey optimization company, is the designated preauthorization and utilization management vendor for Humana-Oak Street Health for select outpatient and inpatient services.
Impacted Plans and Geographies
Impacted plans and geographies include Oak Street Health Medicare Advantage patients in current Oak Street Health states (AZ, GA, IL, IN, LA, MI, MS, NC, NM, NY, OH, OK, PA, SC, TN, TX).
Clinical Scope
Practices must use Cohere when requesting preauthorizations for any of the procedure codes or services listed in the table below.
For more information and to view the official and most up to date Humana Preauthorization List (PAL). Please note, in addition to the procedure codes, other request criteria may impact submission requirements.
Use Cohere to obtain preauthorizations for the following procedure codes:
Outpatient Services | Outpatient Services |
Service Category | Procedure Codes (HCPCS) |
Abdominoplasty | 15830, 15847 |
Abortion (Regulatory and Contractual Review) | 59100, 59830, 59840, 59841, 59850, 59851, 59852, 59855, 59856, 59857, 59866, 1966, S0190, S0191, S0199, S2260, S2265, S2266, S2267, S8055 |
Aorta Repair | 33875, 33877, 33880, 33881, 33883, 33886, 34701, 34702, 34703, 34704, 34705, 34706, 34830, 34831, 34832, 34841, 34842, 34843, 34844, 34845, 34846, 34847, 34848 |
Bladder Slings | 57288 |
Blepharoplasty | 15820, 15821, 15822, 15823, 67900, 67903, 67904, 67908, 67909, 67911, 67914, 67916, 67917, 67921, 67923, 67924, 67950 |
Bone Growth Stimulators | E0747, E0748, E0760 |
Capsule Endoscopy | 91110, 91111, 91113, 0651T |
Cardiac Ablation/ Electrophysiology Study and Ablation for Bone, Liver, Kidney and Prostate cancer | 93650, 93653, 93654, 93656 |
Cardiac Catheterizations | 93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 93593, 93594, 93595, 93596, 93597 |
Cardiac Devices | 0408T, 0409T, 0410T, 0411T, 0412T, 0413T, 0414T, 0415T, 0416T, 0417T, 0418T, C1824, C1605 |
Cardiac implantable devices [e.g., pacemakers, leadless pacemaker, left atrial appendage closure (LAAC), defibrillators (implantable and subcutaneous) and cardiac resynchronization therapy] | 33206, 33207, 33208, 33210, 33211, 33212, 33213, 33214, 33216, 33217, 33221, 33224, 33227, 33228, 33229, 33230, 33231, 33233, 33234, 33235, 33240, 33241, 33244, 33249, 33262, 33263, 33264, 33270, 33271, 33272, 33273, 33274, 33275, 33340, 0266T, 0267T, 0268T, 0269T, 0270T, 0271T, 0272T, 0273T, 0571T, 0572T, 0573T, 0574T, 0580T, 0614T, 0795T, 0796T, 0797T, 0798T, 0799T, 0800T, 0801T, 0802T, 0803T, 0823T, 0824T, 0825T, 0826T, C1721, C1722, C1777, C1779, C1785, C1786, C1825, C1882, C1895, C1896, C1898, C1899, C1900, C2619, C2620, C2621 |
CardioMEMS | 33289, 93264, C2624 |
Cardiovascular, other | 37242, 37243, 33225 |
Carotid Revascularization | 35301, 37215, 37216, 37217, 37218 |
Clinical Review Required (Unlisted) | 15999, 17999, 19499, 21089, 21299, 21499, 21899, 22999, 24999, 25999, 26989, 27899, 28899, 29799, 30999, 31299, 31599, 31899, 33999, 36299, 37501, 37799, 38129, 38589, 38999, 39499, 39599, 40799, 40899, 41899, 42699, 42999, 43289, 43499, 43659, 43999, 44238, 44799, 44899, 44979, 45399, 45499, 45999, 46999, 47379, 47399, 47579, 47999, 48999, 49329, 49659, 49999, 50549, 50949, 51999, 53899, 54699, 55559, 55899, 58578, 58579, 58679, 58999, 59898, 59899, 60659, 60699, 64722, 66999, 67299, 67399, 67599, 67999, 68399, 68899, 69399, 69799, 69949, 69979, 76496, 76497, 76498, 76499, 76999, 77299, 77399, 77499, 77799, 78099, 78199, 78299, 78399, 78499, 78599, 78699, 78799, 78999, 81099, 84999, 85999, 86849, 86999, 87999, 88199, 88399, 88749, 89240, 90399, 90749, 91299, 92700, 93799, 93998, 94799, 95199, 95999, 96379, 96549, 96999, 98978, 99429, A0999, A6512, A6549, A9900, B9998, B9999, C1889, E1399, K0108, L3649, L8608, L8699, L9900, S8189, S8301, S9445, S9446, S9976, S9977, A9279, E0769, T5999 |
Cochlear and Auditory Brainstem Implants | L8614 |
Colonscopy | 45378, 45380 |
Computed Tomography (CT) Scan | 70450, 70460, 70470, 70480, 70481, 70482, 70486, 70487, 70488, 70490, 70491, 70492, 70496, 70498, 71250, 71260, 71270, 71275, 72125, 72126, 72127, 72128, 72129, 72130, 72131, 72132, 72133, 72191, 72192, 72193, 72194, 73200, 73201, 73202, 73206, 73700, 73701, 73702, 73706, 74150, 74160, 74170, 74174, 74175, 74176, 74177, 74178, 74261, 74262, 75572, 75573, 75574, 75635, 76380 |
Coronary Angioplasty/Stent | 92920, 92924, 92928, 92933, 92937, 92943, C9600, C9602, C9604, C9607 |
Coronary Intravascular Lithotripsy | C1761, 92972 |
Cutaneous Vascular Lesion Removal | 17106, 17107, 17108 |
Decompression of Peripheral Nerve (i.e., Carpal Tunnel Surgery) | 29848, 64721 |
Diagnostic Esophagogastroduodenoscopy (EGD) or Esophagoscopy | 0652T, 0653T, 0654T, 43191, 43193, 43197, 43198, 43200, 43202, 43235, 43237, 43238, 43239, 43242, 43252, 43253, 43259 |
Electric Beds | E0194, E0193, E0265, E0266, E0296, E0297 |
Electrophysiology (EPS) or EPS with 3D Mapping | 93600, 93602, 93603, 93610, 93612, 93618, 93619, 93620, 93624, 93631, 93640, 93641, 93642, 93644, 0577T |
Emerging technology/ New indications for existing technology | 31647, 31648, 31649, 31651, 43284, 0446T, 0447T, 0448T, 0745T, 0746T, 0747T, C9769, E0738, E0739, 0716T |
Epidural Injections (Outpatient Only) | 62320, 62321, 62322, 62323, 64479, 64480, 64483, 64484, 0777T |
Epidural Injections (Outpatient Only), Facet Injections, Pain Infusion Pump, Spinal Cord Stimulators | 64999 |
Facet Injections | 64490, 64491, 64492, 64493, 64494, 64495, 64633, 64634, 64635, 64636, 0213T, 0214T, 0215T, 0216T, 0217T, 0218T |
Facility-based Sleep Studies (PSG) | 95807, 95808, 95810, 95811 |
Foot Surgeries: Bunionectomy and Hammertoe | 26535, 26536, 28110, 28240, 28285, 28289, 28291, 28292, 28295, 28296, 28297, 28298, 28299, 28306, 28308, 28310, 28740, 28750, L8641 |
Gastric Pacing | 43647, 43648, 43881, 43882 |
Genicular Nerve Ablation and Genicular Nerve Blocks | 64454, 64624 |
High Frequency Chest Compression Vests | E0483, 94669 |
Home Health/ Home Infusion | 99512, 99600, G0151, G0152, G0153, G0155, G0156, G0157, G0158, G0159, G0160, G0161, G0162, G0493, G0494, G0495, G0496, G2168, G2169, G0299, G0300, 99509, G0179, G0180, G0181, S0270, S0271, S0272, S0273, S0274, S5108, S5109, S5110, S5111, S5115, S5116, S5180, S5181, S9001, S9097, S9098, S9122, S9123, S9124, S9125, S9127, S9128, S9129, S9131, S9208, S9209, S9211, S9212, S9213, S9214, T1000, T1004, T1005, T1021, T1022, T1028, T1030, T1031, T1502, T1503 |
Hyperbaric Therapy | 99183, G0277 |
Infertility Testing and Treatment | 52402, 54800, 54840, 54900, 54901, 55200, 55300, 55400, 55550, 55870, 58321, 58322, 58323, 58340, 58345, 58350, 58555, 58559, 58560, 58660, 58662, 58672, 58673, 58740, 58750, 58752, 58760, 58770, 58900, 58970, 58974, 58976, 74440, 74740, 74742, 76831, 76856, 76857, 76948, 80414, 80415, 80426, 82757, 84830, 89250, 89251, 89253, 89254, 89255, 89257, 89258, 89259, 89260, 89261, 89264, 89268, 89272, 89280, 89281, 89290, 89291, 89300, 89310, 89320, 89321, 89322, 89325, 89329, 89330, 89331, 89335, 89337, 89342, 89343, 89344, 89346, 89352, 89353, 89354, 89356, 89398, G0027, Q0115, S3655, S4011, S4013, S4014, S4015, S4016, S4017, S4018, S4020, S4021, S4022, S4023, S4025, S4026, S4027, S4028, S4030, S4031, S4035, S4037, S4040, S4042 |
Laparoscopic Hiatal Hernia Repair | 43280, 43281, 43282 |
Loop Recorders | 33285, 33286 |
Magnetic Resonance Angiogram (MRA) | 70544, 70545, 70546, 70547, 70548, 70549, 71555, 72159, 72198, 73225, 73725, 74185, C8900, C8901, C8902, C8909, C8910, C8911, C8912, C8913, C8914, C8918, C8919, C8920, C8931, C8932, C8933, C8934, C8935, C8936 |
Magnetic Resonance Imaging (MRI) | 70336, 70540, 70542, 70543, 70551, 70552, 70553, 70554, 70555, 71550, 71551, 71552, 72141, 72142, 72146, 72147, 72148, 72149, 72156, 72157, 72158, 72195, 72196, 72197, 73218, 73219, 73220, 73221, 73222, 73223, 73718, 73719, 73720, 73721, 73722, 73723, 74181, 74182, 74183, 74712, 75557, 75559, 75561, 75563, 77046, 77047, 77048, 77049, 77084, C8903, C8905, C8906, C8908, C9762, C9763, C9791, S8037, S8042 |
Micro invasive glaucoma surgery (MIGS) | 66989, 66991, 0253T, 0449T, 0450T, 0474T, 0660T, 0661T, 0671T |
Molecular Diagnostic/Genetic Testing | 0334U, 0356U, 0364U, 0368U, 0379U, 0388U, 0389U, 0396U, 0398U, 0400U, 0401U, 0417U, 83080, 84433, 81254, 81242, 81209, 81260, 81290, 81244, 81322, 81326, 81330, 81200, 81251, 81331, 81255, 81243, 81250, 81253, 81400, 83951, 81291, 81240, 81241, 81283, 83006, 0004M, 81355, 0017U, 81205, 81221, 81252, 81257, 0009U, 0328U, 81303, 81105, 81106, 81107, 81108, 81109, 81110, 81111, 81112, 81287, 0030U, 0286U, 81171, 81177, 81178, 81179, 81180, 81181, 81182, 81183, 81184, 81187, 81188, 81204, 81234, 81284, 81312, 81329, 81333, 81343, 81344, 81401, 0355U, 0378U, 81304, 81338, 81402, 81224, 81227, 81230, 81231, 81232, 81247, 81328, 81335, 81346, 81361, 0031U, 0032U, 81233, 81237, 81305, 81348, 81536, 81216, 81174, 81186, 81190, 81279, 81289, 81337, 81339, 81345, 81403, 81327, 81288, 81120, 81275, 81347, 81357, 81360, 81203, 81269, 81294, 81363, 81319, 81168, 81191, 81192, 81193, 81278, 81315, 81316, 81297, 81265, 81350, 81300, 81176, 81310, 81313, 81500, 0358U, 81172, 81189, 81239, 81285, 81286, 81404, 0177U, 0232U, 0233U, 81161, 81202, 81165, 81167, 81236, 81406, 0137U, 81225, 81306, 81320, 81121, 81323, 81166, 81173, 81336, 81405, 0230U, 81266, 81299, 81353, 81417, 81364, 81334, 81352, 81293, 81318, 81296, 0033U, 0007M, 81215, 81217, 81248, 81258, 81362, 0195U, 0069U, 81295, 0229U, 0049U, 0136U, 0330U, 0380U, 81222, 81212, 0285U, 81226, 0072U, 0073U, 0074U, 0075U, 0076U, 0078U, 0169U, 0173U, 81163, 0138U, 81223, 81410, 81194, 81504, 81302, 0234U, 81220, 81535, 81164, 81413, 81414, 81435, 81436, 81439, 81448, 0130U, 0237U, 0238U, 81445, 81449, 81249, 81259, 81321, 0071U, 0235U, 0236U, 0268U, 0269U, 0270U, 0271U, 0272U, 0273U, 0274U, 0277U, 0278U, 81298, 81351, 0333U, 81292, 0070U, 81175, 81317, 81431, 0111U, 0133U, 0135U, 0414U, 0131U, 0132U, 0029U, 0348U, 0349U, 0134U, 81324, 81422, 0060U, 0252U, 0254U, 81450, 81451, 0005U, 0011M, 0012M, 0013M, 0089U, 0289U, 0290U, 0293U, 0294U, 0339U, 0343U, 0359U, 0363U, 0403U, 81325, 81201, 0307U, 0327U, 81490, 0360U, 81185, 81407, 0231U, 81503, 81228, 81470, 81471, 81418, 81465, 81493, 0332U, 81229, 81349, 0410U, 0260U, 0264U, 0413U, 0245U, 81460, 0102U, 0129U, 0175U, 0345U, 0347U, 0350U, 0392U, 0411U, 0419U, 81411, 0171U, 81430, 0101U, 0103U, 0291U, 0292U, 0318U, 0405U, 0299U, 0331U, 0067U, 0341U, 0179U, 0090U, 0170U, 0296U, 0314U, 81408, 0317U, 0323U, 81427, 81419, 81441, 81443, 0276U, 81520, 0017M, 0120U, 0336U, 81426, 81538, 0050U, 81455, 81456, 0048U, 0250U, 0297U, 0298U, 0409U, 0172U, 81525, 0253U, 0262U, 0266U, 81440, 0329U, 0037U, 0239U, 0244U, 0340U, 81546, 0026U, 0287U, 0313U, 0362U, 0391U, 0258U, 81540, 81518, 81519, 81521, 81523, 0045U, 0288U, 0306U, 0300U, 81415, 0036U, 0242U, 0326U, 81425, 0335U, 0265U, 81554, 0267U, 81529, 0094U, 0315U, 81416, 81479, 81599, 0079U, S3800, S3840, S3841, S3842, S3844, S3845, S3846, S3849, S3850, S3852, S3853, S3854, S3861, S3865, S3866, S3870, 86386, G9143 |
Negative Pressure Wound Therapy (NPWT) | 97605, 97606, K0743, A6550, E2402 |
Neuromuscular Stimulators | A4593, A4594, E0764, E0770 |
Neurostimulators | 61860, 61863, 61867, 61885, 61886, 61889, 61891, 61892, 64553, 64555, 64561, 64566, 64568, 64575, 64581, 64596, 64597, 64598, 0587T, 0588T, 0720T, 0783T, 0786T, 0787T, 0816T, 0817T, 0818T, 0819T, C1767, C1787, C1826, C1827, E0734, E0735, E0736, L8683, E0733, E0721, E0737, E0743 |
Neurostimulators, Gastric Pacing | 64590 |
Noninvasive Home Ventilators | E0466, E0468 |
Nuclear Stress Test | 78451, 78452, 78453, 78454, 78466, 78468, 78469, 78472, 78473, 78481, 78483, 78494, 93350, 93351, C8928, C8930 |
Obesity Surgeries | 43290, 43291, 43631, 43632, 43633, 43634, 43644, 43645, 43770, 43771, 43772, 43773, 43774, 43775, 43842, 43843, 43845, 43846, 43847, 43848, 43886, 43887, 43888, 0813T, C9784, C9785 |
Observation Stays | 99234, 99235, 99236, G0378, G0379 |
Oral, Orthognathic, Temporomandibular Joint (TMJ) Surgeries | 20910, 21010, 21050, 21070, 21085, 21100, 21110, 21125, 21127, 21141, 21142, 21143, 21145, 21146, 21147, 21150, 21151, 21154, 21155, 21159, 21160, 21188, 21193, 21194, 21195, 21196, 21198, 21199, 21206, 21208, 21210, 21215, 21240, 21242, 21243, 21244, 21247, 29800, 29804 |
Orthopedic Surgeries: Hip, Knee and Shoulder Arthroplasty | 23472, 23473, 23474, 27125, 27130, 27132, 27134, 27137, 27138, 27437, 27438, 27440, 27441, 27442, 27443, 27445, 27446, 27447, 27486, 27487, 23929, 27299, 27412, 27599, 29805, 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29826, 29827, 29828, 29850, 29851, 29860, 29861, 29862, 29863, 29866, 29867, 29868, 29870, 29871, 29873, 29874, 29875, 29876, 29877, 29879, 29880, 29881, 29882, 29883, 29884, 29885, 29886, 29887, 29888, 29889, 29914, 29915, 29916, 29999, C9781, J7330, S2112, S2300 |
Other Breast Procedures | 19355 |
Other Breast Procedures (Excludes breast reconstruction following medically necessary mastectomies for breast cancer.) | 11971, 19316, 19318, 19325, 19328, 19330, 19340, 19342, 19350, 19357, 19370, 19371, 19380, C1789, L8600 |
Other Durable Medical Equipment (DME) | A9274, A9276, A9277, A9278, E0328, E0481, E0492, E0493, E0676, E2599, K0900, K1007, K1027, L0999, L1499, L2999, L3999, L8701, S8130, S8131, E2510, E0652, E0694, L2005, E2508, L3904, E2506, L0710, L1000, L0700, L2034, L0486, L2036, L1690, L1710, L0484, L1710, L0484, L3967, L3973, L3978, L1310, L2128, L2627, L2628, L1300, L2037, L3971, L3977, L1844, L1755, L3901, L1200, L0482, L1700, L4631, E2504, L3961, L3975, L3976, L2038, L0480, L0464, L0636, L1720, E0693, L3900, L0638, L2525, L1680, L2126, L0462, L1685, L2136, L3766, E0670, L2020, L1730, L0637, L0639, L1846, L3765, E2502, L1860, L2108, E0692, L3740, L3674, L2000, L2030, L0640, L0631, L2134, L0460, L0488, L0635, L0456, L1945, L2010, L1840, L1686, L2350, L3730, L3905, L1843, E0651, L1932, L0458, E0691, L1845, L2132, L1951, L3671, L1834, L1950, L3764, L1970, E0491, E0490, L2526, L2106, E0650, L3763, L3720, L2060, L1960, L1848, L1907, E0668, E0482, E0671, E2500, E0675, E0667, E0672, E0673, E2103, A4239, E0669, E3000, E0660, E0666, E0665, E0762, A4238, E0277, E0301, E0302, E0303, E0304, E0486, E0677, E0678, E0679, E0680, E0681, E0682, E0784, E2102, E2511, L0452, L0457, L0624, L0629, L0632, L0634, L1851, L1852, L2006, K1037, E0316, E0637, E0638, E0641, E0642, E0655, E0656, E0657, E2512, L8505, L8510, S1030, S1031, S1034, S1035, S1036, S1037, V5336 |
Pain Infusion Pump | 62324, 62325, 62326, 62327, 62350, 62351, 62360, 62361, 62362, C1772, C1891, C2626, E0782, E0783, E0785, E0786 |
Patent Foramen Ovale (PFO) and Atrial Septal Defect (ASD) Closure | 93580 |
Penile Implant | 54405 |
Percutaneous Lumbar Intravertebral Disc Injection | 0627T, 0628T, 0629T, 0630T |
Percutaneous VADs | 33990, 33991, 33995 |
Peripheral Angiography | 36245, 36246, 36247 |
Peripheral Intravascular Lithotripsy | C9764, C9765, C9766, C9767, C9772, C9773, C9774, C9775 |
Peripheral Revascularization (Atherectomy, Angioplasty) | 37220, 37221, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231, 37236, 37238, 0234T, 0235T, 0236T, 0237T, 0238T, 0505T |
Physical, Occupational and Speech Therapy | 97010, 97012, 97014, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036, 97037, 97039, 97110, 97112, 97113, 97116, 97124, 97129, 97130, 97139, 97140, 97150, 97164, 97168, 97530, 97533, 97535, 97537, 97542, 97545, 97546, 97550, 97551, 97552, 97750, 97755, 97760, 97761, 97763, 97799, 0791T, G0283, G0281 |
Planned air transport | A0430, A0431, A0435, A0436 |
Positron Emission Tomography (PET) Scan | 78429, 78430, 78431, 78432, 78433, 78459, 78491, 78492, 78608, 78811, 78812, 78813, 78814, 78815, 78816 |
Prostate-Specific Membrane Antigen (PSMA/ PET CT) | A9587, A9593, A9594, A9595, A9596, A9597, A9608, A9800 |
Prosthetics | 21081, 21082, 21084, A9282, L3250, L5969, L5999, L7499, L7510, L7520, L7600, L8499, L7181, L7180, L5856, L6880, L5858, L6975, L5973, L6970, L6965, L5859, L6960, L6955, L6945, L6950, L6940, L5991, L6935, L6925, L5857, L6930, L6920, L5987, L7170, L7008, L5250, L5270, L5280, L5341, L5331, L5600, L6570, L5702, L5961, L5595, L6350, L5160, L6550, L5230, L5782, L6026, L6300, L5980, L6881, L6205, L5781, L5150, L7009, L5105, L7007, L5701, L5840, L6624, L5814, L5200, L5312, L8035, L5321, L5968, L7259, L6360, L6885, L6500, L6450, L5930, L6310, L6648, L5981, L6715, L6646, L6588, L5828, L5826, L7040, L6882, L5060, L5220, L5700, L6200, L6250, L6055, L6590, L6130, L5585, L6693, L5613, L5210, L5590, L5728, L6120, L5580, L5100, L6400, L5301, L5050, L5979, L6638, L6884, L6721, L5703, L5610, L6621, L6584, L6110, L6370, L5570, L5020, L5560, L6100, L5649, L6050, L5830, L6586, L6722, L5540, L5988, L5726, L5505, L5530, L6320, L5822, L5535, L7045, L5611, L5845, L6883, L6580, L5643, L5824, L5420, L5614, L6900, L5724, L6010, L6905, L5510, L5520, L6910, L6713, L6020, L6582, L5616, L6000, L6707, L5500, L5707, L5010, L6709, L5651, L5966, L6714, L5681, L5683, L6696, L6697, L5780, L5639, L6712, L5795, L5848, L5960, L5818, L5964, L5705, L5706, L5718, L5722, L5816, L6708, L5645, L5647, L5950, L5811, L5716, L5790, L6690, L6689, L5673, L6694, L5648, L7405, L6623, L5640, L5986, L6915, L5682, L5642, L5661, L6711, L5644, L6686, L5962, L6704, L5653, L5982, L6687, L5926, L5984, L5812, L5976, L6692, L6895, L5679, L6695, L5646, L6625, L5920, L6688, L5704, L5711, L5785, L5665, L5617, L5000, L5940, L7404, L5671, L6698, L5677, L5650, L5810, L5638, L5628, L6628, L5626, L6647, L5630, L5631, L5652, L5712, L5714, L5975, L5656, L6611, L6637, L5658, L5624, L5622, L5676, L5910, L5710, L5972, L6706, L6684, L6691, L6805, L6650, L5925, L7402, L5654, L7403, L6703, L6645, L5629, L5855, L7401, L5634, L6620, L5672, L5978, L5637, L5618, L6640, L5620, L7400, L5670, L6677, L5655, L6682, L5985, L5636, L5974, L6680, L5632, L6642, L6630, L5970, L5971, L6600, L6810, L5699, L6605, L5696, L5694, L6635, L6615, L6672, L6610, L5695, L6641, L6629, L5692, L5850, L6676, L6675, L5685, L5698, L5668, L5690, L6660, L5697, L6655, L5666, L6632, L6616, L5688, L5686, L5684, L6670, L6665, L5678, L5615, L5783, L5841, 21086, 21088, L5990, L6890 |
Radiofrequency Ablation for the SI Joint | 64625 |
Rhinoplasty | 30400, 30410, 30420, 30430, 30435, 30450, 30460, 30462, 30468, 30469 |
SI Joint Injections | 27096 |
Skin and Tissue Substitutes | A2001, A2002, A2004, A2005, A2006, A2007, A2008, A2009, A2010, A2011, A2012, A2013, A2014, A2015, A2016, A2017, A2018, A2019, A2020, A2021, A2022, A2023, A2024, A2025, A4100, C1832, C9354, C9358, C9360, C9361, C9363, C9364, Q4100, Q4101, Q4102, Q4103, Q4104, Q4105, Q4106, Q4107, Q4108, Q4110, Q4111, Q4112, Q4113, Q4114, Q4115, Q4116, Q4117, Q4118, Q4121, Q4122, Q4123, Q4124, Q4125, Q4126, Q4127, Q4128, Q4130, Q4132, Q4133, Q4134, Q4135, Q4136, Q4137, Q4138, Q4139, Q4140, Q4141, Q4142, Q4143, Q4145, Q4146, Q4147, Q4148, Q4149, Q4150, Q4151, Q4152, Q4153, Q4154, Q4155, Q4156, Q4157, Q4158, Q4159, Q4160, Q4161, Q4162, Q4163, Q4164, Q4165, Q4166, Q4167, Q4168, 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, Q4198, Q4199, Q4200, Q4201, Q4202, Q4203, Q4204, Q4205, Q4206, Q4208, Q4209, Q4210, Q4211, Q4212, Q4213, Q4214, Q4215, Q4216, Q4217, Q4218, Q4219, Q4220, Q4221, Q4222, Q4224, Q4225, Q4226, Q4227, Q4229, Q4230, Q4231, Q4232, Q4233, Q4234, Q4235, Q4237, Q4238, Q4239, Q4240, Q4241, Q4242, Q4245, Q4246, Q4247, Q4248, Q4249, Q4250, Q4251, Q4252, Q4253, Q4254, Q4255, Q4256, Q4257, Q4258, Q4259, Q4260, Q4261, Q4262, Q4263, Q4264, Q4265, Q4266, Q4267, Q4268, Q4269, Q4270, Q4271, Q4272, Q4273, Q4274, Q4275, Q4276, Q4277, Q4278, Q4279, Q4280, Q4281, Q4282, Q4283, Q4284, Q4285, Q4286, Q4287, Q4288, Q4289, Q4290, Q4291, Q4292, Q4293, Q4294, Q4295, Q4296, Q4297, Q4298, Q4299, Q4300, Q4301, Q4302, Q4303, Q4304, A2026, Q4305, Q4306, Q4307, Q4308, Q4309, Q4310 |
Spinal Cord Stimulators | 63650, 63655, 63663, 63664, 63685, 63688, 0784T, 0785T, C1816, C1820, C1822, L8679, L8682 |
Spinal Fusion, Decompression, Kyphoplasty and Vertebroplasty | 20999, 22100, 22101, 22102, 22103, 22116, 22510, 22511, 22512, 22513, 22514, 22515, 22526, 22527, 22532, 22533, 22534, 22548, 22551, 22552, 22554, 22556, 22558, 22585, 22586, 22590, 22595, 22600, 22610, 22612, 22614, 22630, 22632, 22633, 22634, 22800, 22802, 22804, 22808, 22810, 22812, 22818, 22819, 22830, 22836, 22837, 22838, 22840, 22841, 22842, 22843, 22844, 22845, 22846, 22847, 22848, 22849, 22853, 22854, 22856, 22857, 22858, 22859, 22860, 22861, 22862, 22867, 22868, 22869, 22870, 22899, 27278, 27279, 27280, 62287, 62380, 63001, 63003, 63005, 63011, 63012, 63015, 63016, 63017, 63020, 63030, 63035, 63040, 63042, 63043, 63044, 63045, 63046, 63047, 63048, 63050, 63051, 63052, 63053, 63055, 63056, 63057, 63064, 63066, 63075, 63076, 63077, 63078, 63081, 63082, 63085, 63086, 63087, 63088, 63090, 63091, 63101, 63102, 63103, 63170, 63172, 63173, 63185, 63190, 63191, 63197, 63200, 63250, 63251, 63252, 63265, 63266, 63267, 63268, 63270, 63271, 63272, 63273, 63275, 63276, 63277, 63278, 63280, 63281, 63282, 63283, 63285, 63286, 63287, 63290, 63295, 63300, 63301, 63302, 63303, 63304, 63305, 63306, 63307, 63308, 64628, 64629, 0095T, 0098T, 0164T, 0165T, 0202T, 0219T, 0220T, 0221T, 0222T, 0274T, 0275T, 0656T, 0657T, 0719T, 0790T, C1821, C2614, C9757, S2348, S2350, S2351 |
Surgery for Obstructive Sleep Apnea | 21685, 33276, 33277, 33278, 33279, 33280, 33281, 33287, 33288, 41512, 41530, 41599, 42140, 42145, 42299, 42950, 64582, 93150, 93151, 93152, 93153, C9727, S2080 |
Surgical Nasal/Sinus Endoscopic Procedures and Balloon Sinuplasty (Excludes diagnostic nasal/sinus endoscopies) | 31237, 31240, 31253, 31254, 31255, 31256, 31257, 31259, 31267, 31276, 31287, 31288, 31295, 31296, 31297, 31298, 69705, 69706 |
Transcatheter Valve Surgeries (TMVR, TAVR/TAVI and MitraClip) | 33361, 33362, 33363, 33364, 33365, 33366, 33418, 0345T, 0805T, 0806T |
Transcranial Magnetic Stimulation (TMS) | 90867, 90868, 90869, E0732 |
Transesophageal Echocardiogram (TEE) | 93312, 93313, 93314, 93315, 93316, 93317, 93318, 93355, C8925, C8926, C8927 |
Varicose Vein: Surgical Treatment and Sclerotherapy | 36465, 36466, 36468, 36470, 36471, 36473, 36474, 36475, 36476, 36478, 36479, 36482, 36483, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780, 37785, 0524T, S2202 |
Wearable Cardiac Devices | 93228, 93229 |
Wheelchairs/Scooters | E1220, E1239, E2331, E2358, K0008, k0013, K0669, K0812, K0830, K0831, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0890, K0891, K0898, K0899, K0005, K0864, K0860, K0863, K0854, K0855, K0853, K0852, K0858, K0862, K0859, K0850, K0851, K0857, K0861, K0856, E2343, K0848, K0849, E0986, E1161, E2312, E1234, E1235, E2398, K0009, E1002, E1003, E1004, E1005, E1006, E1007, E1008, E1009, E1010, E1012, E2207, E2310, E2311, E2321, E2322, E2325, E2327, E2328, E2329, E2330, E2351, E2359, E2360, E2362, E2364, E2368, E2369, E2375, E2376, E2383, K0800, K0801, K0802, K0806, K0807, K0808, K0813, K0814, K0815, K0816, K0820, K0821, K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0835, K0836, K0837, K0838, K0839, K0840, K0841, K0842, K0843, E2298, E1015, E1016, E1018, E1229, E1230, E1231, E2213, E2301, E2367, E2370, E2372, E2374, E2386, E2610, K0010, K0011, K0012, K0014 |
Zoll LifeVest® | K0606 |
Inpatient Services | Inpatient Services |
Service Category | Description |
Long Term Acute Care | Treatment of patients with serious medical conditions that require care on an ongoing basis but no longer require intensive care or extensive diagnostic procedures. |
Medical Care | Medical services to diagnose and/or treat a medical condition, illness, or injury |
Inpatient Rehabilitation | Services related to facilitate the process of recovery from injury, illness, or disease to as normal a condition as possible. |
Skilled Nursing Care | Services for a patient in a skilled nursing facility for the purpose of receiving medical care or other health services. |
Surgical | Surgical services provided by a healthcare provider. |
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