Prior Authorization NOT Required

CPT/HCPCS Codes

Procedure Code

Description

15786

Abrasion; single lesion (e.g., keratosis, scar)

78700

Kidney imaging morphology;

81177

ATN1 (atrophin 1) (e.g., dentatorubral-pallidoluysian atrophy) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles

89050

Cell count, miscellaneous body fluids (e.g., cerebrospinal fluid, joint fluid), except blood;

97022

Application of a modality to 1 or more areas; whirlpool

97035

Application of a modality to 1 or more areas; ultrasound, each 15 minutes

97124

Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion)

97129

Therapeutic interventions that focus on cognitive function (e.g., attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g., managing time or sch

97139

Unlisted therapeutic procedure (specify)

98942

Chiropractic manipulative treatment (CMT); spinal, 5 regions

A4456

Adhesive remover, wipes, any type, each

A4550

Surgical trays

A4602

Replacement battery for external infusion pump owned by patient, lithium, 1.5 volt, each

A4928

Surgical mask, per 20

A6250

Skin sealants, protectants, moisturizers, ointments, any type, any size

A6457

Tubular dressing with or without elastic, any width, per linear yd

D0145

Oral evaluation for a patient under three years of age and counseling with primary caregiver

D1206

Topical fluoride varnish; therapeutic application for moderate to high caries risk patients

K0037

High mount flip-up footrest, each

L2397

Addition to lower extremity orthosis, suspension sleeve