Prior Authorization Required Code List
***If service or procedure is being performed inpatient, prior authorization is required***
***Prior authorization is NOT required when drug administered as an Inpatient or in the ED or Urgent Care Clinic***
***All chemotherapy drugs require prior authorization***
Effective date: Jan 1, 2024
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Plan Year
Showing: 3301 Entries
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Service Category
Code
Rules/Description
Notes
Inpatient Only Code
00176
Anesth pharyngeal surgery
HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2024
Transplant surgeries
0018M
Inpatient Only Code
00192
Anesth facial bone surgery
HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2024
Inpatient Only Code
00211
Anesth cran surg hemotoma
HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2024
Inpatient Only Code
00214
Anesth skull drainage
HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2024
Inpatient Only Code
00215
Anesth skull repair/fract
HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2024
Inpatient Only Code
00474
Anesth surgery of rib
HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2024
Inpatient Only Code
00524
Anesth chest drainage
HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2024
Inpatient Only Code
00540
Anesth chest surgery
HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2024
Inpatient Only Code
00542
Anesthesia removal pleura
HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2024
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Page last updated: Mar 20, 2024
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