_id Index Carrier Year Service category Request Code type Code Description of service Number of requests per code Approval rate Initially denied then approved - approval rate Expedited - Avg response time Standard - Avg response time Extenuating circumstances - Avg response time Expedited - Number of requests Standard - Number of requests Extenuating circumstances - Number of requests Drug name Drug brand names 1 1 Carrier A 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 9 0.89 25.04 240 NA NA 2 2 Carrier A 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0781 External Ambulatory Infus Pu 6 0 384 NA NA 3 3 Carrier A 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9279 Monitoring feature/deviceNOC 1 0 432 NA NA 4 4 Carrier A 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 9 0.89 25.04 NA NA 5 5 Carrier A 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0781 External Ambulatory Infus Pu 6 0 NA NA 6 6 Carrier A 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9279 Monitoring feature/deviceNOC 1 0 NA NA 7 7 Carrier B 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9276 DISPOSABLE SENSOR FOR CONTINUOUS GLUCOSE MONITOR SYSTEM 30 1 39.07 92.8 0.46 NA NA 8 8 Carrier B 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9274 EXTERNAL AMBULATORY INSULIN DELIVERY SYSTEM 13 1 0 92.34 0 NA NA 9 9 Carrier B 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9277 EXTERNAL TRANSMITTER CONTINUOUS GLUCOSE MONITOR 71 0.96 64.63 90.11 0.46 NA NA 10 10 Carrier B 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9278 EXTERNAL RECEIVER FOR CONTINUOUS GLUCOSE MONITOR SYSTEM 21 0.95 0 84.42 0 NA NA 11 11 Carrier B 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 EXTERNAL AMBULATORY INFUSION PUMP, INSULIN 13 0.92 0 114.75 0 NA NA 12 12 Carrier B 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0554 THERAPEUTIC CONTINUOUS GLUCOSE MONITOR RECEIVER/MONITOR 1 0 0 193.68 0 NA NA 13 13 Carrier B 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0553 CONTINUOUS GLUCOSE MONITOR SYSTEM SUPPLIES 1 0 0 193.68 0 NA NA 14 14 Carrier B 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9276 DISPOSABLE SENSOR FOR CONTINUOUS GLUCOSE MONITOR SYSTEM 30 1 39.07 92.8 0.46 NA NA 15 15 Carrier B 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9274 EXTERNAL AMBULATORY INSULIN DELIVERY SYSTEM 13 1 0 92.34 0 NA NA 16 16 Carrier B 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9277 EXTERNAL TRANSMITTER CONTINUOUS GLUCOSE MONITOR 71 0.96 64.63 90.11 0.46 NA NA 17 17 Carrier B 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9278 EXTERNAL RECEIVER FOR CONTINUOUS GLUCOSE MONITOR SYSTEM 21 0.95 0 84.42 0 NA NA 18 18 Carrier B 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 EXTERNAL AMBULATORY INFUSION PUMP, INSULIN 13 0.92 0 114.75 0 NA NA 19 19 Carrier B 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0554 THERAPEUTIC CONTINUOUS GLUCOSE MONITOR RECEIVER/MONITOR 1 0 0 193.68 0 NA NA 20 20 Carrier B 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0553 CONTINUOUS GLUCOSE MONITOR SYSTEM SUPPLIES 1 0 0 193.68 0 NA NA 21 21 Carrier C 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT 95249 GLUCOSE MONITORING 72 HRS, PT PROVIDED EQUIP, TRAINING AND RECORDING 11 1 188.2 NA NA 22 22 Carrier C 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A9277 TRANSMITTER; EXT INTERSTITIAL CONT GLU MON SYS 8 1 0.3 75.4 NA NA 23 23 Carrier C 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A4230 INFUS SET INSULIN PUMP NON NEEDLE 449 0.99 6.7 199.1 NA NA 24 24 Carrier C 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A9274 EXT AMB INSULIN DELIVERY 62 0.98 10.5 270.1 NA NA 25 25 Carrier C 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A4456 ADHESIVE REMOVER, WIPES, ANY TYPE, EACH 11 0.91 7.2 368.8 NA NA 26 26 Carrier C 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT 95250 GLUCOSE MONITORING 72 HRS MD OR OTH QUAL, EQUIP PROV, REC/STORAGE GL 29 0.86 16.1 429.4 NA NA 27 27 Carrier C 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A9276 SENSOR;INVSV DISP INTRSTL CONT GLU MON SYS 1U=1D 1041 0.85 14.7 371.7 NA NA 28 28 Carrier C 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT E0607 HOME BLOOD GLUCOSE MONITOR 10 0.8 7.3 193.9 NA NA 29 29 Carrier C 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT E0784 EXTERN AMBUL INSULIN INFUS PUMP 179 0.78 63.9 385.1 NA NA 30 30 Carrier C 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT K0553 SUPPLY ALLOWANCE FOR THERAPEUTIC CONTINUOUS GLUCOSE MONITOR (CGM), INCLUDES ALL SUPPLIES AND ACCESSORIES 21 0.67 34.3 956.6 NA NA 31 31 Carrier C 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95249 GLUCOSE MONITORING 72 HRS, PT PROVIDED EQUIP, TRAINING AND RECORDING 11 1 188.2 NA NA 32 32 Carrier C 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A9277 TRANSMITTER; EXT INTERSTITIAL CONT GLU MON SYS 8 1 0.3 75.4 NA NA 33 33 Carrier C 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A6460 SYNTHETIC DRSG <= 16 SQ I 2 1 0.1 NA NA 34 34 Carrier C 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4221 WEEKLY SUPPLIES DRUG INFUS CATH 2 1 382.5 NA NA 35 35 Carrier C 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4245 ALCOHOL WIPES PER BOX 1 1 0.2 NA NA 36 36 Carrier C 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A6461 SYNTHETIC DRSG >16<=48 SQ 1 1 0.1 NA NA 37 37 Carrier C 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A9278 RECEIVER MON; EXT INTERSTITIAL CONT GLU MON SYS 1 1 1.5 NA NA 38 38 Carrier C 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4340 INDWELLING CATH SPECIAL 1 1 0.1 NA NA 39 39 Carrier C 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A5120 SKIN BARRIER, WIPE OR SWA 1 1 191.6 NA NA 40 40 Carrier C 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4352 COUDE TIP URINARY CATH 1 1 4.4 NA NA 41 41 Carrier C 2020 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0781 INFUS PUMP AMBULATORY 1 0 1 1013 NA NA 42 42 Carrier C 2020 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0784 EXTERN AMBUL INSULIN INFUS PUMP 179 0 0.02 63.9 385.1 NA NA 43 43 Carrier C 2020 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A9276 SENSOR;INVSV DISP INTRSTL CONT GLU MON SYS 1U=1D 1041 0 0.01 14.7 371.7 NA NA 44 44 Carrier D 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A4230 INFUS INSULIN PUMP NON NE 74 1 6.2 197.2 NA NA 45 45 Carrier D 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A9274 EXT AMB INSULIN DELIVERY 17 1 9.8 517.4 NA NA 46 46 Carrier D 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A9277 TRANSMITTER; EXT INTERSTITIAL CONT GLU MON SYS 7 1 42.7 594.1 NA NA 47 47 Carrier D 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT K0553 SUPPLY ALLOWANCE FOR THERAPEUTIC CONTINUOUS GLUCOSE MONITOR (CGM), INCLUDES ALL SUPPLIES AND ACCESSORIES 19 0.79 19.9 2064.6 NA NA 48 48 Carrier D 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A9276 SENSOR;INVSV DISP INTRSTL CONT GLU MON SYS 1U=1D 469 0.75 13.1 554.1 NA NA 49 49 Carrier D 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT E0784 EXTERN AMBUL INSULIN INFUS PUMP 86 0.69 33.7 474.1 NA NA 50 50 Carrier D 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A4456 ADHESIVE REMOVER, WIPES, ANY TYPE, EACH 3 0.67 199.1 NA NA 51 51 Carrier D 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT Q4186 EPIFIX, PER SQ CM 4 0.5 60.1 258.8 NA NA 52 52 Carrier D 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A4253 BLOOD GLUCOSE/REAGENT STR 2 0.5 1.2 NA NA 53 53 Carrier D 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A6209 FOAM DRSG <=16 SQ IN W/O 2 0 1.2 NA NA 54 54 Carrier D 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4230 INFUS INSULIN PUMP NON NE 74 1 6.2 197.2 NA NA 55 55 Carrier D 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A9274 EXT AMB INSULIN DELIVERY 17 1 9.8 517.4 NA NA 56 56 Carrier D 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A9277 TRANSMITTER; EXT INTERSTITIAL CONT GLU MON SYS 7 1 42.7 594.1 NA NA 57 57 Carrier D 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT Q4110 PRIMATRIX PER SQ CM 1 1 3.3 NA NA 58 58 Carrier D 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT K0553 SUPPLY ALLOWANCE FOR THERAPEUTIC CONTINUOUS GLUCOSE MONITOR (CGM), INCLUDES ALL SUPPLIES AND ACCESSORIES 19 0.79 19.9 2064.6 NA NA 59 59 Carrier D 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A9276 SENSOR;INVSV DISP INTRSTL CONT GLU MON SYS 1U=1D 469 0.75 13.1 554.1 NA NA 60 60 Carrier D 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0784 EXTERN AMBUL INSULIN INFUS PUMP 86 0.69 33.7 474.1 NA NA 61 61 Carrier D 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4456 ADHESIVE REMOVER, WIPES, ANY TYPE, EACH 3 0.67 199.1 NA NA 62 62 Carrier D 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT Q4186 EPIFIX, PER SQ CM 4 0.5 60.1 258.8 NA NA 63 63 Carrier D 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4253 BLOOD GLUCOSE/REAGENT STR 2 0.5 1.2 NA NA 64 64 Carrier D 2020 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0781 EXTERNAL AMBULATORY INFUS 2 0 0.5 26.2 1429.8 NA NA 65 65 Carrier D 2020 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A9276 SENSOR;INVSV DISP INTRSTL CONT GLU MON SYS 1U=1D 469 0 0.01 13.1 554.1 0 NA NA 66 66 Carrier D 2020 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0784 EXTERN AMBUL INSULIN INFUS PUMP 86 0 0.01 33.7 474.1 0 NA NA 67 67 Carrier E 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0553 SUPPLY ALLOW FOR TX CGM1 MO SPL = 1 U OF SERVICE 49 1 18.8 NA NA 68 68 Carrier E 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4230 INFUS INSULIN PUMP NON NEEDL 48 1 3.4 22.6 NA NA 69 69 Carrier E 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4232 SYRINGE W/NEEDLE INSULIN 3CC 28 1 16.4 NA NA 70 70 Carrier E 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9276 SENSOR;INVSV DISP INTRSTL CONT GLU MON SYS 1U=1D 4 1 5.2 NA NA 71 71 Carrier E 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A6257 TRANSPARENT FILM STERL 16 SQ IN OR LESS EA DRESS 3 1 11.2 NA NA 72 72 Carrier E 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0554 RECEIVER DEDICATED FOR USE W/THERAPEUTIC GCM SYS 132 0.9 33.9 NA NA 73 73 Carrier E 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 EXT AMB INFUSN PUMP INSULIN 22 0.86 41.1 NA NA 74 74 Carrier E 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT 95250 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor 32 0.38 NA NA 75 75 Carrier E 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A5120 SKIN BARRIER WIPES OR SWABS EACH 3 0.33 65 NA NA 76 76 Carrier E 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0553 SUPPLY ALLOW FOR TX CGM1 MO SPL = 1 U OF SERVICE 49 1 18.8 NA NA 77 77 Carrier E 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4230 INFUS INSULIN PUMP NON NEEDL 48 1 3.4 22.6 NA NA 78 78 Carrier E 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4232 SYRINGE W/NEEDLE INSULIN 3CC 28 1 16.4 NA NA 79 79 Carrier E 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9276 SENSOR;INVSV DISP INTRSTL CONT GLU MON SYS 1U=1D 4 1 5.2 NA NA 80 80 Carrier E 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A6257 TRANSPARENT FILM STERL 16 SQ IN OR LESS EA DRESS 3 1 11.2 NA NA 81 81 Carrier E 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0554 RECEIVER DEDICATED FOR USE W/THERAPEUTIC GCM SYS 132 0.9 33.9 NA NA 82 82 Carrier E 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 EXT AMB INFUSN PUMP INSULIN 22 0.86 41.1 NA NA 83 83 Carrier E 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95250 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor 32 0.38 NA NA 84 84 Carrier E 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A5120 SKIN BARRIER WIPES OR SWABS EACH 3 0.33 65 NA NA 85 85 Carrier F 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year NA NA test strips 14 0.84 6.57 45.22 NA NA 86 86 Carrier F 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA test strips 14 0.84 6.57 45.22 NA NA 87 87 Carrier F 2020 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NA NA test strips 14 0 0 6.57 45.22 NA NA 88 88 Carrier G 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT E0784 EXTERNAL AMBULATORY INFUSION PUMP INSULIN 13 1 14.8 99.5 NA NA 89 89 Carrier G 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT Q4186 EPIFIX PER SQ CM 1 1 24 NA NA 90 90 Carrier G 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A4230 INFUS SET EXT INSULIN PUMP NONNDLE CANNULA TYPE 10 0.8 13.2 31.7 NA NA 91 91 Carrier G 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A9276 SENSOR;INVSV DISP INTRSTL CONT GLU MON SYS 1U Equal to 1D 29 0.79 7.9 37.9 NA NA 92 92 Carrier G 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A4232 SYRINGE W/NDLE EXTERNAL INSULIN PUMP STERILE 3CC 9 0.78 38.5 NA NA 93 93 Carrier G 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A9277 TRANSMITTER; EXT INTERSTITIAL CONT GLU MON SYS 13 0.77 12.2 22 NA NA 94 94 Carrier G 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT K0553 SUPPLY ALLOW FOR TX CGM1 MO SPL Equal to 1 U OF SERVICE 3 0.67 NA NA 95 95 Carrier G 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A4253 BLD GLU TEST/REAGT STRIPS HOME BLD GLU MON-50 2 0.5 NA NA 96 96 Carrier G 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A5500 DIAB ONLY FIT CSTM PREP AND SPL SHOE MX DNSITY INSRT 1 0 46.5 NA NA 97 97 Carrier G 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT 99499 UNLISTED EVALUATION AND MANAGEMENT SERVICE 1 0 69.1 NA NA 98 98 Carrier G 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0784 EXTERNAL AMBULATORY INFUSION PUMP INSULIN 13 1 14.8 95.5 NA NA 99 99 Carrier G 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A9274 EXTERNAL AMB INSULIN DEL SYSTEM DISPOSABLE EA 1 1 56.9 NA NA 100 100 Carrier G 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A5514 DIAB ONLY MX DEN INSRT DIRECT CARV CUSTOM FAB EA 1 1 76.5 NA NA 101 101 Carrier G 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT Q4186 EPIFIX PER SQ CM 1 1 24 NA NA 102 102 Carrier G 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95249 CONT GLUC MONITORING PATIENT PROVIDED EQUIPTMENT 1 1 18.5 NA NA 103 103 Carrier G 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4230 INFUS SET EXT INSULIN PUMP NONNDLE CANNULA TYPE 10 0.8 14.8 35.4 NA NA 104 104 Carrier G 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A9276 SENSOR;INVSV DISP INTRSTL CONT GLU MON SYS 1U Equal to 1D 29 0.79 8.5 29.2 NA NA 105 105 Carrier G 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4232 SYRINGE W/NDLE EXTERNAL INSULIN PUMP STERILE 3CC 9 0.78 14.8 38.5 NA NA 106 106 Carrier G 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A9277 TRANSMITTER; EXT INTERSTITIAL CONT GLU MON SYS 13 0.77 12.2 22 NA NA 107 107 Carrier G 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT K0553 SUPPLY ALLOW FOR TX CGM1 MO SPL Equal to 1 U OF SERVICE 3 0.67 1.7 213.8 NA NA 108 108 Carrier G 2020 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A4232 SYRINGE W/NDLE EXTERNAL INSULIN PUMP STERILE 3CC 9 0 0.11 14.8 38.5 NA NA 109 109 Carrier G 2020 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A4230 INFUS SET EXT INSULIN PUMP NONNDLE CANNULA TYPE 10 0 0.1 14.8 35.4 NA NA 110 110 Carrier G 2020 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A9277 TRANSMITTER; EXT INTERSTITIAL CONT GLU MON SYS 13 0 0.08 12.2 22 NA NA 111 111 Carrier G 2020 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0784 EXTERNAL AMBULATORY INFUSION PUMP INSULIN 13 0 0.08 14.8 95.5 NA NA 112 112 Carrier G 2020 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A9276 SENSOR;INVSV DISP INTRSTL CONT GLU MON SYS 1U Equal to 1D 29 0 0.03 8.5 29.2 NA NA 113 113 Carrier H 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year NA NA test strips 218 0.84 6.51 8.17 NA NA 114 114 Carrier H 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA test strips 218 0.84 6.51 8.17 NA NA 115 115 Carrier H 2020 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NA NA test strips 218 0 0 6.5 8.17 NA NA 116 116 Carrier I 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 8 1 20.44 360 NA NA 117 117 Carrier I 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 8 1 20.44 0.2 NA NA 118 118 Carrier J 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 95 0.99 49.14 NA NA 119 119 Carrier J 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0781 External Ambulatory Infus Pu 1 0 NA NA 120 120 Carrier J 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9276 Disposable sensor, CGM sys 1 0 125.98 NA NA 121 121 Carrier J 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9277 External transmitter, CGM 1 0 125.98 NA NA 122 122 Carrier J 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 95 0.99 49.14 NA NA 123 123 Carrier J 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0781 External Ambulatory Infus Pu 1 0 11.1 NA NA 124 124 Carrier J 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9276 Disposable sensor, CGM sys 1 0 125.98 28.7 NA NA 125 125 Carrier J 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9277 External transmitter, CGM 1 0 125.98 NA NA 126 126 Carrier K 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT E0784 EXTERNAL AMBULATORY INFUSION PUMP INSULIN 3 1 15.6 57.55 NA NA 127 127 Carrier K 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0784 EXTERNAL AMBULATORY INFUSION PUMP INSULIN 3 1 15.6 57.55 NA NA 128 128 Carrier K 2020 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0784 EXTERNAL AMBULATORY INFUSION PUMP INSULIN 3 0 1 15.6 57.55 NA NA 129 129 Carrier L 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT E0784 EXTERNAL AMBULATORY INFUSION PUMP INSULIN 7 1 16.6 40.26 NA NA 130 130 Carrier L 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A9274 EXTERNAL AMB INSULIN DEL SYSTEM DISPOSABLE EA 3 1 47.4 NA NA 131 131 Carrier L 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT E0607 HOME BLOOD GLUCOSE MONITOR 1 1 95.5 NA NA 132 132 Carrier L 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A9276 SENSOR;INVSV DISP INTRSTL CONT GLU MON SYS 1U=1D 3 0.67 71.31 NA NA 133 133 Carrier L 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A9277 TRANSMITTER; EXT INTERSTITIAL CONT GLU MON SYS 3 0.67 71.31 NA NA 134 134 Carrier L 2020 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A9278 RECEIVER MON; EXT INTERSTITIAL CONT GLU MON SYS 3 0.67 71.31 NA NA 135 135 Carrier L 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0784 EXTERNAL AMBULATORY INFUSION PUMP INSULIN 7 1 16.6 40.26 NA NA 136 136 Carrier L 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A9274 EXTERNAL AMB INSULIN DEL SYSTEM DISPOSABLE EA 3 1 47.4 NA NA 137 137 Carrier L 2020 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0607 HOME BLOOD GLUCOSE MONITOR 1 1 95.5 NA NA 138 138 Carrier M 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5301 BELOW KNEE, MOLDED SOCKET, SHIN, SACH FOOT, ENDOSKELETAL SYSTEM 2 1 0 36 NA NA 139 139 Carrier M 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5620 S/A L5618,BELOW KNEE 2 1 0 36 NA NA 140 140 Carrier M 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5637 ADDITION TO LOWER EXTREMITY, BELOW KNEE, TOTAL CONTACT 2 1 0 36 NA NA 141 141 Carrier M 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5671 ADDITION TO LOWER EXTREMITY, BELOW KNEE / ABOVE KNEE SUSPENSION LOCKING 2 1 0 36 NA NA 142 142 Carrier M 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5673 ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED FROM EXISTING MOLD OR PREFABRICATED, SOCKET INSERT, SILICONE GEL, ELASTOMERIC OR EQUAL, FOR USE WITH LOCKING MECHANISM 2 1 0 36 NA NA 143 143 Carrier M 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5910 ADDITION, ENDOSKELETAL SYSTEM, BELOW KNEE, ALIGNABLE SYSTEM 2 1 0 36 NA NA 144 144 Carrier M 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5940 (TITANIUM, CARBON FIBER OR EQUAL) ADDITION, ENDOSKELETAL SYSTEM, BELOW KNEE, ULTRA-LIGHT MATERIAL 2 1 0 36 NA NA 145 145 Carrier M 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5986 "EQUAL) ALL LOWER EXTREMITY PROSTHESES, MULTI-AXIAL ROTATION UNIT (""MCP"" OR" 2 1 0 36 NA NA 146 146 Carrier M 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1007 WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, COMBINATION TILT AND RECLINE, WITH MECHANICAL SHEAR REDUCTION 2 0.5 12 36 NA NA 147 147 Carrier M 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2311 POWER WHEELCHAIR ACCESSORY, ELECTRONIC CONNECTION BETWEEN WHEELCHAIR CONTROLLER AND TWO OR MORE POWER SEATING SYSTEM MOTORS, INCLUDING ALL RELATED ELECTRONICS, INDICATOR FEATURE, MECHANICAL FUNCTION SELECTION SWITCH, AND FIXEDMOUNTING HARDWARE 2 0.5 12 36 NA NA 148 148 Carrier M 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5301 BELOW KNEE, MOLDED SOCKET, SHIN, SACH FOOT, ENDOSKELETAL SYSTEM 2 1 36 NA NA 149 149 Carrier M 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5620 S/A L5618,BELOW KNEE 2 1 36 NA NA 150 150 Carrier M 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5637 ADDITION TO LOWER EXTREMITY, BELOW KNEE, TOTAL CONTACT 2 1 36 NA NA 151 151 Carrier M 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5671 ADDITION TO LOWER EXTREMITY, BELOW KNEE / ABOVE KNEE SUSPENSION LOCKING 2 1 36 NA NA 152 152 Carrier M 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5673 ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED FROM EXISTING MOLD OR PREFABRICATED, SOCKET INSERT, SILICONE GEL, ELASTOMERIC OR EQUAL, FOR USE WITH LOCKING MECHANISM 2 1 36 NA NA 153 153 Carrier M 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5910 ADDITION, ENDOSKELETAL SYSTEM, BELOW KNEE, ALIGNABLE SYSTEM 2 1 36 NA NA 154 154 Carrier M 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5940 (TITANIUM, CARBON FIBER OR EQUAL) ADDITION, ENDOSKELETAL SYSTEM, BELOW KNEE, ULTRA-LIGHT MATERIAL 2 1 36 NA NA 155 155 Carrier M 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5986 "EQUAL) ALL LOWER EXTREMITY PROSTHESES, MULTI-AXIAL ROTATION UNIT (""MCP"" OR" 2 1 36 NA NA 156 156 Carrier M 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5987 ALL LOWER EXTREMITY PROSTHESIS, SHANK FOOT SYSTEM WITH VERTICAL LOADING PYLON. 2 1 36 NA NA 157 157 Carrier M 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8420 PROSTHETIC SOCK, MULTIPLE PLY, BELOW KNEE, EACH 2 1 36 NA NA 158 158 Carrier A 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0466 HOME VENT NON-INVASIVE INTER 1 1 19.4 NA NA 159 159 Carrier A 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2599 Accessory for speech generating device, not otherwise classified 1 1 45.8 NA NA 160 160 Carrier A 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 Cont Airway Pressure Device 226 0.95 2.3 NA NA 161 161 Carrier A 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without backup rate 10 0.8 17.4 496 NA NA 162 162 Carrier A 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate 5 0.8 5.4 NA NA 163 163 Carrier A 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0748 Elec Osteogen Stim Spinal 9 0.56 51.9 NA NA 164 164 Carrier A 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0747 Elec Osteogen Stim Not Spine 2 0.5 121.5 NA NA 165 165 Carrier A 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1399 Durable Medical Equipment Mi 10 0.2 107.3 NA NA 166 166 Carrier A 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0637 Combination sit to stand system, any size, with seat lift feature, with or without wheels 2 0 112.7 NA NA 167 167 Carrier A 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1233 Wheelchair, Pediatric Size, Tilt-In-Space, Rigid, Adj, Wo Seating 1 0 81.1 NA NA 168 168 Carrier A 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0240 Bath/shower chair, with or without wheels, any size 1 0 NA NA 169 169 Carrier A 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2213 Pneumatic prop tire insert 1 0 81.1 NA NA 170 170 Carrier A 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0973 Wheelchair Adjustabl Height 1 0 81.1 NA NA 171 171 Carrier A 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0978 Wheelchair Belt W/Airplane B 1 0 NA NA 172 172 Carrier A 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1028 Wheelchair accessory, manual swingaway, retractable or removable mounting hardware 1 0 NA NA 173 173 Carrier A 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2231 Solid seat support base 1 0 81.1 NA NA 174 174 Carrier A 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0445 Oximeter Device For Measuring Blood Oxygen Levels Non-Invasively 1 0 NA NA 175 175 Carrier A 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0562 Humidifier, heated, used with positive airway pressure device 1 0 NA NA 176 176 Carrier A 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2221 Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each 1 0 81.1 NA NA 177 177 Carrier A 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2613 Position back cush wd <22in 1 0 81.1 NA NA 178 178 Carrier A 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2607 Skin pro/pos wc cus wd <22in 1 0 NA NA 179 179 Carrier A 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0950 Tray 1 0 81.1 NA NA 180 180 Carrier A 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E8001 Upright gait trainer 1 0 NA NA 181 181 Carrier A 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0956 Wheelchair accessory, lateral trunk or hip support, prefabricated, including fixed mounting hardware, each 1 0 NA NA 182 182 Carrier A 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0957 Wheelchair accessory, medial thigh support, prefabricated, including fixed mounting hardware, each 1 0 NA NA 183 183 Carrier A 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2599 Accessory for speech generating device, not otherwise classified 1 1 45.8 NA NA 184 184 Carrier A 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0466 HOME VENT NON-INVASIVE INTER 1 1 19.4 NA NA 185 185 Carrier A 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0601 Cont Airway Pressure Device 226 0.95 2.3 NA NA 186 186 Carrier A 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without backup rate 10 0.8 17.4 NA NA 187 187 Carrier A 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate 5 0.8 5.4 NA NA 188 188 Carrier A 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0748 Elec Osteogen Stim Spinal 9 0.56 51.9 NA NA 189 189 Carrier A 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0747 Elec Osteogen Stim Not Spine 2 0.5 121.5 NA NA 190 190 Carrier A 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1399 Durable Medical Equipment Mi 10 0.2 107.3 NA NA 191 191 Carrier A 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0637 Combination sit to stand system, any size, with seat lift feature, with or without wheels 2 0 112.7 NA NA 192 192 Carrier A 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1028 Wheelchair accessory, manual swingaway, retractable or removable mounting hardware 1 0 NA NA 193 193 Carrier A 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2221 Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each 1 0 81.1 NA NA 194 194 Carrier A 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0973 Wheelchair Adjustabl Height 1 0 81.1 NA NA 195 195 Carrier A 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0978 Wheelchair Belt W/Airplane B 1 0 NA NA 196 196 Carrier A 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2231 Solid seat support base 1 0 81.1 NA NA 197 197 Carrier A 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1233 Wheelchair, Pediatric Size, Tilt-In-Space, Rigid, Adj, Wo Seating 1 0 81.1 NA NA 198 198 Carrier A 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0562 Humidifier, heated, used with positive airway pressure device 1 0 NA NA 199 199 Carrier A 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2213 Pneumatic prop tire insert 1 0 81.1 NA NA 200 200 Carrier A 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2613 Position back cush wd <22in 1 0 81.1 NA NA 201 201 Carrier A 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0445 Oximeter Device For Measuring Blood Oxygen Levels Non-Invasively 1 0 NA NA 202 202 Carrier A 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0240 Bath/shower chair, with or without wheels, any size 1 0 NA NA 203 203 Carrier A 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2607 Skin pro/pos wc cus wd <22in 1 0 NA NA 204 204 Carrier A 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0950 Tray 1 0 81.1 NA NA 205 205 Carrier A 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E8001 Upright gait trainer 1 0 NA NA 206 206 Carrier A 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0956 Wheelchair accessory, lateral trunk or hip support, prefabricated, including fixed mounting hardware, each 1 0 NA NA 207 207 Carrier A 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0957 Wheelchair accessory, medial thigh support, prefabricated, including fixed mounting hardware, each 1 0 NA NA 208 208 Carrier N 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0766 ELEC STIM CANCER TREATMENT 2 1 96 NA NA 209 209 Carrier N 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0760 OSTEOGEN ULTRASOUND STIMLTOR 2 1 24 NA NA 210 210 Carrier N 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E1002 PWR SEAT TILT 1 1 72 NA NA 211 211 Carrier N 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0748 ELEC OSTEOGEN STIM SPINAL 1 1 48 NA NA 212 212 Carrier N 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT K0856 PWC GP3 STD SING POW OPT S/B 1 1 72 NA NA 213 213 Carrier N 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L8614 COCHLEAR DEVICE 1 1 48 NA NA 214 214 Carrier N 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0747 ELEC OSTEOGEN STIM NOT SPINE 1 0 48 NA NA 215 215 Carrier N 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E2300 PWR SEAT ELEVATION SYS 1 0 72 NA NA 216 216 Carrier N 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L8699 PROSTHETIC IMPLANT NOS 1 0 72 NA NA 217 217 Carrier N 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0766 ELEC STIM CANCER TREATMENT 2 1 96 NA NA 218 218 Carrier N 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0760 OSTEOGEN ULTRASOUND STIMLTOR 2 1 24 NA NA 219 219 Carrier N 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E1002 PWR SEAT TILT 1 1 72 NA NA 220 220 Carrier N 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0748 ELEC OSTEOGEN STIM SPINAL 1 1 48 NA NA 221 221 Carrier N 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT K0856 PWC GP3 STD SING POW OPT S/B 1 1 72 NA NA 222 222 Carrier N 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L8614 COCHLEAR DEVICE 1 1 48 NA NA 223 223 Carrier N 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0747 ELEC OSTEOGEN STIM NOT SPINE 1 0 48 NA NA 224 224 Carrier N 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E2300 PWR SEAT ELEVATION SYS 1 0 72 NA NA 225 225 Carrier N 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L8699 PROSTHETIC IMPLANT NOS 1 0 72 NA NA 226 226 Carrier B 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC B9004 PARENTERAL NUTRITION INFUSION PUMP PORTABLE 14 1 0 218.62 0 NA NA 227 227 Carrier B 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC B9002 ENTERAL NUTRITION INFUSION PUMP WITH ALARM 12 1 26.15 84.31 0 NA NA 228 228 Carrier B 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE 514 0.95 28.76 129.91 0 NA NA 229 229 Carrier B 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0471 RESPIRATORY DEVICE/BI-LEVEL PRESSURE CAPABILITY WITH BACKUP RATE FEATURE WITH NONINVASIVE INTERFACE 20 0.95 35.48 111.49 0 NA NA 230 230 Carrier B 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1390 OXYGEN CONCENTRATOR/1 DELIVERY PORTABLE/CAPABLE OF DELIVERNG 85% OR>OXYGEN CONCENTRATION 154 0.94 24.31 191.52 0 NA NA 231 231 Carrier B 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0781 AMBULATORY INFUSION PUMP SINGLE OR MULTIPLE CHANNELS WORN BY PATIENT 96 0.93 54.37 125.18 0 NA NA 232 232 Carrier B 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0466 HOME VENTILATOR TYPE USED NON-INVASIVE INTERFACE 14 0.93 21.4 108.13 0 NA NA 233 233 Carrier B 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2402 NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR PORTABLE 31 0.87 0 165.58 0 NA NA 234 234 Carrier B 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0470 RESPIRATORY DEVICE/BI-LEVEL PRESSURE CAPABILITY WITHOUT BACKUP RATE FEATURE WITH NONINVASIVE INTERFACE 21 0.81 0 129.03 0 NA NA 235 235 Carrier B 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0935 PASSIVE MOTION EXERCISE DEVICE 10 0.8 66.32 144.16 0 NA NA 236 236 Carrier B 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC B9004 PARENTERAL NUTRITION INFUSION PUMP PORTABLE 14 1 0 218.62 0 NA NA 237 237 Carrier B 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC B9002 ENTERAL NUTRITION INFUSION PUMP WITH ALARM 12 1 26.15 84.31 0 NA NA 238 238 Carrier B 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0791 PARENTERAL INFUSION PUMP STATIONARY SINGLE OR MULTICHANNEL 7 1 0 169.11 0 NA NA 239 239 Carrier B 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0739 REPAIR OR NONROUTINE SERVICE ON DURABLE MEDICAL EQUIPMENT OTHER THAN OXYGEN EQUIPMENT 5 1 0 44.18 0 NA NA 240 240 Carrier B 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0260 HOSPITAL BED SEMI-ELECTRIC WITH ANY RAILS WITH MATTRESS 5 1 0 228.24 0 NA NA 241 241 Carrier B 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0760 OSTEOGENESIS STIMULATOR-LOW INTENSITY ULTRASOUND NON-INVASIVE 4 1 0 136.65 0 NA NA 242 242 Carrier B 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0483 HIGH FREQUENCY CHEST WALL OSCILLATION SYSTEM, INCLUDES ALL ACCESSORIES AND SUPPLIES 4 1 0 211.55 0 NA NA 243 243 Carrier B 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0003 LIGHTWEIGHT WHEELCHAIR 4 1 28.06 78.01 0 NA NA 244 244 Carrier B 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0565 COMPRESSOR AIR POWER SOURCE EQUIPMENT 3 1 29.03 119.6 0 NA NA 245 245 Carrier B 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0108 OTHER ACCESSORY 3 1 0 78.23 0 NA NA 246 246 Carrier C 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT A7034 NASAL APPLICATION DEVICE 4096 1 1.78 50.04 NA NA 247 247 Carrier C 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0603 DME ELECTRIC BREAST PUMP KIT PURCHASE 1263 1 3.28 13.36 NA NA 248 248 Carrier C 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0118 CRUTCH SUBSTITUTE, LOWER LEG PLATFORM, WITH OR WITHOUT WHEELS, EACH 451 0.99 5.48 288.24 0 NA NA 249 249 Carrier C 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0143 WALKER, FOLDING, WHEELED, ADJUSTABLE OR FIXED HEIGHT 545 0.98 8.52 153.8 NA NA 250 250 Carrier C 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L4361 PNEUMATIC, WALKING BOOT 517 0.98 5.24 105.74 NA NA 251 251 Carrier C 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT A7030 CPAP FULL FACE MASK 516 0.98 0.84 28.42 NA NA 252 252 Carrier C 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0114 CRUTCHES METAL UNDERARM PAIR 475 0.98 1.83 125.98 NA NA 253 253 Carrier C 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0439 STATIONARY LIQUID 02 462 0.98 3.84 116.45 NA NA 254 254 Carrier C 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0604 DME ELECTRIC BREAST PUMP KIT RENTAL 1280 0.93 14.68 164.9 NA NA 255 255 Carrier C 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0601 CPAP DEVICE 3186 0.91 4.53 162.26 NA NA 256 256 Carrier C 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A7031 REPLACEMENT FACEMASK INTERFA 416 1 22.75 816.21 NA NA 257 257 Carrier C 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A7027 COMB ORAL/NASAL MASK USED W/CPAP DEVICE EA 365 1 6.86 596.81 NA NA 258 258 Carrier C 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 94762 NONINVASIVE EAR/PULSE OXIM O2 SAT CONT OVERNIGHT 79 1 12.3 142.81 NA NA 259 259 Carrier C 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A7032 CUSHN NASAL MASK INTERFACE REPLACEMENT ONLY EACH 76 1 52.87 NA NA 260 260 Carrier C 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0445 OXIMETER DEVICE FOR MEASURING BLOOD OXYGEN LEVELS, NON INVASIVE 64 1 3.56 76.61 NA NA 261 261 Carrier C 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT S9497 HIT ANTIBIOTIC Q3H DIEM 56 1 6.94 91.48 NA NA 262 262 Carrier C 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L1846 KO W ADJ FLEX/EXT ROTAT MOLD 51 1 1.34 84.28 NA NA 263 263 Carrier C 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4361 OSTOMY FACE PLATE 48 1 29.1 7.62 NA NA 264 264 Carrier C 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0849 TRACTION EQUIP,CERVICAL,FREE STAND,TRACTION FORCE OTHER THAN MANDIBLE 47 1 1.24 60.58 NA NA 265 265 Carrier C 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0100 CANES OF ANY MATERIAL 46 1 0.98 267.66 NA NA 266 266 Carrier C 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0483 HIGH FREQ CHEST WALL OCSILLATION SYSTEM, INCL ALL ACCESSORIES/SUPPLIES, EA 7 0 0.29 227.38 0 NA NA 267 267 Carrier C 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L5701 REPLACE SOCKET AB KNEE/KNEE 6 0 0.17 598.09 NA NA 268 268 Carrier C 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E2510 SPEECH GENERATING DEVICE, SYNTHESIZED SPEECH 8 0 0.13 759.75 0 NA NA 269 269 Carrier C 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L5301 BK MOLD SOCKET SACH FT ENDO 17 0 0.06 733.66 NA NA 270 270 Carrier C 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT B4150 ENTERAL FORMULAE CATEGORY I 39 0 0.05 31.66 641.68 NA NA 271 271 Carrier C 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0691 UV LIGHT THERAPY SYS, INCL BULBS/LAMPS/TIMER/EYE PROT; TX AREA 2 SQ FT OR < 26 0 0.04 35.97 234.88 NA NA 272 272 Carrier C 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L1970 AFO PLASTIC MOLDED W/ANKLE J 47 0 0.02 1.29 242.97 NA NA 273 273 Carrier C 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A6549 GRADIENT COMPRESSION STOCKING/SLEEVE NOS 122 0 0.01 16.43 503.16 NA NA 274 274 Carrier C 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0485 ORAL DEVICE/APPLIANCE PRE 73 0 0.01 3.95 411.01 0 NA NA 275 275 Carrier C 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E2402 NEGATIVE PRESSURE WOUND THERAPY ELECT PUMP, STATIONARY OR PORTABLE 263 0 0 29.09 396.45 NA NA 276 276 Carrier D 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT A7034 NASAL APPLICATION DEVICE 1033 1 1.8 128.7 NA NA 277 277 Carrier D 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0603 ELECTRIC BREAST PUMP 452 1 3.6 14.6 NA NA 278 278 Carrier D 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT A7031 REPLACEMENT FACEMASK INTERFA 194 1 11.1 732.6 NA NA 279 279 Carrier D 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L3660 SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND 147 1 172.1 NA NA 280 280 Carrier D 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT A7027 COMB ORAL/NASAL MASK USED W/CPAP DEVICE EA 143 1 7.1 427.1 NA NA 281 281 Carrier D 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0439 STATIONARY LIQUID 02 155 0.99 4.7 179.8 NA NA 282 282 Carrier D 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT A7030 CPAP FULL FACE MASK 138 0.99 2.2 238.2 NA NA 283 283 Carrier D 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0143 WALKER FOLDING WHEELED W/ 136 0.99 24.2 423.6 NA NA 284 284 Carrier D 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0601 CPAP DEVICE 1318 0.95 3.8 126.4 NA NA 285 285 Carrier D 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0604 HOSP GRADE ELEC BREAST PU 435 0.89 4.9 168.1 NA NA 286 286 Carrier D 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A7031 REPLACEMENT FACEMASK INTERFA 194 1 11.1 732.6 NA NA 287 287 Carrier D 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L3660 SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND 147 1 172.1 NA NA 288 288 Carrier D 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A7027 COMB ORAL/NASAL MASK USED W/CPAP DEVICE EA 143 1 7.1 427.1 NA NA 289 289 Carrier D 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L3260 POST-OP SHOE CANVAS 56 1 84.2 NA NA 290 290 Carrier D 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L3809 WRIST THUMB SPICA 55 1 303.9 NA NA 291 291 Carrier D 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT S9500 HIT ANTIBIOTIC Q24H DIEM 44 1 4.1 115 NA NA 292 292 Carrier D 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L3670 SHLDER IMMOB W/ABDUCTION PILLOW 42 1 274.6 NA NA 293 293 Carrier D 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L4205 ORTHO DVC REPAIR PER 15 M 35 1 1.9 232.1 NA NA 294 294 Carrier D 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT S9379 HIT NOC PER DIEM 31 1 6.3 91.4 NA NA 295 295 Carrier D 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E1390 OXYGEN CONCENTRATOR 25 1 6.2 861.5 NA NA 296 296 Carrier D 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0986 MAN W/C PUSH-RIM POWR SYS 1 0 1 256.9 0 NA NA 297 297 Carrier D 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E2622 ADJ SKIN PRO W/C CUS WD<2 2 0 0.5 388.4 0 NA NA 298 298 Carrier D 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT B4161 ENTERAL FORM,PEDS, HYDROLYZED/AMINO ACID/PEPTIDE CHAIN PROT,100 CAL=1 UN 13 0 0.15 486.1 0 NA NA 299 299 Carrier D 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A6533 GRADIENT COMPRESSION STK THIGH LEN 18-30 MMHG EA 8 0 0.13 528.6 0 NA NA 300 300 Carrier D 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0652 PNEUMATIC COMPRESS SEGMNT W GRAD 11 0 0.09 417.2 0 NA NA 301 301 Carrier D 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0766 ELECT STIMULATION DEV USED FOR CANCER TX, INCL ALL ACCESS, ANY TYPE 14 0 0.07 551.3 0 NA NA 302 302 Carrier D 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT K0739 REPAIR OR NONROUTN SVC DME OTHER THAN O2 EQUIP,REQ TECH SKILL,PER 15 MINS 41 0 0.02 13.4 569.5 0 NA NA 303 303 Carrier D 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E2402 NEGATIVE PRESSURE WOUND THERAPY ELECT PUMP, STATIONARY OR PORTABLE 93 0 0.01 32.8 1022.2 0 NA NA 304 304 Carrier D 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0601 CPAP DEVICE 1318 0 0 3.8 126.4 0 NA NA 305 305 Carrier E 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0143 WALKER FOLDING WHEELED W/O S 154 1 1.5 28.8 NA NA 306 306 Carrier E 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0570 NEBULIZER WITH COMPRESSOR 96 1 9.3 12.6 216 NA NA 307 307 Carrier E 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0202 PHOTOTHERAPY LIGHT W/ PHOTOM 28 1 4.8 24.6 NA NA 308 308 Carrier E 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L1970 AFO PLASTIC MOLDED W/ANKLE J 25 1 30.8 NA NA 309 309 Carrier E 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1390 OXYGEN CONCENTRATOR 79 0.99 4.3 22.6 NA NA 310 310 Carrier E 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L1852 KNEE ORTHOSIS DOUBLE UPRIGHT THIGH AND CALF 58 0.98 29.1 NA NA 311 311 Carrier E 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A5500 DIAB ONLY FIT CSTM PREP&SPL SHOE MX DNSITY INSRT PER SHOE 54 0.98 33.7 NA NA 312 312 Carrier E 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0604 BREAST PUMP HEAVY DUTY HOSP GRADE PISTON OP 131 0.97 5 17.4 NA NA 313 313 Carrier E 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L0464 TLSO 4MOD SACRO-SCAP PRE 27 0.93 1.8 39.2 NA NA 314 314 Carrier E 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0730 TENS DEVICE 4/MORE LEADS MULTI NERVE STIMULATION 102 0.89 33 NA NA 315 315 Carrier E 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0143 WALKER FOLDING WHEELED W/O S 154 1 1.5 28.8 NA NA 316 316 Carrier E 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0570 NEBULIZER WITH COMPRESSOR 96 1 9.3 12.6 NA NA 317 317 Carrier E 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0202 PHOTOTHERAPY LIGHT W/ PHOTOM 28 1 4.8 24.6 NA NA 318 318 Carrier E 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L1970 AFO PLASTIC MOLDED W/ANKLE J 25 1 30.8 NA NA 319 319 Carrier E 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0001 STANDARD WHEELCHAIR 25 1 0.3 13.8 NA NA 320 320 Carrier E 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0693 UV LT TX SYS PANL W/BULBS/LAMPS TIMER 6 FT PANEL 24 1 23.6 NA NA 321 321 Carrier E 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0260 HOSP BED SEMI-ELECTR W/ MATT 23 1 0.4 15.5 NA NA 322 322 Carrier E 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2402 NEG PRESS WOUND THERAPY PUMP 19 1 9.3 NA NA 323 323 Carrier E 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0691 UV LIGHT TX SYS BULB/LAMP TIMER; TX 2 SQ FT/LESS 18 1 27.3 NA NA 324 324 Carrier E 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A6212 FOAM DRESS STERL PAD SZ 16 SQ/> W/ADHES BORDR EA 16 1 31.4 NA NA 325 325 Carrier E 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E1399 DURABLE MEDICAL EQUIPMENT MISC 5 0 0.2 35.7 NA NA 326 326 Carrier F 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0486 Oral Device/appliance Cusfab 5 1 24 NA NA 327 327 Carrier F 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0108 Wheelchair Component Or Accessory, Not Otherwise Specified 1 1 120 NA NA 328 328 Carrier F 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L2755 Addition To Lower Extremity Orthosis Carbon Graphite Lamination 1 1 96 NA NA 329 329 Carrier F 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L1945 Afo, Molded To Patient Model, Plastic, Rigid Anterior Tibial Section 1 1 96 NA NA 330 330 Carrier F 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC S1040 Cranial Remolding Orthosis, Rigid, With Soft Interface Material, Custom Fabricated, Includes Fitting And Adjustment(s) 2 0.5 36 NA NA 331 331 Carrier F 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0760 Osteogenesis Stimulator Low Intensity Ultrasound Noninvasive 1 0 120 NA NA 332 332 Carrier F 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L0650 Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf 6 1 89 NA NA 333 333 Carrier F 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A6550 Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories 5 1 34 153 NA NA 334 334 Carrier F 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A7000 Canister, disposable, used with suction pump, each 5 1 34 153 NA NA 335 335 Carrier F 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2402 Negative pressure wound therapy electrical pump, stationary or portable 5 1 34 153 NA NA 336 336 Carrier F 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L2755 Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only 5 1 88 NA NA 337 337 Carrier F 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0486 Oral Device/appliance Cusfab 5 1 24 NA NA 338 338 Carrier F 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0108 Wheelchair Component Or Accessory, Not Otherwise Specified 1 1 120 NA NA 339 339 Carrier F 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L2755 Addition To Lower Extremity Orthosis Carbon Graphite Lamination 1 1 96 NA NA 340 340 Carrier F 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L1945 Afo, Molded To Patient Model, Plastic, Rigid Anterior Tibial Section 1 1 96 NA NA 341 341 Carrier F 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S1040 Cranial Remolding Orthosis, Rigid, With Soft Interface Material, Custom Fabricated, Includes Fitting And Adjustment(s) 2 0.5 36 NA NA 342 342 Carrier F 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0694 Ultraviolet multidirectional light therapy system in 6 ft cabinet, includes bulbs/lamps, timer, and eye protection 4 0 0.25 29 76 NA NA 343 343 Carrier F 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with interstitial continuous glucose monitoring system, 1 unit = 1 day supply 38 0 0.03 31 100 NA NA 344 344 Carrier G 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0784 EXTERNAL AMBULATORY INFUSION PUMP INSULIN 13 1 14.8 98.5 NA NA 345 345 Carrier G 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT V2624 POLISHING/RESURFACING OF OCULAR PROSTHESIS 5 1 44.7 NA NA 346 346 Carrier G 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT A4230 INFUS SET EXT INSULIN PUMP NONNDLE CANNULA TYPE 10 0.8 14.8 35.4 NA NA 347 347 Carrier G 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT A9276 SENSOR;INVSV DISP INTRSTL CONT GLU MON SYS 1U Equal to 1D 29 0.79 8.5 29.2 NA NA 348 348 Carrier G 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT A4232 SYRINGE W/NDLE EXTERNAL INSULIN PUMP STERILE 3CC 9 0.78 14.8 38.5 NA NA 349 349 Carrier G 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT A9277 TRANSMITTER; EXT INTERSTITIAL CONT GLU MON SYS 13 0.77 12.2 22 NA NA 350 350 Carrier G 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0294 HOSPITAL BED SEMI-ELEC W/O SIDE RAILS W/MATTRSS 4 0.75 91 NA NA 351 351 Carrier G 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT K0606 AUTO EXT DEFIB W/INTGR ECG ANALY GARMENT TYPE 5 0.6 98.8 100.9 NA NA 352 352 Carrier G 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0652 PNEUMAT COMPRS SEG HOM MDL W/CALBRTD GRADNT PRSS 7 0.43 79.2 NA NA 353 353 Carrier G 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0601 CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE 4 0 62.6 NA NA 354 354 Carrier G 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0784 EXTERNAL AMBULATORY INFUSION PUMP INSULIN 13 1 14.8 95.5 NA NA 355 355 Carrier G 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT V2624 POLISHING/RESURFACING OF OCULAR PROSTHESIS 5 1 44.7 NA NA 356 356 Carrier G 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E2611 GEN WC BACK CUSHN WDTH LT 22 IN HT MOUNT HARDWARE 3 1 22.4 77.1 NA NA 357 357 Carrier G 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A6550 WND CARE SET NEG PRSS WND TX ELEC PUMP SPL 3 1 49.2 124.7 NA NA 358 358 Carrier G 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A7000 CANISTER DISPOSABLE USED WITH SUCTION PUMP EACH 3 1 49.2 124.7 NA NA 359 359 Carrier G 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E2402 NEG PRESS WOUND THERAPY ELEC PUMP STATION/PRTBLE 3 1 49.2 124.7 NA NA 360 360 Carrier G 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E2624 SKIN PROTECT and POSITIONING WC CUSH WIDTH LT 22 IN 3 1 22.4 32.9 NA NA 361 361 Carrier G 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L1960 AFO POSTERIOR SOLID ANK PLASTIC CUSTOM FAB 3 1 93.7 NA NA 362 362 Carrier G 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0295 HOSP BED SEMI-ELEC W/O SIDE RAILS W/O MATTRSS 2 1 17.3 326.1 NA NA 363 363 Carrier G 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT K0108 OTHER ACCESSORIES 2 1 22.4 4.9 NA NA 364 364 Carrier G 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT V2623 PROSTHETIC EYE PLASTIC CUSTOM 1 0 1 140.8 NA NA 365 365 Carrier G 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0766 ELEC STIM DVC U CANCER TX INCL ALL ACC ANY TYPE 2 0 0.5 77.3 NA NA 366 366 Carrier G 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT V2628 FABRICATION AND FITTING OF OCULAR CONFORMER 2 0 0.5 72.2 NA NA 367 367 Carrier G 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT V2627 SCLERAL COVER SHELL 2 0 0.5 72.2 NA NA 368 368 Carrier G 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E1399 DURABLE MEDICAL EQUIPMENT MISCELLANEOUS 3 0 0.33 5.6 64.7 NA NA 369 369 Carrier G 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L8699 PROSTHETIC IMPLANT NOT OTHERWISE SPECIFIED 3 0 0.33 215.4 NA NA 370 370 Carrier G 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0667 SEG PNEUMAT APPLINC W/PNEUMAT COMPRS FULL LEG 3 0 0.33 63 NA NA 371 371 Carrier G 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0652 PNEUMAT COMPRS SEG HOM MDL W/CALBRTD GRADNT PRSS 7 0 0.29 79.2 NA NA 372 372 Carrier G 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A4232 SYRINGE W/NDLE EXTERNAL INSULIN PUMP STERILE 3CC 9 0 0.11 14.8 38.5 NA NA 373 373 Carrier G 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A4230 INFUS SET EXT INSULIN PUMP NONNDLE CANNULA TYPE 10 0 0.1 14.8 35.4 NA NA 374 374 Carrier H 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0486 Oral Device/appliance Cusfab 284 0.99 3.39 NA NA 375 375 Carrier H 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L8680 Implantable Neurostimulator Electrode Each 26 0.93 143.35 NA NA 376 376 Carrier H 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0005 Ultralightweight Wheelchair 28 0.86 102.77 9.2 NA NA 377 377 Carrier H 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0108 Wheelchair Component Or Accessory, Not Otherwise Specified 87 0.78 102.04 NA NA 378 378 Carrier H 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC S1040 Cranial Remolding Orthosis, Rigid, With Soft Interface Material, Custom Fabricated, Includes Fitting And Adjustment(s) 58 0.78 76.54 NA NA 379 379 Carrier H 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0652 Pneumatic Compressor, Segmental Home Model With Calibrated Gradient Pr 30 0.64 66.98 164.4 NA NA 380 380 Carrier H 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0606 Aed Garment With Electrocardiogram Analysis 25 0.64 31.54 60 NA NA 381 381 Carrier H 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0760 Osteogenesis Stimulator Low Intensity Ultrasound Noninvasive 38 0.6 83.4 146.3 NA NA 382 382 Carrier H 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0748 Osteogenic Stimulator, Noninvasive, Spinal Applications 57 0.43 86.2 NA NA 383 383 Carrier H 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0747 Osteogenesis Stimulator (non-invasive) 30 0.37 82.38 NA NA 384 384 Carrier H 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0861 Pwc Gp3 Std Mult Pow Opt S/b 13 1 159.16 NA NA 385 385 Carrier H 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2622 Skin Protection Wheelchair Seat Cushion, Adjustable, Width Less Than 22 Inches, Any Depth 11 1 96 NA NA 386 386 Carrier H 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8614 Cochlear Device/system 10 1 91.64 NA NA 387 387 Carrier H 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2617 Custom Fabricated Wheelchair Back Cushion, Any Size, Including Any Type 6 1 63 NA NA 388 388 Carrier H 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8619 Cochlear Implant External Speech Processor And Controller, Integrated System, Replacement 6 1 54.86 NA NA 389 389 Carrier H 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2609 Custom Fabricated Wheelchair Seat Cushion, Any Size 6 1 66 NA NA 390 390 Carrier H 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1161 Manual Adult Size Wheelchair, Includes Tilt In Space 6 1 111.27 NA NA 391 391 Carrier H 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0260 Hospital Bed, Seimi-electric (head And Foot Adjustment), With Any Type 5 1 85.33 NA NA 392 392 Carrier H 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8694 Auditory Osseointegrated Device, Transducer/actuator, Replacement Only, Each 5 1 87.43 NA NA 393 393 Carrier H 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8691 Auditory Osseointegrated Device, External Sound Processor, Excludes Transducer/actuator, Replacement Only, Each 5 1 79.06 NA NA 394 394 Carrier H 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC S1040 Cranial Remolding Orthosis, Rigid, With Soft Interface Material, Custom Fabricated, Includes Fitting And Adjustment(s) 58 0 1 76.54 NA NA 395 395 Carrier H 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0748 Osteogenic Stimulator, Noninvasive, Spinal Applications 57 0 1 86.2 NA NA 396 396 Carrier H 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L5856 Addition To Lower Extremity Prosthesis, Endoskeletal Knee-shin System, 4 0 1 78 NA NA 397 397 Carrier H 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0748 Osteogenic Stimulator, Noninvasive, Spinal Applications 3 0 1 96 NA NA 398 398 Carrier H 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L8690 Aud Osseo Dev, Int/ext Comp 2 0 1 52.8 NA NA 399 399 Carrier H 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0652 Pneumatic Compressor, Segmental Home Model With Calibrated Gradient Pr 30 0 0.6 66.98 NA NA 400 400 Carrier H 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0483 High Frequency Chest Wall Oscillation Air-pulse Generator System, (inc 11 0 0.5 88.7 NA NA 401 401 Carrier H 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0986 Manual Wheelchair Accessory, Push-rim Activated Power Assist, Each 1 0 0.5 120 NA NA 402 402 Carrier H 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC K0606 Aed Garment With Electrocardiogram Analysis 25 0 0.29 31.54 60 NA NA 403 403 Carrier H 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0766 Electrical Stimulation Device Used For Cancer Treatment, Includes All Accessories, Any Type 10 0 0.27 24 55.79 NA NA 404 404 Carrier I 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate 4 1 7.67 432 NA NA 405 405 Carrier I 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1399 Durable Medical Equipment Mi 1 1 91.24 NA NA 406 406 Carrier I 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0483 High frequency chest wall oscillation system, includes all accessories and supplies, each 1 1 23.75 NA NA 407 407 Carrier I 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0748 Elec Osteogen Stim Spinal 1 1 41.07 NA NA 408 408 Carrier I 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 Cont Airway Pressure Device 254 0.98 1.12 NA NA 409 409 Carrier I 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without backup rate 9 0.89 9.79 NA NA 410 410 Carrier I 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0760 Osteogen Ultrasound Stimltor 1 0 24.06 NA NA 411 411 Carrier I 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0995 Wheelchair accessory, calf rest/pad, replacement only, each 1 0 139.76 NA NA 412 412 Carrier I 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2361 Power wheelchair accessory, 22nf sealed lead acid battery, each 1 0 139.76 NA NA 413 413 Carrier I 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0484 Oscillatory Positive Expiratory Pressure Device, Nonelectric, Any Type 1 0 NA NA 414 414 Carrier I 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate 4 1 7.67 2 NA NA 415 415 Carrier I 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1399 Durable Medical Equipment Mi 1 1 91.24 95 NA NA 416 416 Carrier I 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0748 Elec Osteogen Stim Spinal 1 1 41.07 7.6 NA NA 417 417 Carrier I 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0483 High frequency chest wall oscillation system, includes all accessories and supplies, each 1 1 23.75 16.5 NA NA 418 418 Carrier I 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0601 Cont Airway Pressure Device 254 0.98 1.12 NA NA 419 419 Carrier I 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without backup rate 9 0.89 9.79 NA NA 420 420 Carrier I 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0484 Oscillatory Positive Expiratory Pressure Device, Nonelectric, Any Type 1 0 15.8 NA NA 421 421 Carrier I 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2361 Power wheelchair accessory, 22nf sealed lead acid battery, each 1 0 139.76 24 NA NA 422 422 Carrier I 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0760 Osteogen Ultrasound Stimltor 1 0 24.06 NA NA 423 423 Carrier I 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0995 Wheelchair accessory, calf rest/pad, replacement only, each 1 0 139.76 NA NA 424 424 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 Cont Airway Pressure Device 3538 0.96 2.17 NA NA 425 425 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without backup rate 165 0.95 2.18 NA NA 426 426 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate 66 0.91 4.21 NA NA 427 427 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0748 Elec Osteogen Stim Spinal 15 0.6 63.03 NA NA 428 428 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1399 Durable Medical Equipment Mi 31 0.55 86 NA NA 429 429 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0747 Elec Osteogen Stim Not Spine 11 0.36 90.09 NA NA 430 430 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0760 Osteogen Ultrasound Stimltor 12 0.33 102.28 NA NA 431 431 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0466 HOME VENT NON-INVASIVE INTER 6 0.33 44.45 NA NA 432 432 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2615 Pos back post/lat wdth <22in 2 0 24.98 NA NA 433 433 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2293 Contour back for ped size wc 1 0 NA NA 434 434 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1234 Wheelchair, Pediatric Size, Tilt-In-Space, Folding, Adj, Wo Seating 1 0 NA NA 435 435 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0978 Wheelchair Belt W/Airplane B 1 0 NA NA 436 436 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0652 Pneum Compres W/Cal Pressure 1 0 NA NA 437 437 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2231 Solid seat support base 1 0 NA NA 438 438 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0667 Seg Pneumatic Appl Full Leg 1 0 NA NA 439 439 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0641 Multi-position stnd fram sys 1 0 110.86 NA NA 440 440 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0637 Combination sit to stand system, any size, with seat lift feature, with or without wheels 1 0 73.83 NA NA 441 441 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0990 Whellchair Elevating Leg Res 1 0 NA NA 442 442 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0328 Ped hospital bed, manual 1 0 NA NA 443 443 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0483 High frequency chest wall oscillation system, includes all accessories and supplies, each 1 0 NA NA 444 444 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0638 Standing frame system, any size, with or without wheels 1 0 47.08 NA NA 445 445 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2292 Planar seat for ped size wc 1 0 NA NA 446 446 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2613 Position back cush wd <22in 1 0 126.74 NA NA 447 447 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2607 Skin pro/pos wc cus wd <22in 1 0 NA NA 448 448 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0562 Humidifier, heated, used with positive airway pressure device 1 0 NA NA 449 449 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0973 Wheelchair Adjustabl Height 1 0 NA NA 450 450 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0950 Tray 1 0 NA NA 451 451 Carrier J 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0956 Wheelchair accessory, lateral trunk or hip support, prefabricated, including fixed mounting hardware, each 1 0 NA NA 452 452 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0601 Cont Airway Pressure Device 3538 0.96 2.17 NA NA 453 453 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without backup rate 165 0.95 2.18 NA NA 454 454 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate 66 0.91 4.21 15.3 NA NA 455 455 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0748 Elec Osteogen Stim Spinal 15 0.6 63.03 NA NA 456 456 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1399 Durable Medical Equipment Mi 31 0.55 86 NA NA 457 457 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0747 Elec Osteogen Stim Not Spine 11 0.36 90.09 NA NA 458 458 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0760 Osteogen Ultrasound Stimltor 12 0.33 102.28 28.9 NA NA 459 459 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0466 HOME VENT NON-INVASIVE INTER 6 0.33 44.45 6.2 NA NA 460 460 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2615 Pos back post/lat wdth <22in 2 0 24.98 25 NA NA 461 461 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2293 Contour back for ped size wc 1 0 NA NA 462 462 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1234 Wheelchair, Pediatric Size, Tilt-In-Space, Folding, Adj, Wo Seating 1 0 3.2 NA NA 463 463 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0978 Wheelchair Belt W/Airplane B 1 0 NA NA 464 464 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0652 Pneum Compres W/Cal Pressure 1 0 32.6 NA NA 465 465 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2231 Solid seat support base 1 0 29.4 NA NA 466 466 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0667 Seg Pneumatic Appl Full Leg 1 0 NA NA 467 467 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0973 Wheelchair Adjustabl Height 1 0 NA NA 468 468 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0562 Humidifier, heated, used with positive airway pressure device 1 0 28.9 NA NA 469 469 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0990 Whellchair Elevating Leg Res 1 0 NA NA 470 470 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0328 Ped hospital bed, manual 1 0 29.4 NA NA 471 471 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0638 Standing frame system, any size, with or without wheels 1 0 47.08 NA NA 472 472 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2613 Position back cush wd <22in 1 0 126.74 6.1 NA NA 473 473 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2292 Planar seat for ped size wc 1 0 NA NA 474 474 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2607 Skin pro/pos wc cus wd <22in 1 0 2.4 NA NA 475 475 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0641 Multi-position stnd fram sys 1 0 110.86 NA NA 476 476 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0637 Combination sit to stand system, any size, with seat lift feature, with or without wheels 1 0 73.83 NA NA 477 477 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0956 Wheelchair accessory, lateral trunk or hip support, prefabricated, including fixed mounting hardware, each 1 0 NA NA 478 478 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0483 High frequency chest wall oscillation system, includes all accessories and supplies, each 1 0 NA NA 479 479 Carrier J 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0950 Tray 1 0 NA NA 480 480 Carrier J 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0760 Osteogen Ultrasound Stimltor 12 0 0.08 102.28 NA NA 481 481 Carrier J 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E1399 Durable Medical Equipment Mi 31 0 0.03 86 NA NA 482 482 Carrier J 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0601 Cont Airway Pressure Device 3538 0 0 2.17 NA NA 483 483 Carrier J 2020 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0747 Elec Osteogen Stim Not Spine 11 0 0 90.09 NA NA 484 484 Carrier K 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0748 OSTOGNS STIMULATOR ELEC NONINVASV SPINAL APPLIC 2 1 0 13.35 NA NA 485 485 Carrier K 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0760 OSTOGNS STIM LOW INTENS ULTRASOUND NON-INVASV 1 1 0 0.2 NA NA 486 486 Carrier K 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E2402 NEG PRESS WOUND THERAPY ELEC PUMP STATION/PRTBLE 1 1 0 53.6 NA NA 487 487 Carrier K 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0486 ORL DEVC/APPL RDUC UP AIRWAY COLLAPSIBILITY CSTM 1 1 0 75.7 56.9 NA NA 488 488 Carrier K 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0747 OSTOGNS STIM ELEC NONINVASV OTH THAN SP APPLIC 2 0 0 69.2 NA NA 489 489 Carrier K 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0748 OSTOGNS STIMULATOR ELEC NONINVASV SPINAL APPLIC 2 1 0 13.35 NA NA 490 490 Carrier K 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0760 OSTOGNS STIM LOW INTENS ULTRASOUND NON-INVASV 1 1 0 0.2 NA NA 491 491 Carrier K 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E2402 NEG PRESS WOUND THERAPY ELEC PUMP STATION/PRTBLE 1 1 0 53.6 NA NA 492 492 Carrier K 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0486 ORL DEVC/APPL RDUC UP AIRWAY COLLAPSIBILITY CSTM 1 1 0 75.7 NA NA 493 493 Carrier L 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0471 RESP ASST DEVC BI-LEVL PRSS CAPABILITY W/BACK-UP 3 1 21.8 59.5 NA NA 494 494 Carrier L 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5679 ADD LW EXT BK/AK CSTM MOLD/PRFAB NOT W/LOCK MECH 3 0.67 62.67 NA NA 495 495 Carrier L 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5981 ALL LOWER EXTREM PROSTH FLEX-WALK SYSTEM/EQUAL 3 0.67 52.9 NA NA 496 496 Carrier L 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5321 ABOVE KNEE OPEN END SACH FT ENDO SYS 1 AXIS KNEE 3 0.33 62.67 NA NA 497 497 Carrier L 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5624 ADDITION LOWER EXTREMITY TEST SOCKET ABOVE KNEE 3 0.33 62.67 NA NA 498 498 Carrier L 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5631 ADD LW EXT ABVE KNEE/KNEE DISARTIC ACRYLC SOCKT 3 0.33 62.67 NA NA 499 499 Carrier L 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5649 ADD LW EXT ISCHIAL CONTAINMENT/NARROW M-L SOCKET 3 0.33 62.67 NA NA 500 500 Carrier L 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5650 ADD LW EXT TOTAL CONTACT ABVE KNEE/KNEE DISARTC 3 0.33 62.67 NA NA 501 501 Carrier L 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5671 ADD LW EXTRM BELW/ABVE KNEE SUSP LOCK MECH 3 0.33 62.67 NA NA 502 502 Carrier L 2020 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5673 ADD LW EXT CSTM MOLD/PRFAB FOR USE W/LOCK MECH 3 0.33 62.67 NA NA 503 503 Carrier L 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0471 RESP ASST DEVC BI-LEVL PRSS CAPABILITY W/BACK-UP 3 1 21.8 59.5 NA NA 504 504 Carrier L 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0562 HUMDIFIR HEATED USED W/POS ARWAY PRESSURE DEVICE 2 1 21.8 44.2 NA NA 505 505 Carrier L 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2402 NEG PRESS WOUND THERAPY ELEC PUMP STATION/PRTBLE 2 1 20.7 NA NA 506 506 Carrier L 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L2820 ADD LW EXT ORTH SFT INTERFCE MOLD BELW KNEE 2 1 47.25 NA NA 507 507 Carrier L 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5620 ADDITION LOWER EXTREMITY TEST SOCKET BELOW KNEE 2 1 42.25 NA NA 508 508 Carrier L 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5637 ADDITION LOWER EXTREMITY BELOW KNEE TOTAL CNTC 2 1 42.25 NA NA 509 509 Carrier L 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5679 ADD LW EXT BK/AK CSTM MOLD/PRFAB NOT W/LOCK MECH 2 1 42.25 NA NA 510 510 Carrier L 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5685 ADD LOW EXT PROS BELW KNEE SUSP/SEAL SLEEVE EA 2 1 42.25 NA NA 511 511 Carrier L 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5910 ADD ENDOSKEL SYSTEM BELOW KNEE ALIGNABLE SYSTEM 2 1 42.25 NA NA 512 512 Carrier L 2020 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5940 ADD ENDOSKEL SYSTEM BELW KNEE ULTRA-LGHT MATL 2 1 42.25 NA NA 513 513 Carrier M 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44207 LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH ANASTOMOSIS, WITH COLOPROCTOSTOMY (LOW PELVIC ANASTOMOSIS) 8 1 0 309 NA NA 514 514 Carrier M 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22842 POSTERIOR SEGMENTAL INSTRUMENTATION (EG, PEDICLE FIXATION, DUAL RODS WITH MULTIPLE HOOKS AND SUBLAMINAR WIRES); 3 TO 6 VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 8 0.88 9 48 NA NA 515 515 Carrier M 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22612 ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL ; LUMBAR (WITH LATERAL TRANSVERSE TECHNIQUE, WHEN PERFORMED) 8 0.75 9 96 NA NA 516 516 Carrier M 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20931 ALLOGRAFT, STRUCTURAL, FOR SPINE SURGERY ONLY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 7 0.71 3.43 61.71 NA NA 517 517 Carrier M 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20930 ALLOGRAFT, MORSELIZED, OR PLACEMENT OF OSTEOPROMOTIVE MATERIAL, FOR SPINE SURGERY ONLY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 17 0.65 4.24 25.41 NA NA 518 518 Carrier M 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22840 POSTERIOR NON-SEGMENTAL INSTRUMENTATION (EG, HARRINGTON ROD TECHNIQUE, PEDICLE FIXATION ACROSS ONE INTERSPACE, ATLANTOAXIAL TRANSARTICULAR SCREW FIXATION, SUBLAMINAR WIRING AT C1, FACET SCREW FIXATION) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PRO 11 0.64 6.55 28.36 NA NA 519 519 Carrier M 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20936 AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); LOCAL (EG, RIBS, SPINOUS PROCESS, OR LAMINAR FRAGMENTS) OBTAINED FROM SAME INCISION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 8 0.63 9 63 NA NA 520 520 Carrier M 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DESKECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION); LUMBAR 8 0.63 9 69 NA NA 521 521 Carrier M 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63047 LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT(S) (EG; SPINAL OR LATERAL RECESS STENOSIS) SINGLE VERTEBRAL SEGMENT; LUMBAR 8 0.63 9 45 NA NA 522 522 Carrier M 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 INSERTION OF INTERBODY BIOMECHANICAL DEVICE(S) (EG, SYNTHETIC CAGE, MESH) WITH INTEGRAL ANTERIOR INSTRUMENTATION FOR DEVICE ANCHORING (EG, SCREWS, FLANGES), WHEN PERFORMED, TO INTERVERTEBRAL DISC SPACE IN CONJUNCTION WITH INTERBODY ARTHRODESIS, EACH INTE 18 0.56 4 44 NA NA 523 523 Carrier M 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22840 LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH ANASTOMOSIS, WITH COLOPROCTOSTOMY (LOW PELVIC ANASTOMOSIS) 8 1 0 309 NA NA 524 524 Carrier M 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22612 LAPAROSCOPY, SURGICAL PROSTATECTOMY, RETROPUBIC RADICAL, INCLUDING NERVE SPARING, INCLUDES ROBOTIC ASSISTANCE, WHEN PERFORMED 7 1 3.43 48 NA NA 525 525 Carrier M 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22842 TOTAL HYSTERECTOMY (CORPUS AND CERVIX), WITH OR WITHOUT REMOVAL OF TUBE(S), WITH OR WITHOUT REMOVAL OF OVARY(S); 7 1 0 24 NA NA 526 526 Carrier M 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44207 INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A COMPREHENSIVE HISTORY; A COMPREHENSIVE EXAMINATION; AND MEDICAL DECISION MAKING OF MODERATE COMPLEXITY. COUNSELING AND/OR COORDINATIO 7 1 10.29 48 NA NA 527 527 Carrier M 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22558 POSTERIOR SEGMENTAL INSTRUMENTATION (EG, PEDICLE FIXATION, DUAL RODS WITH MULTIPLE HOOKS AND SUBLAMINAR WIRES); 3 TO 6 VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 8 0.88 9 48 NA NA 528 528 Carrier M 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63047 ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL ; LUMBAR (WITH LATERAL TRANSVERSE TECHNIQUE, WHEN PERFORMED) 8 0.75 9 96 NA NA 529 529 Carrier M 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22853 ALLOGRAFT, MORSELIZED, OR PLACEMENT OF OSTEOPROMOTIVE MATERIAL, FOR SPINE SURGERY ONLY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 17 0.65 4.24 25.41 NA NA 530 530 Carrier M 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 20936 POSTERIOR NON-SEGMENTAL INSTRUMENTATION (EG, HARRINGTON ROD TECHNIQUE, PEDICLE FIXATION ACROSS ONE INTERSPACE, ATLANTOAXIAL TRANSARTICULAR SCREW FIXATION, SUBLAMINAR WIRING AT C1, FACET SCREW FIXATION) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PRO 11 0.64 6.55 28.36 NA NA 531 531 Carrier M 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 20931 AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); LOCAL (EG, RIBS, SPINOUS PROCESS, OR LAMINAR FRAGMENTS) OBTAINED FROM SAME INCISION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 8 0.63 9 63 NA NA 532 532 Carrier M 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 20930 INSERTION OF INTERBODY BIOMECHANICAL DEVICE(S) (EG, SYNTHETIC CAGE, MESH) WITH INTEGRAL ANTERIOR INSTRUMENTATION FOR DEVICE ANCHORING (EG, SCREWS, FLANGES), WHEN PERFORMED, TO INTERVERTEBRAL DISC SPACE IN CONJUNCTION WITH INTERBODY ARTHRODESIS, EACH INTE 18 0.56 4 44 NA NA 533 533 Carrier A 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22551 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2 7 1 42.71 NA NA 534 534 Carrier A 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) 9 0.89 97.24 84.54 NA NA 535 535 Carrier A 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 27 0.82 97.24 61.33 NA NA 536 536 Carrier A 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 11 0.82 64.01 NA NA 537 537 Carrier A 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22845 Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure) 14 0.71 66.08 NA NA 538 538 Carrier A 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 20 0.7 194.36 82.72 NA NA 539 539 Carrier A 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22614 Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure) 10 0.7 97.24 77.6 NA NA 540 540 Carrier A 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) 18 0.67 194.36 91.31 NA NA 541 541 Carrier A 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar 15 0.67 194.36 79.52 NA NA 542 542 Carrier A 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22585 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); each additional interspace (List separately in addition to code for primary procedure) 11 0.55 97.24 113.88 NA NA 543 543 Carrier A 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22551 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2 7 1 42.71 NA NA 544 544 Carrier A 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22552 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2, each additional interspace (List separately in addition to code for separate procedure) 6 1 49.55 NA NA 545 545 Carrier A 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); 5 1 3.51 30.44 NA NA 546 546 Carrier A 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29888 Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction 4 1 1.16 26.16 NA NA 547 547 Carrier A 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22846 Anterior instrumentation; 4 to 7 vertebral segments (List separately in addition to code for primary procedure) 3 1 37.93 NA NA 548 548 Carrier A 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 20931 Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure) 3 1 77.56 NA NA 549 549 Carrier A 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22610 Arthrodesis, posterior or posterolateral technique, single level; thoracic (with lateral transverse technique, when performed) 2 1 0.13 0.13 NA NA 550 550 Carrier A 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22630 Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar 2 1 41.48 NA NA 551 551 Carrier A 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar 2 1 41.48 NA NA 552 552 Carrier A 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22855 Removal of anterior instrumentation 2 1 22.48 NA NA 553 553 Carrier A 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 11 0 0.09 64.01 NA NA 554 554 Carrier A 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar 15 0 0.07 194.36 79.52 NA NA 555 555 Carrier A 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) 18 0 0.06 194.36 91.31 NA NA 556 556 Carrier A 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 20 0 0.05 194.36 82.72 NA NA 557 557 Carrier A 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 27 0 0.04 97.24 61.33 NA NA 558 558 Carrier A 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22845 Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure) 14 0 0 66.08 NA NA 559 559 Carrier A 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22585 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); each additional interspace (List separately in addition to code for primary procedure) 11 0 0 97.24 113.88 NA NA 560 560 Carrier A 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22614 Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure) 10 0 0 97.24 77.6 NA NA 561 561 Carrier A 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63048 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; each additional segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure) 6 0 0 194.36 54.79 NA NA 562 562 Carrier A 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63056 Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; lumbar (including transfacet, or lateral extraforaminal approach) (eg, far lateral herniated intervertebral disc) 4 0 0 91.05 NA NA 563 563 Carrier N 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44120 REMOVAL OF SMALL INTESTINE 2 1 0 NA NA 564 564 Carrier N 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44625 REPAIR BOWEL OPENING 1 1 0 NA NA 565 565 Carrier N 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 33416 REVISE VENTRICLE MUSCLE 1 1 0 NA NA 566 566 Carrier N 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 61582 CRANIOFACIAL APPROACH SKULL 1 1 0 NA NA 567 567 Carrier N 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58952 RESECT OVARIAN MALIGNANCY 1 1 24 NA NA 568 568 Carrier N 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 38571 LAPAROSCOPY LYMPHADENECTOMY 1 1 0 NA NA 569 569 Carrier N 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 19303 MAST SIMPLE COMPLETE 1 1 72 NA NA 570 570 Carrier N 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44139 MOBILIZATION OF COLON 1 1 24 NA NA 571 571 Carrier N 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22633 LUMBAR SPINE FUSION COMBINED 2 0.5 60 NA NA 572 572 Carrier N 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 49320 DIAG LAPARO SEPARATE PROC 2 0 96 NA NA 573 573 Carrier N 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44120 REMOVAL OF SMALL INTESTINE 2 1 0 NA NA 574 574 Carrier N 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44625 REPAIR BOWEL OPENING 1 1 0 NA NA 575 575 Carrier N 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33416 REVISE VENTRICLE MUSCLE 1 1 0 NA NA 576 576 Carrier N 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 61582 CRANIOFACIAL APPROACH SKULL 1 1 0 NA NA 577 577 Carrier N 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58952 RESECT OVARIAN MALIGNANCY 1 1 24 NA NA 578 578 Carrier N 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 38571 LAPAROSCOPY LYMPHADENECTOMY 1 1 0 NA NA 579 579 Carrier N 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19303 MAST SIMPLE COMPLETE 1 1 72 NA NA 580 580 Carrier N 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44139 MOBILIZATION OF COLON 1 1 24 NA NA 581 581 Carrier N 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22633 LUMBAR SPINE FUSION COMBINED 2 0.5 60 NA NA 582 582 Carrier N 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 49320 DIAG LAPARO SEPARATE PROC 2 0 96 NA NA 583 583 Carrier B 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 TOTAL ABDOMINAL HYSTORECOMY WITH/WITHOUT REMOVAL OF TUBE(S) - OVARY(S) 12 1 69.74 161.59 0 NA NA 584 584 Carrier B 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 49000 EXPLORATORY LAPAROTOMY-CELIOTOMY WITH OR WITHOUT BIOPSY 9 1 0 86.56 0 NA NA 585 585 Carrier B 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22612 LUMBAR SPINE FUSION 8 1 0 44.85 0 NA NA 586 586 Carrier B 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96416 CHEMOTHERAPY ADMNIISTRATION TO INITIALIZE PROLONG CHEMOTHERAPY WITH I NFUSION PUMP 8 1 7.68 83.3 0 NA NA 587 587 Carrier B 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27130 HIP JOINT REPLACEMENT BY PROSTHESIS OR ARTIFICIAL JOINT 23 0.96 0 35.55 0 NA NA 588 588 Carrier B 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22840 PLACEMENT OF SPINAL INSTRUMENTATION IN NECK ACROSS A SINGLE LEVEL TO CORRECT SPINAL DEFORMITY 12 0.92 0 64.48 0 NA NA 589 589 Carrier B 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 INSERTION OF METALLIC CAGE OR MESH DEVICE BETWEEN TWO VERTEBRAE WITH SCREWS AND FLANGES 16 0.88 0 68.91 0 NA NA 590 590 Carrier B 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20930 BONE GRAFT OF DONOR OR SYNTHETIC MATERIAL-ADD ON 12 0.83 0 45.25 0 NA NA 591 591 Carrier B 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63047 LAMINECTOMY OF SINGLE VERTEBRAE EITHER UNILATERAL OR BILATERAL OF LUMBAR SPINE 15 0.67 0 43.1 0 NA NA 592 592 Carrier B 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63048 ADDITIONAL VERTEBRAL LAMINECTOMY, FACETECTOMY, and FORAMINOTOMY PROCEDURES 10 0.6 0 49.27 0 NA NA 593 593 Carrier B 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58150 TOTAL ABDOMINAL HYSTORECOMY WITH/WITHOUT REMOVAL OF TUBE(S) - OVARY(S) 12 1 69.74 161.59 0 NA NA 594 594 Carrier B 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 49000 EXPLORATORY LAPAROTOMY-CELIOTOMY WITH OR WITHOUT BIOPSY 9 1 0 86.56 0 NA NA 595 595 Carrier B 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27447 ARTHROPLASTY OF KNEE CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS OF THE KNEE 8 1 0 127.47 0 NA NA 596 596 Carrier B 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96416 CHEMOTHERAPY ADMNIISTRATION TO INITIALIZE PROLONG CHEMOTHERAPY WITH I NFUSION PUMP 8 1 7.68 83.3 0 NA NA 597 597 Carrier B 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22612 LUMBAR SPINE FUSION 8 1 0 44.85 0 NA NA 598 598 Carrier B 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22558 ARTHRODESIS-ANTERIOR INTERBODY WITH MINI DISKECTOMYOF LUMBAR SPINE 7 1 0 36.39 0 NA NA 599 599 Carrier B 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 38571 LAPAROSCOPY WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY 7 1 0.71 79.47 0 NA NA 600 600 Carrier B 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 20936 AUTOGRAFT DURING SPINAL SURGERY ONLY; LOCAL THRU SAME INCISION 7 1 0 38.3 0 NA NA 601 601 Carrier B 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22842 PLACEMENT OF SPINAL INTRUMENTATION; 3 TO 6 VERTEBRAE SEGMENT 6 1 0 63.49 0 NA NA 602 602 Carrier B 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 47120 HEPATECTOMY RESECTION OF LIVER; PART LOBECTOMY OF LIVER 6 1 7.23 251.89 0 NA NA 603 603 Carrier B 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 61760 STEREOTACTIC IMPLANT DEPTH ELECTRODES-CEREBRUM 1 0 1 0 100.88 0 NA NA 604 604 Carrier B 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22610 THORACIC SPINE FUSION 1 0 1 0 0 0 NA NA 605 605 Carrier B 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63046 LAMINECTOMY SINGLE VERTEBRAL SEGMENT-UNILATERAL/BILATERLA; THORACIC REGION 1 0 1 0 0 0 NA NA 606 606 Carrier B 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 61781 COM:UTED TOMOGRAPHY or MAGNETIC RESONANCE IMAGING DURING PROCEDURE OF INTRADUAL CRANIAL PROCEDURE 3 0 0.33 0 91.23 0 NA NA 607 607 Carrier B 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27487 REVISION TOTAL KNEE ARTHROPLASTY; FEMORAL AND WHOLE TIBIA COMPARTMENTS 3 0 0.33 0 39.94 0 NA NA 608 608 Carrier B 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22842 PLACEMENT OF SPINAL INTRUMENTATION; 3 TO 6 VERTEB SEGMENT 6 0 0.17 0 63.49 0 NA NA 609 609 Carrier B 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22614 ARTHRODESIS-POST/POSTLATERAL TECHNIQUE; EACH ADD VERTEBRAE SEGMENT 7 0 0.14 0 60.71 0 NA NA 610 610 Carrier B 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63048 ADDITIONAL VERTEBRAL LAMINECTOMY, FACETECTOMY, and FORAMINOTOMY PROCEDURES 10 0 0.1 0 49.27 0 NA NA 611 611 Carrier C 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44204 LAPARO PARTIAL COLECTOMY 51 1 2.95 128.38 600 NA NA 612 612 Carrier C 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 59510 FULL ROUT OBSTE CARE,CESAREAN DELIV 99 0.99 6.42 112.83 NA NA 613 613 Carrier C 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 762 MISC SERVICES 5526 0.98 40.54 530.38 NA NA 614 614 Carrier C 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 120 ROOM AND BOARD 11682 0.97 37.54 247.41 NA NA 615 615 Carrier C 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 59514 CESAREAN DELIVERY ONLY 48 0.96 0.88 55.73 NA NA 616 616 Carrier C 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43644 LAP GASTRIC BYPASS/ROUX-EN-Y 55 0.95 66.05 NA NA 617 617 Carrier C 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43775 LAP SLEEVE GASTRECTOMY 38 0.92 140.76 NA NA 618 618 Carrier C 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 59400 FULL ROUT OBSTE CARE,VAGINAL DELIV 101 0.9 5.4 434.69 NA NA 619 619 Carrier C 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 ARTHRODESIS ANT INTERBODY W/ DISKECTOMY LU 58 0.74 53.13 1068.04 NA NA 620 620 Carrier C 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 128 ROOM AND BOARD 154 0.59 37.32 70.48 NA NA 621 621 Carrier C 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44204 LAPARO PARTIAL COLECTOMY 51 1 2.95 128.38 NA NA 622 622 Carrier C 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 55866 LAPARO RADICAL PROSTATECT 21 1 0.48 121.39 NA NA 623 623 Carrier C 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58960 EXPLORATION OF ABDOMEN 21 1 1.01 21.99 NA NA 624 624 Carrier C 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 362 SURGERY 20 1 0.17 45.39 NA NA 625 625 Carrier C 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 656 HOSPICE GEN INPT/NOT RESP 18 1 157.02 73.52 NA NA 626 626 Carrier C 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 61781 SCAN PROC CRANIAL INTRA 17 1 1.13 40.63 NA NA 627 627 Carrier C 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 50543 LAPARO PARTIAL NEPHRECTOM 16 1 12.59 36.42 NA NA 628 628 Carrier C 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27487 REVISE/REPLACE KNEE JOINT 15 1 52.78 178.65 NA NA 629 629 Carrier C 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 55970 INTERSEX SURG MALE TO FEMALE 14 1 383.01 NA NA 630 630 Carrier C 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27570 FIXATION OF KNEE JOINT 14 1 0.74 4.28 NA NA 631 631 Carrier C 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21141 LEFORT I-1 PIECE W/O GRAF 1 0 1 2103.45 NA NA 632 632 Carrier C 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 53854 TRANSURETHRAL DESTRUCT PROSTAT TISSUE;BY RADIOFRQ WATER THERMOTHERPY 2 0 0.5 483.88 NA NA 633 633 Carrier C 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 33270 INS/REP SUBQ DEFIBRILLATO 3 0 0.33 23.82 596.94 NA NA 634 634 Carrier C 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22514 PERQ VERTEBRAL AUGMENTATI 3 0 0.33 46.7 347.14 NA NA 635 635 Carrier C 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 33945 TRANSPLANTATION OF HEART 4 0 0.25 81.76 211.16 NA NA 636 636 Carrier C 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43645 LAP GASTR BYPASS INCL SML 8 0 0.13 159.29 NA NA 637 637 Carrier C 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 128 ROOM AND BOARD 154 0 0.02 37.32 70.48 NA NA 638 638 Carrier C 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43644 LAP GASTRIC BYPASS/ROUX-EN-Y 55 0 0.02 66.05 NA NA 639 639 Carrier C 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22558 ARTHRODESIS ANT INTERBODY W/ DISKECTOMY LU 58 0 0.02 53.13 1068.04 NA NA 640 640 Carrier C 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 120 ROOM AND BOARD 11682 0 0 37.54 247.41 NA NA 641 641 Carrier D 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 59400 OBSTETRICAL CARE 27 1 3.8 194.23 NA NA 642 642 Carrier D 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 59510 CESAREAN DELIVERY 21 1 0.11 77.22 NA NA 643 643 Carrier D 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99221 INITIAL HOSPITAL CARE,LEVL I 16 1 62.12 NA NA 644 644 Carrier D 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 367 SURGERY 14 1 162.31 NA NA 645 645 Carrier D 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 762 MISC SERVICES 1204 0.99 45.98 NA NA 646 646 Carrier D 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 120 ROOM AND BOARD 4830 0.97 37.07 72.8 NA NA 647 647 Carrier D 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27130 TOTAL HIP ARTHROPLASTY 44 0.75 38.01 339.93 NA NA 648 648 Carrier D 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43644 LAP GASTRIC BYPASS/ROUX-EN-Y 12 0.75 31.32 203.96 NA NA 649 649 Carrier D 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 LUMBAR SPINE FUSION 15 0.53 57.11 613.99 NA NA 650 650 Carrier D 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 128 ROOM AND BOARD 88 0.52 34.87 74.87 NA NA 651 651 Carrier D 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 59400 OBSTETRICAL CARE 27 1 3.8 194.23 NA NA 652 652 Carrier D 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 59510 CESAREAN DELIVERY 21 1 0.11 77.22 NA NA 653 653 Carrier D 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99221 INITIAL HOSPITAL CARE,LEVL I 16 1 62.12 NA NA 654 654 Carrier D 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 367 SURGERY 14 1 162.31 NA NA 655 655 Carrier D 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44207 L COLECTOMY/COLOPROCTOSTO 11 1 1.1 14.1 NA NA 656 656 Carrier D 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 55866 LAPARO RADICAL PROSTATECT 10 1 91.33 NA NA 657 657 Carrier D 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 23472 ARTHROPLASTY GLENOHUM JNT TOTAL SHOULDER 9 1 127.07 NA NA 658 658 Carrier D 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44620 REPAIR BOWEL OPENING 8 1 0.56 170.91 NA NA 659 659 Carrier D 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58150 TOTAL ABDOM HYSTERECTOMY 8 1 28.44 3.63 NA NA 660 660 Carrier D 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44204 LAPARO PARTIAL COLECTOMY 7 1 39.86 NA NA 661 661 Carrier D 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43775 LAP SLEEVE GASTRECTOMY 9 0 0.22 534.68 NA NA 662 662 Carrier D 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22633 ARTHDSIS POST/POSTEROLATRL/POSTINTERBODY LUMBAR 11 0 0.18 76.86 346.45 NA NA 663 663 Carrier D 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22558 LUMBAR SPINE FUSION 15 0 0.13 57.11 613.99 NA NA 664 664 Carrier D 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 128 ROOM AND BOARD 88 0 0.02 34.87 74.87 NA NA 665 665 Carrier E 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT 5 1 57.1 NA NA 666 666 Carrier E 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 50360 RENAL ALLOTRANSPLANTATION, IMPLANTATION OF GRAFT 4 1 NA NA 667 667 Carrier E 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96409 CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG 3 1 4.5 NA NA 668 668 Carrier E 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC J9328 INJECTION TEMOZOLOMIDE 1 MG 2 1 29.8 NA NA 669 669 Carrier E 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 71046 RADIOLOGIC EXAM CHEST 2 VIEWS 2 1 NA NA 670 670 Carrier E 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 38240 BONE MARROW STEM CELL TRANSPLANTATION, ALLOGENIC 2 1 0.3 NA NA 671 671 Carrier E 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27447 ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS 2 1 15.8 NA NA 672 672 Carrier E 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC Q5006 HOSPICE CARE PROV INPATIENT HOSPICE FACILITY 1 1 NA NA 673 673 Carrier E 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC J7187 INJ VONWILLEBRND FACTOR CMPLX HUMN RISTOCETIN IU 1 1 4.3 600 NA NA 674 674 Carrier E 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC D0301 D0301NON-TRAUMATIC BRAIN INJURY WITH MOTOR >41.05.,COMORBIDITY IN TIER 3 1 1 0.1 NA NA 675 675 Carrier E 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT 5 1 57.1 NA NA 676 676 Carrier E 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 50360 RENAL ALLOTRANSPLANTATION, IMPLANTATION OF GRAFT 4 1 NA NA 677 677 Carrier E 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96409 CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG 3 1 4.5 NA NA 678 678 Carrier E 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC J9328 INJECTION TEMOZOLOMIDE 1 MG 2 1 29.8 NA NA 679 679 Carrier E 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 71046 RADIOLOGIC EXAM CHEST 2 VIEWS 2 1 NA NA 680 680 Carrier E 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 38240 BONE MARROW STEM CELL TRANSPLANTATION, ALLOGENIC 2 1 0.3 NA NA 681 681 Carrier E 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27447 ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS 2 1 15.8 NA NA 682 682 Carrier E 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC Q5006 HOSPICE CARE PROV INPATIENT HOSPICE FACILITY 1 1 NA NA 683 683 Carrier E 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC J7187 INJ VONWILLEBRND FACTOR CMPLX HUMN RISTOCETIN IU 1 1 4.3 NA NA 684 684 Carrier E 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC D0301 D0301NON-TRAUMATIC BRAIN INJURY WITH MOTOR >41.05.,COMORBIDITY IN TIER 3 1 1 0.1 NA NA 685 685 Carrier F 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar 21 0.81 67 18.29 NA NA 686 686 Carrier F 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft 40 0.8 20 55 NA NA 687 687 Carrier F 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27447 Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) 20 0.8 43 61 NA NA 688 688 Carrier F 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20936 Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure) 15 0.8 28 91 18.3 NA NA 689 689 Carrier F 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) 18 0.78 3 72 NA NA 690 690 Carrier F 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 37 0.76 27 79 NA NA 691 691 Carrier F 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) 16 0.75 82 NA NA 692 692 Carrier F 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 121 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Medical/Surgical/GYN 355 0.72 23 67 NA NA 693 693 Carrier F 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure) 20 0.7 37 75 NA NA 694 694 Carrier F 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 22 0.68 23 66 NA NA 695 695 Carrier F 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44207 Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) 11 1 37 67 NA NA 696 696 Carrier F 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar 10 1 33 86 NA NA 697 697 Carrier F 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22634 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; each additional interspace and segment (List separately in addition to code for primary procedure) 7 1 1 86 NA NA 698 698 Carrier F 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 55866 Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed 7 1 47 44 NA NA 699 699 Carrier F 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 50545 Laparoscopy, surgical; radical nephrectomy (includes removal of Gerota's fascia and surrounding fatty tissue, removal of regional lymph nodes, and adrenalectomy) 5 1 2 43 NA NA 700 700 Carrier F 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 36223 Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the extracranial carotid and cervicocerebral arch, when performed 4 1 87 NA NA 701 701 Carrier F 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 36224 Selective catheter placement, internal carotid artery, unilateral, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the extracranial carotid and cervicocerebral arch, when performed 4 1 87 NA NA 702 702 Carrier F 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 36226 Selective catheter placement, vertebral artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed 4 1 87 NA NA 703 703 Carrier F 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 36227 Selective catheter placement, external carotid artery, unilateral, with angiography of the ipsilateral external carotid circulation and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure) 4 1 87 NA NA 704 704 Carrier F 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 36228 Selective catheter placement, each intracranial branch of the internal carotid or vertebral arteries, unilateral, with angiography of the selected vessel circulation and all associated radiological supervision and interpretation (eg, middle cerebral artery, posterior inferior cerebellar artery) (List separately in addition to code for primary procedure) 4 1 87 NA NA 705 705 Carrier F 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 33418 Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesis 1 0 1 26 NA NA 706 706 Carrier F 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22634 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; each additional interspace and segment (List separately in addition to code for primary procedure) 7 0 0.14 1 86 NA NA 707 707 Carrier F 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar 10 0 0.1 33 86 NA NA 708 708 Carrier F 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) 16 0 0.06 82 NA NA 709 709 Carrier F 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 121 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Medical/Surgical/GYN 355 0 0.01 23 67 NA NA 710 710 Carrier G 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 120 Room & Board - Semiprivate - 2 Beds - General 10 1 32.6 NA NA 711 711 Carrier G 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22633 ARTHDSIS POST/POSTEROLATRL/POSTINTERBODY LUMBAR 13 0.92 159.9 NA NA 712 712 Carrier G 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63047 LAM FACETECTOMY AND FORAMOTOMY 1 SEGMENT LUMBAR 11 0.91 159 NA NA 713 713 Carrier G 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63048 LAM FACETECTOMY and FORAMTOMY 1 SGM EA CRV THRC/LMBR 10 0.9 145.9 NA NA 714 714 Carrier G 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22840 POSTERIOR NON-SEGMENTAL INSTRUMENTATION 13 0.85 132.8 NA NA 715 715 Carrier G 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT 13 0.85 42.7 NA NA 716 716 Carrier G 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20930 ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED 12 0.83 132 NA NA 717 717 Carrier G 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96416 CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP 11 0.82 32.3 42.2 NA NA 718 718 Carrier G 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20936 AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION 11 0.82 139.2 NA NA 719 719 Carrier G 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 INSJ BIOMCHN DEV INTERVERTEBRAL DSC SPC W/ARTHRD 19 0.79 7.5 133.6 NA NA 720 720 Carrier G 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 120 Room & Board - Semiprivate - 2 Beds - General 10 1 32.6 NA NA 721 721 Carrier G 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33518 CORONARY ARTERY BYP W/VEIN and ARTERY GRAFT 2 VEIN 8 1 4 108.3 NA NA 722 722 Carrier G 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44207 LAPS COLECTOMY PRTL W/COLOPXTSTMY LW ANAST 6 1 14.4 43 NA NA 723 723 Carrier G 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J9070 CYCLOPHOSPHAMIDE 100 MG 6 1 17.9 64.1 NA NA 724 724 Carrier G 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 38571 LAPS SURG BILATERAL TOTAL PELVIC LMPHADECTOMY 6 1 5.1 50.6 NA NA 725 725 Carrier G 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J1453 INJECTION FOSAPREPITANT 1 MG 5 1 30.1 114.9 NA NA 726 726 Carrier G 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22614 ARTHRODESIS POSTERIOR/POSTEROLATERAL EA ADDL 5 1 135.6 NA NA 727 727 Carrier G 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44204 LAPAROSCOPY COLECTOMY PARTIAL W/ANASTOMOSIS 5 1 45.9 NA NA 728 728 Carrier G 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 61624 TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS 5 1 18.7 131 NA NA 729 729 Carrier G 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 36226 SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY 4 1 9.7 160.1 NA NA 730 730 Carrier G 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 164 Other Room & Board - Sterile Environment 1 0 1 73.9 NA NA 731 731 Carrier G 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22846 ANTERIOR INSTRUMENTATION 4-7 VERTEBRAL SEGMENTS 1 0 1 145.6 NA NA 732 732 Carrier G 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27685 LNGTH/SHRT TENDON LEG/ANKLE 1 TENDON SPX 1 0 1 241.7 NA NA 733 733 Carrier G 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27702 ARTHROPLASTY ANKLE W/IMPLANT 1 0 1 241.7 NA NA 734 734 Carrier G 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 33979 INSJ VENTR ASSIST DEV IMPLTABLE ICORP 1 VNTRC 1 0 1 49.3 NA NA 735 735 Carrier G 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 20680 REMOVAL IMPLANT DEEP 3 0 0.67 42.5 141.8 NA NA 736 736 Carrier G 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 206 Intensive Care - Intermediate (ICU) 2 0 0.5 50.1 NA NA 737 737 Carrier G 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22552 ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC 3 0 0.33 103.8 NA NA 738 738 Carrier G 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 120 Room & Board - Semiprivate - 2 Beds - General 10 0 0.3 32.6 NA NA 739 739 Carrier G 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 55866 LAPS PROSTECT RETROPUBIC RAD W/NRV SPARING ROBOT 4 0 0.25 5.1 70.1 NA NA 740 740 Carrier H 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27487 Revis.totl Knee Arthroplas,w/wo Allogft; 10 1 52.8 NA NA 741 741 Carrier H 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27134 Revis.tot.hip Arthropl;both Compnts 9 1 90 NA NA 742 742 Carrier H 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43644 Laparoscopy, Surg, Gastric Restrictive Procedure; W Gastric Bypass And Roux-en-y Gastroenterostomy (roux Limb <= 150 Cm) 31 0.97 48 135.77 NA NA 743 743 Carrier H 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27447 Replacement Knee Total 85 0.91 82.05 NA NA 744 744 Carrier H 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27130 Replacement Hip Total Simple 116 0.9 12 44 NA NA 745 745 Carrier H 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43775 Laps Gstrc Rstrictiv Px Longitudinal Gastrectomy 49 0.9 110.4 NA NA 746 746 Carrier H 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22551 Arthodesis, Anterior Interbody, Including Disc Space Preparation, Discectomy, Osteophytectomy And Decompression Of Spinal Cord And/or Nerve Roots; Cervical Below C2 42 0.86 8 75.13 NA NA 747 747 Carrier H 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22633 Arthrodesis, Combnd Post Or Postlat Techq W/post Interbdy Techq Incl Laminctmy And/or Discctmy Suffcnt To Prepre Interspce (oth Thn For Decomp), Sgl Interspce&segmnt; Lumbar 43 0.73 24 102.92 NA NA 748 748 Carrier H 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 Arthrod,interbdy Tech;lumbar,allogf 65 0.67 117.33 NA NA 749 749 Carrier H 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63047 Laminectomy W Facetectomy-lumbar 31 0.55 94.86 NA NA 750 750 Carrier H 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27487 Revis.totl Knee Arthroplas,w/wo Allogft; 10 1 52.8 NA NA 751 751 Carrier H 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27134 Revis.tot.hip Arthropl;both Compnts 9 1 90 NA NA 752 752 Carrier H 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22802 Arthrod,post,spin.deform,gft;7+vert 7 1 61.71 NA NA 753 753 Carrier H 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 75894 Transcatheter Therapy Embolize Any Meth 6 1 68.57 NA NA 754 754 Carrier H 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22533 Arthrodesis, Lateral Extracavitary Technique, Including Minimal Diskectomy To Prepare Interspace; Lumbar 5 1 24 67.2 NA NA 755 755 Carrier H 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22804 Arthrodesis, 13 Or More Vertebral Segments 4 1 100.8 NA NA 756 756 Carrier H 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 38241 Hematopoietic Progenitor Cell (hpc);autologous Transplantation 4 1 24 64 NA NA 757 757 Carrier H 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27486 Revis.totl Knee Arthroplas;1 Compon 4 1 36 NA NA 758 758 Carrier H 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63056 Transped App/decomp;sgle;lumb 3 1 72 NA NA 759 759 Carrier H 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63045 Laminectomy W Facetectomy-cervical 5 0 48 84 NA NA 760 760 Carrier H 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22551 Arthodesis, Anterior Interbody, Including Disc Space Preparation, Discectomy, Osteophytectomy And Decompression Of Spinal Cord And/or Nerve Roots; Cervical Below C2 42 0 1 0.333333 75.13 NA NA 761 761 Carrier H 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43644 Laparoscopy, Surg, Gastric Restrictive Procedure; W Gastric Bypass And Roux-en-y Gastroenterostomy (roux Limb <= 150 Cm) 31 0 1 2 135.77 NA NA 762 762 Carrier H 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 55970 Intersex Op Male To Female 8 0 1 121.6 NA NA 763 763 Carrier H 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22600 Fusion Cervical Post < C1 8 0 1 1 153 NA NA 764 764 Carrier H 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22630 Arthrodesis Post Interbody-lumbar 7 0 1 154 NA NA 765 765 Carrier H 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22614 Arthrodesis, Each Additional Vertebral Segment 4 0 1 216 NA NA 766 766 Carrier H 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 20931 Allograft, Structural, For Spine Surgery Only; (list Separately In Addition To Code For Primary Procedure) 1 0 1 108 NA NA 767 767 Carrier H 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 38999 Unlisted Proc Hemic/lymphatic Syst 1 0 1 2 72 NA NA 768 768 Carrier H 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22214 Osteotomy Spine Post Appr-lumbar 1 0 1 72 NA NA 769 769 Carrier H 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27130 Replacement Hip Total Simple 116 0 0.9 12 44 NA NA 770 770 Carrier I 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft 7 1 23.04667278 NA NA 771 771 Carrier I 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 5 1 21.82893333 NA NA 772 772 Carrier I 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); 3 1 1.390000001 51.785 NA NA 773 773 Carrier I 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22845 Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure) 3 1 13.96756852 NA NA 774 774 Carrier I 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27447 Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) 11 0.91 13.08 NA NA 775 775 Carrier I 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22614 Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure) 4 0.75 7.796146042 NA NA 776 776 Carrier I 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22600 Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment 3 0.67 9.986528055 NA NA 777 777 Carrier I 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 47600 Cholecystectomy; 4 0 68.65444445 46.25231454 NA NA 778 778 Carrier I 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 47605 Cholecystectomy; with cholangiography 3 0 68.65444445 35.73902736 NA NA 779 779 Carrier I 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44204 Laparoscopy, surgical; colectomy, partial, with anastomosis 3 0 72.79083333 NA NA 780 780 Carrier I 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft 7 1 23.05 NA NA 781 781 Carrier I 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 5 1 21.83 NA NA 782 782 Carrier I 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); 3 1 1.39 51.79 NA NA 783 783 Carrier I 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22845 Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure) 3 1 13.97 NA NA 784 784 Carrier I 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27487 Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component 2 1 139.77 NA NA 785 785 Carrier I 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 23472 Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total shoulder)) 2 1 69.77 NA NA 786 786 Carrier I 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 2 1 33.62 199.4 NA NA 787 787 Carrier I 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) 2 1 0.09 NA NA 788 788 Carrier I 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22552 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2, each additional interspace (List separately in addition to code for separate procedure) 2 1 0.41 NA NA 789 789 Carrier I 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar 2 1 54.14 NA NA 790 790 Carrier I 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar 2 1 33.62 NA NA 791 791 Carrier I 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22551 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2 2 1 0.41 NA NA 792 792 Carrier I 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 23470 Arthroplasty, glenohumeral joint; hemiarthroplasty 2 1 23.76 32.3 NA NA 793 793 Carrier I 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43280 Laparoscopy, surgical, esophagogastric fundoplasty (eg, Nissen, Toupet procedures) 2 1 205.43 NA NA 794 794 Carrier I 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43280 Laparoscopy, surgical, esophagogastric fundoplasty (eg, Nissen, Toupet procedures) 2 0 1 205.43 NA NA 795 795 Carrier I 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63042 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar 1 0 1 67.21 NA NA 796 796 Carrier I 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 52332 Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type) 1 0 1 22.11 NA NA 797 797 Carrier I 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63012 Laminectomy with removal of abnormal facets and/or pars inter-articularis with decompression of cauda equina and nerve roots for spondylolisthesis, lumbar (Gill type procedure) 1 0 1 67.21 NA NA 798 798 Carrier I 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar 2 0 0.5 33.62 NA NA 799 799 Carrier I 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 2 0 0.5 33.62 NA NA 800 800 Carrier I 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar 2 0 0.5 54.14 NA NA 801 801 Carrier I 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 5 0 0.2 21.83 NA NA 802 802 Carrier J 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft 64 0.86 0.89 32.22 NA NA 803 803 Carrier J 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22845 Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure) 31 0.84 0.73 61.39 NA NA 804 804 Carrier J 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 25 0.8 0.18 64.04 NA NA 805 805 Carrier J 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 28 0.79 0.18 61.12 NA NA 806 806 Carrier J 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63048 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; each additional segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure) 27 0.78 72.88 NA NA 807 807 Carrier J 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar 34 0.77 0.18 68.48 NA NA 808 808 Carrier J 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27447 Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) 31 0.77 63.78 NA NA 809 809 Carrier J 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar 22 0.77 56.5 NA NA 810 810 Carrier J 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 54 0.74 0.35 70.67 NA NA 811 811 Carrier J 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) 25 0.72 0.15 52.33 NA NA 812 812 Carrier J 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22843 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments (List separately in addition to code for primary procedure) 7 1 89.48 17.8 NA NA 813 813 Carrier J 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29881 Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed 7 1 2.98 9.04 36.7 NA NA 814 814 Carrier J 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 38240 Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor 7 1 111.35 27.3 NA NA 815 815 Carrier J 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33340 Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, when performed, and radiological supervision and interpretation 5 1 106.12 NA NA 816 816 Carrier J 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15769 Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia) 5 1 123.06 NA NA 817 817 Carrier J 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22856 Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); single interspace, cervical 4 1 86.09 NA NA 818 818 Carrier J 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27486 Revision of total knee arthroplasty, with or without allograft; 1 component 4 1 0.41 52.8 NA NA 819 819 Carrier J 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 47370 Laparoscopy, surgical, ablation of 1 or more liver tumor(s); radiofrequency 4 1 89.51 NA NA 820 820 Carrier J 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63012 Laminectomy with removal of abnormal facets and/or pars inter-articularis with decompression of cauda equina and nerve roots for spondylolisthesis, lumbar (Gill type procedure) 4 1 53.19 NA NA 821 821 Carrier J 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29882 Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral) 4 1 0.8 40.73 NA NA 822 822 Carrier J 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27446 Arthroplasty, knee, condyle and plateau; medial OR lateral compartment 6 0 0.5 168.88 NA NA 823 823 Carrier J 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43282 Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; with implantation of mesh 3 0 0.33 148.34 NA NA 824 824 Carrier J 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21141 Reconstruction midface, LeFort I; single piece, segment movement in any direction (eg, for Long Face Syndrome), without bone graft 3 0 0.33 183.67 NA NA 825 825 Carrier J 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 95720 Electroencephalogram (EEG), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, each increment of greater than 12 hours, up to 26 hours of EEG recording, interpret 6 0 0.17 85.74 NA NA 826 826 Carrier J 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21085 Impression and custom preparation; oral surgical splint 7 0 0.14 142.47 NA NA 827 827 Carrier J 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21196 Reconstruction of mandibular rami and/or body, sagittal split; with internal rigid fixation 7 0 0.14 146.54 NA NA 828 828 Carrier J 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 20931 Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure) 14 0 0.07 59.64 NA NA 829 829 Carrier J 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) 19 0 0.05 0.18 78.39 NA NA 830 830 Carrier J 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22551 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2 21 0 0.05 0.73 63.36 NA NA 831 831 Carrier J 2020 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 25 0 0.04 0.18 64.04 NA NA 832 832 Carrier K 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year NA NA MH Inpatient Adult 269 1 5.97 2.14 89.3 NA NA 833 833 Carrier K 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year NA NA MH Inpatient Adolescent 49 1 7.58 28.31 NA NA 834 834 Carrier K 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year NA NA MH Inpatient Child 15 1 11.13 0.02 NA NA 835 835 Carrier K 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27447 ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS 7 1 46 42.5 NA NA 836 836 Carrier K 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 23472 ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER 5 1 65 42.5 NA NA 837 837 Carrier K 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year NA NA SUD Inpatient Adult 5 1 5.63 0.02 NA NA 838 838 Carrier K 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year NA NA MH Inpatient Adult Intensive 5 1 0.05 213.9 NA NA 839 839 Carrier K 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year NA NA MH Acute Inpatient Adult 4 1 0.96 42.5 NA NA 840 840 Carrier K 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year NA NA SUD Inpatient Detox Adult 47 0.98 5.94 0.05 NA NA 841 841 Carrier K 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22633 ARTHDSIS POST/POSTEROLATRL/POSTINTERBODY LUMBAR 8 0.88 46 61 0 NA NA 842 842 Carrier K 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA MH Inpatient Adult 269 1 5.97 2.14 NA NA 843 843 Carrier K 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA MH Inpatient Adolescent 49 1 7.58 28.31 NA NA 844 844 Carrier K 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA MH Inpatient Child 15 1 11.13 0.02 NA NA 845 845 Carrier K 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 23472 ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER 5 1 65 NA NA 846 846 Carrier K 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA SUD Inpatient Adult 5 1 5.63 0.02 NA NA 847 847 Carrier K 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA MH Inpatient Adult Intensive 5 1 0.05 NA NA 848 848 Carrier K 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA MH Acute Inpatient Adult 4 1 0.96 NA NA 849 849 Carrier K 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27134 REVJ TOT HIP ARTHRP BTH W/WO AGRFT/ALGRFT 3 1 71 66 NA NA 850 850 Carrier K 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22558 ARTHRODESIS ANTERIOR INTERBODY LUMBAR 2 1 0 70 NA NA 851 851 Carrier K 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22551 ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2 2 1 109 NA NA 852 852 Carrier L 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96413 CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG 4 1 28.35 68.2 NA NA 853 853 Carrier L 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96409 CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG 2 1 28.35 NA NA 854 854 Carrier L 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96411 CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG 2 1 28.35 NA NA 855 855 Carrier L 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96415 CHEMOTHERAPY ADMN IV INFUSION TQ EA HR 2 1 68.2 35 NA NA 856 856 Carrier L 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96417 CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR 2 1 68.2 NA NA 857 857 Carrier L 2020 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 26951 AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR 2 0 92.3 NA NA 858 858 Carrier L 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96413 CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG 4 1 28.35 68.2 NA NA 859 859 Carrier L 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96409 CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG 2 1 28.35 NA NA 860 860 Carrier L 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96411 CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG 2 1 28.35 NA NA 861 861 Carrier L 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96415 CHEMOTHERAPY ADMN IV INFUSION TQ EA HR 2 1 68.2 NA NA 862 862 Carrier L 2020 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96417 CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR 2 1 68.2 NA NA 863 863 Carrier M 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Internal RMH Residential Mental Health 19 0.74 1.3 72 NA NA 864 864 Carrier M 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Internal DAA Detoxification 45 0.53 0.5 72 NA NA 865 865 Carrier M 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Internal MEN Mental Health 112 0.51 0.21 84 NA NA 866 866 Carrier M 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Internal RSA Residential Substance Abuse 53 0.45 1.7 21 NA NA 867 867 Carrier M 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Internal REH Rehabilitation 36 0.44 2.6 57 NA NA 868 868 Carrier M 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Internal DAR Drug & Alcohol Rehabilitation 6 0.17 0 NA NA 869 869 Carrier M 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Internal DAA Detoxification 16 1 4.5 229.5 NA NA 870 870 Carrier M 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Internal DAR Drug & Alcohol Rehabilitation 1 1 0 0 NA NA 871 871 Carrier M 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Internal MEN Mental Health 57 0.98 0.42 32.84 NA NA 872 872 Carrier M 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Internal RSA Residential Substance Abuse 24 0.96 1 118 NA NA 873 873 Carrier M 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Internal RMH Residential Mental Health 24 0.79 1 458 NA NA 874 874 Carrier M 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Internal REH Rehabilitation 14 0.71 5.14 77.14 NA NA 875 875 Carrier A 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 99251 Inpatient consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 20 minutes 1 0 41.59 NA NA 876 876 Carrier A 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99251 Inpatient consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 20 minutes 1 0 41.59 NA NA 877 877 Carrier N 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year NA NA Substance Abuse Residential 3 1 24 NA NA 878 878 Carrier N 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year NA NA Detox 1 1 24 NA NA 879 879 Carrier N 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year NA NA Mental Health Inpatient 1 1 24 NA NA 880 880 Carrier N 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA Substance Abuse Residential 3 1 24 NA NA 881 881 Carrier N 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA Detox 1 1 24 NA NA 882 882 Carrier N 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA Mental Health Inpatient 1 1 24 NA NA 883 883 Carrier B 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 Psychiatric Admission 1 1 26.8 0 0 NA NA 884 884 Carrier B 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 Psychiatric Admission 1 1 26.8 0 0 NA NA 885 885 Carrier C 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90870 ECT (W/ MONITORING) SINGLE SEIZURE 5 1 164.53 NA NA 886 886 Carrier C 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96132 NEUROPSYCHOLOGICAL TEST EVAL BY PHYS OR QUAL PROF; FIRST HOUR 2 1 350.4 NA NA 887 887 Carrier C 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96156 HEALTH BEHAVIOR ASSESSMENT, OR RE-ASSESSMENT 1 1 89.12 NA NA 888 888 Carrier C 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 912 OTHER THERAPY SERV 1 1 590.18 NA NA 889 889 Carrier C 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 126 ACCOM SEMI-PRVT DETOX/2BD 230 0.99 28.55 183.66 NA NA 890 890 Carrier C 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 124 ACCOM SEMI-PRVT 2 BED PSY 797 0.98 22.57 277.87 NA NA 891 891 Carrier C 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 900 OTHER THERAPY SERV 228 0.97 32.67 740 NA NA 892 892 Carrier C 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 128 ROOM AND BOARD 301 0.88 70.79 321.87 NA NA 893 893 Carrier C 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 BEHAV IDENTIFICATION ASSESSMNT, ADM BY PHYS OR QUAL PROF, EA 15 MINS 3 0.67 318.51 NA NA 894 894 Carrier C 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 905 BH/INTENS OP/PSYCH 2 0.5 852.84 NA NA 895 895 Carrier C 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90870 ECT (W/ MONITORING) SINGLE SEIZURE 5 1 164.53 NA NA 896 896 Carrier C 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96132 NEUROPSYCHOLOGICAL TEST EVAL BY PHYS OR QUAL PROF; FIRST HOUR 2 1 350.4 NA NA 897 897 Carrier C 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96156 HEALTH BEHAVIOR ASSESSMENT, OR RE-ASSESSMENT 1 1 89.12 NA NA 898 898 Carrier C 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 912 OTHER THERAPY SERV 1 1 590.18 NA NA 899 899 Carrier C 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 126 ACCOM SEMI-PRVT DETOX/2BD 230 0.99 28.55 183.66 NA NA 900 900 Carrier C 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 124 ACCOM SEMI-PRVT 2 BED PSY 797 0.98 22.57 277.87 NA NA 901 901 Carrier C 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 900 OTHER THERAPY SERV 228 0.97 32.67 740 NA NA 902 902 Carrier C 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 128 ROOM AND BOARD 301 0.88 70.79 321.87 NA NA 903 903 Carrier C 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97151 BEHAV IDENTIFICATION ASSESSMNT, ADM BY PHYS OR QUAL PROF, EA 15 MINS 3 0.67 318.51 NA NA 904 904 Carrier C 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 905 BH/INTENS OP/PSYCH 2 0.5 852.84 NA NA 905 905 Carrier C 2020 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 128 ROOM AND BOARD 301 0 0.01 70.79 321.87 NA NA 906 906 Carrier C 2020 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 900 OTHER THERAPY SERV 228 0 0 32.67 740 NA NA 907 907 Carrier C 2020 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 126 ACCOM SEMI-PRVT DETOX/2BD 230 0 0 28.55 183.66 NA NA 908 908 Carrier D 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90870 ELECTROCONVULSIVE THERAPY 1 1 87.96 NA NA 909 909 Carrier D 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 900 PSYCH TREATMENTS GEN THER 190 0.99 32.06 NA NA 910 910 Carrier D 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 124 ROOM AND BOARD 337 0.97 34 423.7 NA NA 911 911 Carrier D 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 126 ROOM AND BOARD 91 0.93 27.08 4.07 NA NA 912 912 Carrier D 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 128 ROOM AND BOARD 311 0.89 39.95 732.43 NA NA 913 913 Carrier D 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90870 ELECTROCONVULSIVE THERAPY 1 1 87.96 NA NA 914 914 Carrier D 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 900 PSYCH TREATMENTS GEN THER 190 0.99 32.06 NA NA 915 915 Carrier D 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 124 ROOM AND BOARD 337 0.97 34 423.7 NA NA 916 916 Carrier D 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 126 ROOM AND BOARD 91 0.93 27.08 4.07 NA NA 917 917 Carrier D 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 128 ROOM AND BOARD 311 0.89 39.95 732.43 NA NA 918 918 Carrier D 2020 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 124 ROOM AND BOARD 337 0 0.01 34 423.7 NA NA 919 919 Carrier D 2020 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 128 ROOM AND BOARD 311 0 0.01 39.95 732.43 NA NA 920 920 Carrier E 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 ROOM & BOARD, SEMIPRIVATE TWO-BED - PSYCHIATRIC 57 1 17.5 NA NA 921 921 Carrier E 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 128 ROOM & BOARD, SEMIPRIVATE TWO-BED - REHABILITATION 5 1 21.2 NA NA 922 922 Carrier E 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 194 SUBACUTE CARE, LEVEL IV 3 1 9.7 NA NA 923 923 Carrier E 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0005 ALCOHOL AND/OR DRUG SERVICES GROUP COUNSELING BY CLINICIAN 1 1 26.2 NA NA 924 924 Carrier E 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 99284 EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY 1 1 45.8 NA NA 925 925 Carrier E 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 129 ROOM & BOARD, SEMIPRIVATE TWO-BED - OTHER 1 1 68.2 NA NA 926 926 Carrier E 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1002 BEHAVIORAL HEALTH ACCOMMODATIONS, RESIDENTIAL TREATMENT, CHEM DEP 10 0.9 33.2 NA NA 927 927 Carrier E 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1001 BEHAVIORAL HEALTH ACCOMMODATIONS, RESIDENTIAL TREATMENT, PSYCHIATRIC 12 0.83 26.1 NA NA 928 928 Carrier E 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 99255 INITIAL INPATIENT CONSULT NEW/ESTAB PT 110 MIN 1 0 72.4 NA NA 929 929 Carrier E 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 136 ROOM & BOARD, THREE AND FOUR BEDS - DETOXIFICATION 1 0 98.4 NA NA 930 930 Carrier E 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 ROOM & BOARD, SEMIPRIVATE TWO-BED - PSYCHIATRIC 57 1 17.5 NA NA 931 931 Carrier E 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 128 ROOM & BOARD, SEMIPRIVATE TWO-BED - REHABILITATION 5 1 21.2 NA NA 932 932 Carrier E 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 194 SUBACUTE CARE, LEVEL IV 3 1 9.7 NA NA 933 933 Carrier E 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0005 ALCOHOL AND/OR DRUG SERVICES GROUP COUNSELING BY CLINICIAN 1 1 26.2 NA NA 934 934 Carrier E 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99284 EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY 1 1 45.8 NA NA 935 935 Carrier E 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 129 ROOM & BOARD, SEMIPRIVATE TWO-BED - OTHER 1 1 68.2 NA NA 936 936 Carrier E 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 114 ROOM & BOARD, PRIVATE - PSYCHIATRIC 1 1 NA NA 937 937 Carrier E 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1002 BEHAVIORAL HEALTH ACCOMMODATIONS, RESIDENTIAL TREATMENT, CHEM DEP 10 0.9 33.2 NA NA 938 938 Carrier E 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1001 BEHAVIORAL HEALTH ACCOMMODATIONS, RESIDENTIAL TREATMENT, PSYCHIATRIC 12 0.83 26.1 NA NA 939 939 Carrier E 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99255 INITIAL INPATIENT CONSULT NEW/ESTAB PT 110 MIN 1 0 72.4 NA NA 940 940 Carrier F 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Psychiatric 3 1 20 39 NA NA 941 941 Carrier F 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 128 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Rehabilitation 8 0.75 16 38 NA NA 942 942 Carrier F 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Psychiatric 3 1 20 39 NA NA 943 943 Carrier F 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 128 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Rehabilitation 8 0.75 16 38 NA NA 944 944 Carrier G 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 55970 INTERSEX SURG MALE FEMALE 2 1 117.5 NA NA 945 945 Carrier G 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90870 ELECTROCONVULSIVE THERAPY 2 1 65 NA NA 946 946 Carrier G 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 Room & Board - Semiprivate - 2 Beds - Psychiatric 1 1 NA NA 947 947 Carrier G 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 450 Emergency Room - General 1 0 432 NA NA 948 948 Carrier G 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 424 Physical Therapy - Evaluation or Reevaluation 1 0 NA NA 949 949 Carrier G 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 259 Pharmacy - Other Pharmacy 1 0 NA NA 950 950 Carrier G 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 440 Speech-Language Pathology - General 1 0 NA NA 951 951 Carrier G 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 300 Laboratory - General 1 0 NA NA 952 952 Carrier G 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 730 EKG/ECG (Electrocardiogram) - General 1 0 NA NA 953 953 Carrier G 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 636 Drugs Requiring Specific Identification - Drug Requiring Det 1 0 NA NA 954 954 Carrier G 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 55970 INTERSEX SURG MALE FEMALE 2 1 117.5 NA NA 955 955 Carrier G 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90870 ELECTROCONVULSIVE THERAPY 2 1 64.3 NA NA 956 956 Carrier G 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 Room & Board - Semiprivate - 2 Beds - Psychiatric 1 1 0 NA NA 957 957 Carrier G 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 120 Room & Board - Semiprivate - 2 Beds - General 1 1 146.3 NA NA 958 958 Carrier G 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 259 Pharmacy - Other Pharmacy 1 0 NA NA 959 959 Carrier G 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 450 Emergency Room - General 1 0 NA NA 960 960 Carrier G 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 440 Speech-Language Pathology - General 1 0 NA NA 961 961 Carrier G 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 636 Drugs Requiring Specific Identification - Drug Requiring Det 1 0 NA NA 962 962 Carrier G 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 730 EKG/ECG (Electrocardiogram) - General 1 0 NA NA 963 963 Carrier G 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 214 Coronary Care - Intermediate Coronary Care Unit (CCU) 1 0 NA NA 964 964 Carrier G 2020 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 120 Room & Board - Semiprivate - 2 Beds - General 1 0 1 146.3 NA NA 965 965 Carrier H 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0017 Behavioral health; residential (hospital residential treatment program), without room and board, per diem 3 1 3480 0 NA NA 966 966 Carrier H 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 128 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Rehabilitation 6 0.67 31 36 NA NA 967 967 Carrier H 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Psychiatric 4 0.5 29 NA NA 968 968 Carrier H 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0017 Behavioral health; residential (hospital residential treatment program), without room and board, per diem 3 1 0 3480 NA NA 969 969 Carrier H 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 128 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Rehabilitation 6 0.67 31 36 NA NA 970 970 Carrier H 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Psychiatric 4 0.5 29 NA NA 971 971 Carrier J 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H2036 Alcohol And/Or Drug Services 2 1 132.43 NA NA 972 972 Carrier J 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90791 Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed 1 1 21.85 NA NA 973 973 Carrier J 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0019 Alcohol And/Or Drug Services 4 0 24.56 NA NA 974 974 Carrier J 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0017 Alcohol And/Or Drug Services 1 0 142.44 NA NA 975 975 Carrier J 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 1 0 43.35 NA NA 976 976 Carrier J 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 99233 Alcohol And/Or Drug Services 1 0 NA NA 977 977 Carrier J 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 95720 Alcohol And/Or Drug Services 1 0 67.56 NA NA 978 978 Carrier J 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0018 Alcohol and/or other drug treatment program, per diem 1 0 73.15 NA NA 979 979 Carrier J 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0010 Psychiatric diagnostic evaluation 1 0 NA NA 980 980 Carrier J 2020 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0011 Electroencephalogram (EEG), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, each increment of greater than 12 hours, up to 26 hours of EEG recording, interpret 1 0 124.9 NA NA 981 981 Carrier J 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H2036 Alcohol and/or other drug treatment program, per diem 2 1 132.43 42.4 NA NA 982 982 Carrier J 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90791 Psychiatric diagnostic evaluation 1 1 21.85 14.4 NA NA 983 983 Carrier J 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0019 Alcohol And/Or Drug Services 4 0 24.56 18.9 NA NA 984 984 Carrier J 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0017 Alcohol And/Or Drug Services 1 0 142.44 NA NA 985 985 Carrier J 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99233 Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed 1 0 19.3 NA NA 986 986 Carrier J 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0010 Alcohol And/Or Drug Services 1 0 NA NA 987 987 Carrier J 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0018 Alcohol And/Or Drug Services 1 0 73.15 NA NA 988 988 Carrier J 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95720 Electroencephalogram (EEG), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, each increment of greater than 12 hours, up to 26 hours of EEG recording, interpret 1 0 67.56 NA NA 989 989 Carrier J 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 1 0 43.35 NA NA 990 990 Carrier J 2020 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0011 Alcohol And/Or Drug Services 1 0 124.9 NA NA 991 991 Carrier M 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC S4016 FROZEN IN VITRO FERTILIZATION CYCLE, CASE RATE 56 0.88 1.29 54.86 NA NA 992 992 Carrier M 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 19318 REDUCTION MAMMAPLASTY 41 0.59 1.76 14.63 NA NA 993 993 Carrier M 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 89253 ASSISTED EMBRYO HATCHING, MICROTECHNIQUES (ANY METHOD) 71 0.48 1.01 56.79 NA NA 994 994 Carrier M 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 89342 STORAGE, (PER YEAR); EMBRYO(S) 42 0.36 1.71 75.43 NA NA 995 995 Carrier M 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 89258 CRYOPRESERVATION; EMBRYO 42 0.31 1.71 86.29 NA NA 996 996 Carrier M 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC S4015 COMPLETE IN VITRO FERTILIZATION CYCLE, CASE RATE; NOT OTHERWISE SPECIFIED 29 0.31 2.48 82.76 NA NA 997 997 Carrier M 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC S4011 IN VITRO FERTILIZATION; INCLUDING BUT NOT LIMITED TO IDENTIFICATION 51 0.2 1.41 64.47 NA NA 998 998 Carrier M 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC S4022 ASSISTED OOCYTE FERTILIZATION, CASE RATE 61 0.16 1.18 74.75 NA NA 999 999 Carrier M 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 89290 BIOPSY, OOCYTE POLAR BODY OR EMBRYO BLASTOMERE, MICROTECHNIQUE (FOR PRE-IMPLANTATION GENETIC DIAGNOSIS); LESS THAN OR EQUAL TO 5 EMBRYOS 39 0.05 1.85 78.77 NA NA 1000 1000 Carrier M 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 89291 BIOPSY, OOCYTE POLAR BODY OR EMBRYO BLASTOMERE, MICROTECHNIQUE (FOR PRE-IMPLANTATION GENETIC DIAGNOSIS); GREATER THAN 5 EMBRYOS 39 0.05 1.85 70.77 NA NA 1001 1001 Carrier M 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58322 ARTIFICIAL INSEMINATION; INTRA-UTERINE 23 1 3.13 65.74 NA NA 1002 1002 Carrier M 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19325 MAMMAPLASTY, AUGMENTATION; WITH PROSTHETIC IMPLANT 17 1 4.24 31.06 NA NA 1003 1003 Carrier M 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S4016 FROZEN IN VITRO FERTILIZATION CYCLE, CASE RATE 56 0.88 1.29 54.86 NA NA 1004 1004 Carrier M 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99499 UNLISTED EVALUATION AND MANAGEMENT SERVICE 16 0.88 4.5 27 NA NA 1005 1005 Carrier M 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63047 LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT(S) (EG; SPINAL OR LATERAL RECESS STENOSIS) SINGLE VERTEBRAL SEGMENT; LUMBAR 23 0.78 3.13 29.22 NA NA 1006 1006 Carrier M 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63030 LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC; 1 INTERSPACE, LUMBAR 25 0.76 2.88 32.64 NA NA 1007 1007 Carrier M 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 36475 ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, RADIOFREQUENCY; FIRST VEIN TREATED 27 0.74 2.67 16.89 NA NA 1008 1008 Carrier M 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19318 REDUCTION MAMMAPLASTY 41 0.59 1.76 14.63 NA NA 1009 1009 Carrier M 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 89253 ASSISTED EMBRYO HATCHING, MICROTECHNIQUES (ANY METHOD) 71 0.48 1.01 56.79 NA NA 1010 1010 Carrier M 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 89342 STORAGE, (PER YEAR); EMBRYO(S) 42 0.36 1.71 75.43 NA NA 1011 1011 Carrier M 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC S4042 MANAGEMENT OF OVULATION INDUCTION (INTERPRETATION OF DIAGNOSTIC TESTS AND STUDIES, NON-FACE-TO-FACE MEDICAL MANAGEMENT OF THE PATIENT), PER CYCLE 2 0 1 12 NA NA 1012 1012 Carrier M 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 76948 ULTRASONIC GUIDANCE FOR ASPIRATION OF OVA, IMAGING AND INTERPRETATION 2 0 0.67 12 NA NA 1013 1013 Carrier M 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 58970 FOLLICLE PUNCTURE FOR OOCYTE RETRIEVAL, ANY METHOD 2 0 0.5 12 NA NA 1014 1014 Carrier M 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 76942 ULTRASONIC GUIDANCE FOR NEEDLE PLACEMENT (EG, BIOPSY, ASPIRATION, INJECTION, LOCALIZATION DEVICE), IMAGING SUPERVISION AND INTERPRETATION 2 0 0.5 12 NA NA 1015 1015 Carrier M 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22856 TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, INCLUDING DISCECTOMY WITH END PLATE PREPARATION (INCLUDES OSTEOPHYTECTOMY FOR NERVE ROOT OR SPINAL CORD DECOMPRESSION AND MICRODISSECTION); SINGLE INTERSPACE, CERVICAL 2 0 0.4 48 NA NA 1016 1016 Carrier M 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 36471 INJECTION OF SCLEROSING SOLUTION; MULTIPLE VEINS, SAME LEG 1 0 0.33 48 NA NA 1017 1017 Carrier M 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 58974 EMBRYO TRANSFER, INTRAUTERINE 2 0 0.29 12 NA NA 1018 1018 Carrier M 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC S4015 COMPLETE IN VITRO FERTILIZATION CYCLE, CASE RATE; NOT OTHERWISE SPECIFIED 2 0 0.1 12 NA NA 1019 1019 Carrier M 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 89258 CRYOPRESERVATION; EMBRYO 2 0 0.07 12 NA NA 1020 1020 Carrier M 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 89253 ASSISTED EMBRYO HATCHING, MICROTECHNIQUES (ANY METHOD) 2 0 0.05 12 NA NA 1021 1021 Carrier A 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74176 Computed tomography, abdomen and pelvis; without contrast material 304 0.94 10.5 5.5 NA NA 1022 1022 Carrier A 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography 280 0.91 5.8 NA NA 1023 1023 Carrier A 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material 229 0.88 4.5 NA NA 1024 1024 Carrier A 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73221 Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s) 124 0.87 6.1 NA NA 1025 1025 Carrier A 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72148 Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material 194 0.78 9.5 NA NA 1026 1026 Carrier A 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 550 0.77 9.9 22.8 NA NA 1027 1027 Carrier A 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97014 Application of a modality to 1 or more areas; electrical stimulation (unattended) 162 0.77 16.2 24.4 NA NA 1028 1028 Carrier A 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97140 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes 505 0.75 12 23.6 NA NA 1029 1029 Carrier A 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 241 0.73 24.7 NA NA 1030 1030 Carrier A 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97112 Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities 288 0.71 25.5 NA NA 1031 1031 Carrier A 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29827 Arthroscopy, shoulder, surgical; with rotator cuff repair 26 1 67.57 NA NA 1032 1032 Carrier A 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 73722 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s) 14 1 3.61 NA NA 1033 1033 Carrier A 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93303 Transthoracic echocardiography for congenital cardiac anomalies; complete 13 1 1.73 NA NA 1034 1034 Carrier A 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77046 Magnetic resonance imaging, breast, without contrast material; unilateral 12 1 20.09 2.04 NA NA 1035 1035 Carrier A 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70480 Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material 12 1 0.02 NA NA 1036 1036 Carrier A 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72125 Computed tomography, cervical spine; without contrast material 11 1 2.82 NA NA 1037 1037 Carrier A 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29888 Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction 11 1 45.32 NA NA 1038 1038 Carrier A 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72157 Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; thoracic 9 1 5.38 NA NA 1039 1039 Carrier A 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64495 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure) 9 1 5.33 NA NA 1040 1040 Carrier A 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 73218 Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s) 9 1 5.92 NA NA 1041 1041 Carrier A 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58552 Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) 9 1 55.22 NA NA 1042 1042 Carrier A 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 42145 Palatopharyngoplasty (eg, uvulopalatopharyngoplasty, uvulopharyngoplasty) 1 0 1 93.99 NA NA 1043 1043 Carrier A 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 58353 Endometrial ablation, thermal, without hysteroscopic guidance 1 0 1 173.5 NA NA 1044 1044 Carrier A 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43282 Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; with implantation of mesh 1 0 1 317.1 NA NA 1045 1045 Carrier A 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22899 Unlisted procedure, spine 1 0 1 101.25 NA NA 1046 1046 Carrier A 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22858 Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); second level, cervical (List separately in addition to code for primary procedure) 4 0 0.5 0.44 188.61 NA NA 1047 1047 Carrier A 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22856 Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); single interspace, cervical 4 0 0.5 0.44 188.61 NA NA 1048 1048 Carrier A 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64590 Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling 2 0 0.5 81.09 NA NA 1049 1049 Carrier A 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 29867 Arthroscopy, knee, surgical; osteochondral allograft (eg, mosaicplasty) 2 0 0.5 17.01 NA NA 1050 1050 Carrier A 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43281 Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; without implantation of mesh 5 0 0.4 206.86 NA NA 1051 1051 Carrier A 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43280 Laparoscopy, surgical, esophagogastric fundoplasty (eg, Nissen, Toupet procedures) 5 0 0.4 217.56 NA NA 1052 1052 Carrier N 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 77049 Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; bilateral 22 1 12 NA NA 1053 1053 Carrier N 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 MRI, brain, including brain stem; without contrast material(s), followed by contrast material(s) and further sequences 51 0.96 12 NA NA 1054 1054 Carrier N 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64483 Injection, anesthetic agent and/or steroid, transforaminal epidural;lumbar or sacral, single level 22 0.95 12 NA NA 1055 1055 Carrier N 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74177 Computed tomography, abdomen and pelvis; with contrast material(s 77 0.91 12 NA NA 1056 1056 Carrier N 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 MRI, any joint of lower extremity; without contrast materia 81 0.88 12 NA NA 1057 1057 Carrier N 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 71260 Computed tomography (CT), thorax; with contrast material(s) 57 0.88 12 NA NA 1058 1058 Carrier N 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74183 MRI, abdomen; without contrast material(s), followed by with contrast material(s) and further sequences 24 0.83 12 NA NA 1059 1059 Carrier N 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72141 MRI, spinal canal and contents, cervical; without contrast material 40 0.82 12 NA NA 1060 1060 Carrier N 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72148 MRI spinal canal and contents, lumbar; without contrast material 52 0.69 12 NA NA 1061 1061 Carrier N 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73221 MRI, any joint of upper extremity; without contrast material(s) 30 0.67 12 NA NA 1062 1062 Carrier N 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63650 Percutaneous implantation of neurostimulator electrode array, epidural 12 1 12 NA NA 1063 1063 Carrier N 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 75571 Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium 12 1 12 NA NA 1064 1064 Carrier N 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J1745 INFLIXIMAB NOT BIOSIMIL 10MG 10 1 72 126 NA NA 1065 1065 Carrier N 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 92507 SPEECH/HEARING THERAPY 8 1 48 61.7 NA NA 1066 1066 Carrier N 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63042 LAMINOTOMY SINGLE LUMBAR 4 1 12 NA NA 1067 1067 Carrier N 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J3380 INJECTION, VEDOLIZUMAB 4 1 12 NA NA 1068 1068 Carrier N 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J9035 BEVACIZUMAB INJECTION 4 1 12 NA NA 1069 1069 Carrier N 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99213 OFFICE O/P EST LOW 20-29 MIN 4 1 90 NA NA 1070 1070 Carrier N 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 30465 REPAIR NASAL STENOSIS 4 1 66 NA NA 1071 1071 Carrier N 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29999 Unlisted procedure, arthroscopy 4 1 12 NA NA 1072 1072 Carrier B 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 551 SKILLED NURSING VISIT IN HOME 126 0.98 18.97 129.96 0 NA NA 1073 1073 Carrier B 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99601 HOME INFUSION/SPCAILTY DRUG ADMINISTRATION-SKILLED NURSE VISIT 109 0.9 0 129.61 0 NA NA 1074 1074 Carrier B 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC J0585 INJECTION OF ONABOTULINUMTOXINA 99 0.87 22.83 206.59 0 NA NA 1075 1075 Carrier B 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64483 TRANSFORAMINAL EPIDURAL INJECTION INTO A SINGLE LEVEL EITHER LUMBAR OR SACRAL 80 0.84 34.84 234.69 0 NA NA 1076 1076 Carrier B 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0481 DEFNITIVE DRUG TEST FOR DRUG CLASSES 8-14 202 0.6 34.48 99.43 0 NA NA 1077 1077 Carrier B 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99212 OFFICE/OUTPATIENT VISIT ESTABLISHED 133 0.56 103.53 261.3 42.78 NA NA 1078 1078 Carrier B 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 0296T EXTENDED ECG RECORDING 71 0.55 219.48 153.64 0.15 NA NA 1079 1079 Carrier B 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0480 DEFNITIVE DRUG TEST FOR DRUG CLASSES 1-7 148 0.53 0 118.5 0 NA NA 1080 1080 Carrier B 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0483 DEFNITIVE DRUG TEST FOR DRUG CLASSES 22+ 139 0.37 0 116.46 0 NA NA 1081 1081 Carrier B 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0482 DEFNITIVE DRUG TEST FOR DRUG CLASSES 15-21 134 0.36 0 113.64 0 NA NA 1082 1082 Carrier B 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99442 PHONE EVALUTATION/MANAGEMENT PHYSICIAN WITH ESTABLISHED PATIENT OF 11-20 MINUTES 67 1 0 0.03 0 NA NA 1083 1083 Carrier B 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC Q5101 INJECTION OF FILGRASTIM-SNDZ(ZARXIO), BIOSIMILAR 1 MICROGRAM 53 1 11.17 67.28 0 NA NA 1084 1084 Carrier B 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 30520 SEPTOPLASTY OF DEVIATED SEPTUM 41 1 2.67 119.35 0 NA NA 1085 1085 Carrier B 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99443 PHONE EVALUTATION/MANAGEMENT PHYSICIAN WITH ESTABLISHED PATIENT OF 21-30 MINUTES 26 1 0 0 0 NA NA 1086 1086 Carrier B 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99441 PHONE EVALUTATION/MANAGEMENT PHYSICIAN WITH ESTABLISHED PATIENT OF 5-10 MINUTES 25 1 0 0 0 NA NA 1087 1087 Carrier B 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC J2350 INJECTION OF OCRELIZUMAB 1 MG 16 1 24.03 125.1 0 NA NA 1088 1088 Carrier B 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC J9299 INJECTION OF NIVOLUMAB 1 MG 13 1 14.86 96.29 0 NA NA 1089 1089 Carrier B 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J9306 INJECTION OF PERTUZUMAB, 1 MG 13 1 22.43 81.97 0 NA NA 1090 1090 Carrier B 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC Q5119 INJ RITUXIMAB-PVVR(RUXIENCE) BIOSIMILAR RUXIENCE 10 MG 13 1 80.71 91.25 0 NA NA 1091 1091 Carrier B 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 66982 EXTRACAPSULAR CATARACT REMOVAL WITH COMPLEX TECHNIQUE AND DEVICES 12 1 0 59.79 0 NA NA 1092 1092 Carrier B 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 88305 LEVEL IV-SURGICAL PATHOLOGY GROSS/MICROSCOPIC EXAM 3 0 1 0 0 0.22 NA NA 1093 1093 Carrier B 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 88321 CONSULTATION AND REPORT OF SLIDES PREPARED ELSEWHERE 1 0 1 0 0 0 NA NA 1094 1094 Carrier B 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 45385 COLONOSCOPY FLEXIBLE; WITH REMOVAL IF TUMOR/LESION BY SNARE TECHNIQUE 1 0 1 0 0 0 NA NA 1095 1095 Carrier B 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43239 UPPER GATROINTESTIAL ENDOSCOPY WITH REMOVAL OF ONE OR MORE BIOPSIES 1 0 1 0 0 0 NA NA 1096 1096 Carrier B 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 99202 OFFICE/OUTPATIENT NEW PATIENT FOR MEDICAL DECISION MAKING of 15-29 MINUTES 1 0 1 0 74.31 0 NA NA 1097 1097 Carrier B 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC J1650 INJECTION OF ENOXAPARIN SODIUM, 10 MG 1 0 1 0 0 0 NA NA 1098 1098 Carrier B 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 36415 COLLECTION VENOUS BLOOD VENIPUNCTURE 1 0 1 0 0 0 NA NA 1099 1099 Carrier B 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 11104 PUNCH BIOPSY SKIN SINGLE LESION 1 0 1 0 0 0 NA NA 1100 1100 Carrier B 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 80053 COMPREHENSIVE METABOLIC PANEL 1 0 1 0 0 0 NA NA 1101 1101 Carrier B 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 99203 OFFICE/OUTPATIENT VISIT NEW PATIENT 2 0 0.5 0 313.77 0.07 NA NA 1102 1102 Carrier C 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 COLONOSCOPY W/ BX SINGLE/MULT 3105 0.99 1.76 13.32 NA NA 1103 1103 Carrier C 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 COLONOSCOPY W/ BX SINGLE/MULT 4416 0.98 16.25 178.1 NA NA 1104 1104 Carrier C 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73218 MRI, UPPER EXTREMITY 2022 0.98 7.76 136.31 NA NA 1105 1105 Carrier C 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43235 UPPER GI ENDO DX (SEP PROC) 1686 0.97 13.06 159.87 NA NA 1106 1106 Carrier C 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 OFFICE VISIT E&M EST PT, MODERATE MDM, 30-39 MINS 52496 0.96 17.59 126.64 NA NA 1107 1107 Carrier C 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97802 MED NUTRIT THRPY INIT ASSESS 15 MIN 3230 0.96 25.88 156.24 NA NA 1108 1108 Carrier C 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99202 OFFICE VISIT E&M NEW PT STRAIGHTFORWARD MDM, 15-29 MINS 2367 0.93 17.17 250.08 NA NA 1109 1109 Carrier C 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99201 OFFICE VISIT E&M NEW SELF LIMIT/MINOR 10 13013 0.91 22.27 228.84 NA NA 1110 1110 Carrier C 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97110 THERA PROC 1+ AREAS EA 15 MIN THERA EXERCISES 4792 0.85 17.51 227.26 NA NA 1111 1111 Carrier C 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97124 THERA PROC 1+ AREAS EA 15 MIN MASSAGE 4430 0.83 15.79 189.24 NA NA 1112 1112 Carrier C 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 76885 ECHOGRAPHY OF INFANT HIPS, DYNAMIC 183 1 8.05 110.96 NA NA 1113 1113 Carrier C 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 73222 MRI JOINT UPR EXTREM W/ DYE 173 1 8.88 85.93 NA NA 1114 1114 Carrier C 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 91034 GASTROESOPHAGEAL REFLUX TEST 154 1 22.14 320.84 NA NA 1115 1115 Carrier C 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 76642 ULTRASOUND BREAST LIMITED 150 1 1.43 37.94 NA NA 1116 1116 Carrier C 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93971 BACK OFFICE DUPLEX SCAN, VEINS, UNILATERAL 122 1 8.51 81.04 NA NA 1117 1117 Carrier C 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58300 INSERT INTRAUTERINE DEVICE 108 1 6.32 124.43 NA NA 1118 1118 Carrier C 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93922 UPR/L XTREMITY ART 2 LEVE 107 1 13.3 160.33 NA NA 1119 1119 Carrier C 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93880 DUPLEX SCAN EXTRACRANIAL,BILAT 102 1 6.72 69.06 NA NA 1120 1120 Carrier C 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 78227 HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ 90 1 3.32 77.16 NA NA 1121 1121 Carrier C 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 76882 BACK OFFICE US, LIMITED, JOINT OR OTH NONVASC EXT, REAL TIME W/IMAG DOC 83 1 10.93 19.69 NA NA 1122 1122 Carrier C 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 81479 UNLISTED MOLELCULAR PATHOLOGY PROCEDURE 94 0 0.05 68.34 658.76 NA NA 1123 1123 Carrier C 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 812 ANES LWR INTESTINAL ENDO PX, INTRO DISTAL/DUODENUM, SCREENING COL 533 0 0.02 43.07 541.01 NA NA 1124 1124 Carrier C 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 813 ANES COMBINED UPR/LWR GI ENDOSCOPIC PX, INTRO BOTH PROX/DISTAL DUODENUM 188 0 0.02 29.52 297.51 NA NA 1125 1125 Carrier C 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 740 ANES UPR GI NDSC PX PROX DUO 142 0 0.02 37.07 682.69 NA NA 1126 1126 Carrier C 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97530 THERA ACTVI DIRECT PAT CONTACT EA 15 MIN 880 0 0.01 38.47 291.57 NA NA 1127 1127 Carrier C 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 811 ANES LWR INTESTINAL ENDO PX, INTRO DISTAL/DUODENUM, NOS 485 0 0.01 27.82 332.51 NA NA 1128 1128 Carrier C 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 78815 TUMORIMAGE PET/CT SKUL-THIGH 455 0 0.01 33.73 441.52 NA NA 1129 1129 Carrier C 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 99214 OFFICE VISIT E&M EST PT, MODERATE MDM, 30-39 MINS 52496 0 0 17.59 126.64 NA NA 1130 1130 Carrier C 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97110 THERA PROC 1+ AREAS EA 15 MIN THERA EXERCISES 4792 0 0 17.51 227.26 NA NA 1131 1131 Carrier C 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 99201 OFFICE VISIT E&M NEW SELF LIMIT/MINOR 10 13013 0 0 22.27 228.84 NA NA 1132 1132 Carrier D 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 COLONOSCOPY W/ BX SINGLE/MULT 1328 1 18.22 114.75 NA NA 1133 1133 Carrier D 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 MRI JNT OF LWR EXTRE W/O 543 1 1.6 57.01 NA NA 1134 1134 Carrier D 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74177 CT ABD & PELV W/CONTRAST 497 1 2.32 68.72 NA NA 1135 1135 Carrier D 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 OFFICE VISIT E&M EST PT, MODERATE MDM, 30-39 MINS 11503 0.99 13.4 184.68 NA NA 1136 1136 Carrier D 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73218 MRI, UPPER EXTREMITY 851 0.99 17.13 227.02 NA NA 1137 1137 Carrier D 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97802 MED NUTRIT THRPY INIT ASSESS 15 MIN 514 0.99 17.29 163.46 NA NA 1138 1138 Carrier D 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97110 THERA PROC 1+ AREAS EA 15 MIN THERA EXERCISES 781 0.98 18.93 195.01 NA NA 1139 1139 Carrier D 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99201 OFFICE VISIT E&M NEW SELF LIMIT/MINOR 10 1843 0.97 19.78 222.38 NA NA 1140 1140 Carrier D 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 762 MISC SERVICES 1176 0.97 29.19 126.32 NA NA 1141 1141 Carrier D 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97124 THERA PROC 1+ AREAS EA 15 MIN MASSAGE 643 0.97 58.09 226.44 NA NA 1142 1142 Carrier D 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70553 MRI BRAIN STEM W/O & W/DY 435 1 2.82 91.38 NA NA 1143 1143 Carrier D 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 73221 MAGNETIC RESONANCE (EG, PROTON) JOINT 284 1 2.8 72.68 NA NA 1144 1144 Carrier D 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77080 DXA BONE DENSITY STUDY 1+ SITS AXIAL SKE 267 1 8.11 202.78 NA NA 1145 1145 Carrier D 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 71260 COMPUTED TOMOGRAPHY, THORAX, DIAGNOSTIC; W/CONTRAST MATERIAL(S) 267 1 6.37 124.48 NA NA 1146 1146 Carrier D 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70551 MRI BRAIN STEM W/O DYE 250 1 14.16 189.13 NA NA 1147 1147 Carrier D 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72141 MRI NECK SPINE W/O DYE 232 1 0.78 90.43 NA NA 1148 1148 Carrier D 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 45378 DIAGNOSTIC COLONOSCOPY 211 1 9.53 71.09 NA NA 1149 1149 Carrier D 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70010 MYLOGRAPHY POSTERIOR FOSSA COMPLETE 195 1 8.23 249.34 NA NA 1150 1150 Carrier D 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 11102 TANGNTL BX SKIN SINGLE LE 191 1 1.62 117.94 NA NA 1151 1151 Carrier D 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70486 CT MAXILLOFACIAL W/O DYE 184 1 2.16 102.29 NA NA 1152 1152 Carrier D 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT J7330 CULTURED CHONDROCYTES IMP 3 0 0.67 1631.68 NA NA 1153 1153 Carrier D 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27279 ARTHRODESIS, SACROID JNT, PERCUTANE OR MINIMAL INVASIVE W/ IMAGE GUIDE 3 0 0.67 427.26 NA NA 1154 1154 Carrier D 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 77522 PROTON TRMT SIMPLE W/COMP 5 0 0.4 37.28 840.14 NA NA 1155 1155 Carrier D 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 19318 BREAST REDUCTION 63 0 0.03 71.94 450.34 NA NA 1156 1156 Carrier D 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 77049 MRI BREAST C-+ W/CAD BI 331 0 0.02 22.68 293.71 NA NA 1157 1157 Carrier D 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 731 ANES UPR GI NDSC PX NOS 209 0 0.02 32.07 318.62 NA NA 1158 1158 Carrier D 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 811 ANES LWR INTESTINAL ENDO PX, INTRO DISTAL/DUODENUM, NOS 354 0 0.01 35.69 334.59 NA NA 1159 1159 Carrier D 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 812 ANES LWR INTESTINAL ENDO PX, INTRO DISTAL/DUODENUM, SCREENING COL 244 0 0.01 45.43 594.55 NA NA 1160 1160 Carrier D 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 72148 MRI LUMBAR SPINE W/O DYE 462 0 0 14.08 122.05 NA NA 1161 1161 Carrier D 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 99201 OFFICE VISIT E&M NEW SELF LIMIT/MINOR 10 1843 0 0 19.78 222.38 NA NA 1162 1162 Carrier E 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97162 PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS 72 1 0.3 20 NA NA 1163 1163 Carrier E 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC NA PT IN THE HOME PER DIEM 70 1 8.3 NA NA 1164 1164 Carrier E 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97110 THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES 86 0.99 0.5 14.4 NA NA 1165 1165 Carrier E 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL 72 0.97 4.8 27.2 NA NA 1166 1166 Carrier E 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97161 PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS 749 0.96 10.5 19.4 NA NA 1167 1167 Carrier E 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99203 OFFICE/OUTPATIENT NEW LOW MDM 30-44 MINUTES 410 0.96 1.2 25.9 NA NA 1168 1168 Carrier E 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99213 OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN 103 0.95 0.5 27.2 NA NA 1169 1169 Carrier E 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97810 ACUPUNCTURE 1/> NDLES W/O ELEC STIMJ INIT 15 MIN 302 0.89 39.6 NA NA 1170 1170 Carrier E 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 98940 CHIROPRACTIC MANIPULATIVE TX SPINAL 1-2 REGIONS 165 0.76 39.2 NA NA 1171 1171 Carrier E 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99202 OFFICE/OUTPATIENT NEW SF MDM 15-29 MINUTES 68 0.63 11.4 35.2 NA NA 1172 1172 Carrier E 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97162 PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS 72 1 0.3 20 NA NA 1173 1173 Carrier E 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S9131 PT IN THE HOME PER DIEM 70 1 8.3 NA NA 1174 1174 Carrier E 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70553 MRI BRAIN WO/W CONTRAST 58 1 11.3 15.3 NA NA 1175 1175 Carrier E 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96040 MEDICAL GENETICS COUNSELING EACH 30 MINUTES 48 1 29.1 NA NA 1176 1176 Carrier E 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 73721 MRI RIGHT KNEE NO CONTRAST 37 1 17.3 16.5 NA NA 1177 1177 Carrier E 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70551 MRI BRAIN NO CONTRAST 36 1 0.1 16.1 NA NA 1178 1178 Carrier E 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 73721 MRI LEFT KNEE NO CONTRAST 29 1 1.5 8.5 NA NA 1179 1179 Carrier E 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99204 OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES 28 1 10.7 36.1 NA NA 1180 1180 Carrier E 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97813 ACUPUNCTURE 1/> NDLS W/ELEC STIMJ 1ST 15 MIN 26 1 32 NA NA 1181 1181 Carrier E 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 74177 CT ABD AND PELVIS W CONTRAST 26 1 7.1 28.7 NA NA 1182 1182 Carrier E 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97533 SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES 2 0 0.5 50.5 NA NA 1183 1183 Carrier E 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 10005 FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION 4 0 0.25 53.2 NA NA 1184 1184 Carrier E 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 99202 OFFICE/OUTPATIENT NEW SF MDM 15-29 MINUTES 68 0 0.03 11.4 35.2 NA NA 1185 1185 Carrier F 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 Mri Brain; W/o Contrast & W/contrast & A 60 1 0 0 NA NA 1186 1186 Carrier F 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation 62 0.94 30 123 NA NA 1187 1187 Carrier F 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27447 Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) 54 0.94 37 127 NA NA 1188 1188 Carrier F 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple 481 0.91 30 98 NA NA 1189 1189 Carrier F 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64483 Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, single level 86 0.91 2 111 NA NA 1190 1190 Carrier F 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 29881 Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed 75 0.91 19 94 NA NA 1191 1191 Carrier F 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 380 0.9 30 98 0 NA NA 1192 1192 Carrier F 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft 69 0.9 51 94 NA NA 1193 1193 Carrier F 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99215 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter. 119 0.61 36 113 NA NA 1194 1194 Carrier F 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter. 198 0.31 34 92 0 NA NA 1195 1195 Carrier F 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70553 Mri Brain; W/o Contrast & W/contrast & A 60 1 0.35 NA NA 1196 1196 Carrier F 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95800 Slp Stdy Unatnd W/hrt Rate/o2 Sat/resp/slp Time 20 1 9.33 NA NA 1197 1197 Carrier F 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 71260 Computed Tomography, Thorax, Diagnostic; With Contrast Material(s) 20 1 6.26 NA NA 1198 1198 Carrier F 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 37765 Stab phlebectomy of varicose veins, 1 extremity; 10-20 stab incisions 17 1 45 83 NA NA 1199 1199 Carrier F 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70491 Ct,soft Tissue Neck;w/contrast Mat. 11 1 16 NA NA 1200 1200 Carrier F 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 73722 Mri, Any Joint Of Lower Extremity; With Contrast Material(s) 9 1 NA NA 1201 1201 Carrier F 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72157 Mri Spinal Canal Wo & W Contrast; Thorac 9 1 25.41 NA NA 1202 1202 Carrier F 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72197 Mri, Pelvis; W/o Contrast Then With Contrast And Further Sequences 7 1 NA NA 1203 1203 Carrier F 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72156 Mri Spinal Wo & W Contrast: Cerv 7 1 29 NA NA 1204 1204 Carrier F 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90837 Psychotherapy, 60 Minutes With Patient 6 1 84 NA NA 1205 1205 Carrier F 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97110 Tx,1 Area,15 Min,ea.vist;ther.exerc 32 0 1 24 86 NA NA 1206 1206 Carrier F 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 19350 Reconstruct Nipple/areolar Unil 4 0 1 72 NA NA 1207 1207 Carrier F 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 15877 Suction Assist Lipectomy Trunk 1 0 1 84 NA NA 1208 1208 Carrier F 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 19303 Mastectomy Simple Complete 4 0 1 72 NA NA 1209 1209 Carrier F 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 55970 Intersex Op Male To Female 3 0 1 112 NA NA 1210 1210 Carrier F 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 54520 Orchiectomy Simple Unilat 1 0 1 16 120 NA NA 1211 1211 Carrier F 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 15840 Graft for facial nerve paralysis; free fascia graft (including obtaining fascia) 1 0 1 97 NA NA 1212 1212 Carrier F 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 15830 Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy 1 0 1 96 NA NA 1213 1213 Carrier F 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63020 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, cervical 1 0 1 118 NA NA 1214 1214 Carrier F 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 93622 Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left ventricular pacing and recording (List separately in addition to code for primary procedure) 1 0 1 118 NA NA 1215 1215 Carrier G 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 19325 BREAST AUGMENTATION WITH IMPLANT 1 1 98.2 NA NA 1216 1216 Carrier G 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63030 LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LUMBR 1 1 1 NA NA 1217 1217 Carrier G 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 33518 CORONARY ARTERY BYP W/VEIN and ARTERY GRAFT 2 VEIN 1 0 NA NA 1218 1218 Carrier G 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 52310 CYSTO W/SIMPLE REMOVAL STONE and STENT 1 0 45.8 NA NA 1219 1219 Carrier G 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 49329 UNLISTED LAPAROSCOPIC PX ABD PERTONEUM AND OMENTUM 1 0 0.6 NA NA 1220 1220 Carrier G 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20902 BONE GRAFT ANY DONOR AREA MAJOR/LARGE 1 0 107.2 NA NA 1221 1221 Carrier G 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43621 GSTRCT TOT W/ROUX-EN-Y RCNSTJ 1 0 16.7 NA NA 1222 1222 Carrier G 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 21040 EXCISION BENIGN TUMOR/CYST MANDIBLE ENCL and CURT 1 0 107.2 NA NA 1223 1223 Carrier G 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 49905 OMENTAL FLAP INTRA-ABDOMINAL 1 0 0.6 NA NA 1224 1224 Carrier G 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 23472 ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER 1 0 89.8 NA NA 1225 1225 Carrier G 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63030 LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LUMBR 1 1 1 NA NA 1226 1226 Carrier G 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 55970 INTERSEX SURG MALE FEMALE 1 1 98.2 NA NA 1227 1227 Carrier G 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19325 BREAST AUGMENTATION WITH IMPLANT 1 1 98.2 NA NA 1228 1228 Carrier G 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 49905 OMENTAL FLAP INTRA-ABDOMINAL 1 0 0.6 NA NA 1229 1229 Carrier G 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 21040 EXCISION BENIGN TUMOR/CYST MANDIBLE ENCL and CURT 1 0 107.2 NA NA 1230 1230 Carrier G 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 11044 DEBRIDEMENT BONE MUSCLE and /FASCIA 20 SQ CM OR LT 1 0 107.2 NA NA 1231 1231 Carrier G 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 23472 ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER 1 0 89.8 NA NA 1232 1232 Carrier G 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 49329 UNLISTED LAPAROSCOPIC PX ABD PERTONEUM AND OMENTUM 1 0 0.6 NA NA 1233 1233 Carrier G 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 31536 LARYNGOSCOPY W/BIOPSY MICROSCOPE/TELESCOPE 1 0 6 NA NA 1234 1234 Carrier G 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 52310 CYSTO W/SIMPLE REMOVAL STONE and STENT 1 0 45.8 NA NA 1235 1235 Carrier H 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0399 Home Sleep Test W/type Iii Portable Monitor 3012 0.97 3.7 NA NA 1236 1236 Carrier H 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 Echocardiography, Transthoracic, Real-time W/ Image Documentation (2d), Includes M-mode Recording, When Performed 4949 0.96 3.71 NA NA 1237 1237 Carrier H 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 Mri Brain; W/o Contrast & W/contrast & A 2493 0.96 5 NA NA 1238 1238 Carrier H 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43239 Esophagogastroduodenoscopy Flexible, Transoral; With Biopsy, Single Or Multiple 1983 0.94 16.35 47.47 NA NA 1239 1239 Carrier H 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74176 Ct Abd & Pelvis W/o Contrast 5042 0.93 1.71 5.72 NA NA 1240 1240 Carrier H 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 Magnetic Resonance Imaging, Any Jnt-lowe 4215 0.87 7.35 NA NA 1241 1241 Carrier H 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73221 Mri, Any Joint Of Upper Extremity 2218 0.84 8.38 NA NA 1242 1242 Carrier H 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72141 Mri,spin.canal,cerv;w/o Contrst Mat 1808 0.84 10.45 NA NA 1243 1243 Carrier H 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72148 Mri,spin.canal,lumb;w/o Cntrst Matl 3101 0.83 18 9.72 0 NA NA 1244 1244 Carrier H 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT MSMPT Physical Therapy 11186 0.71 1 39 NA NA 1245 1245 Carrier H 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29888 Arthroscopically Aided Anter,cruciate Li 151 1 72 81.43 NA NA 1246 1246 Carrier H 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 75557 Cardiac Mri For Morph 50 1 4 NA NA 1247 1247 Carrier H 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 75572 Ct Heart Contrast Eval Cardiac Structure&morph 36 1 NA NA 1248 1248 Carrier H 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43242 Egd Flex Transoral W/transendoscpic Us-guided Intramrl Or Transmrl Fine Ndl Aspiratn/biop(s) Esophag (incl Endoscpic Us Exam Of Esoph, Stom, &either Duod, Or Surg Altrd Stomac 33 1 18 48 NA NA 1249 1249 Carrier H 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63035 Laminotomy, With Decompression Of Nerve Root(s), Incl Partial Facetectomy, Formaninotomy And/or Excision Of Herniated Intervertabral Disc, Cervical Or Lumbar 28 1 24 70.55 NA NA 1250 1250 Carrier H 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77790 Supervise,handle,load Radioelement 26 1 15 NA NA 1251 1251 Carrier H 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77761 Intracavitary Radioelement Application;s 26 1 15 NA NA 1252 1252 Carrier H 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77316 Brachytherapy Isodose Plan; Simple (calculation[s] Made From 1 To 4 Sources, Or Remote Afterloading Brachytherapy, 1 Channel), Includes Basic Dosimetry Calculation(s) 26 1 15 NA NA 1253 1253 Carrier H 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 38241 Hematopoietic Progenitor Cell (hpc);autologous Transplantation 25 1 96 105.88 NA NA 1254 1254 Carrier H 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19380 Revision Of Reconstructed Breast (eg, Significant Removal Of Tissue, Re-advancement And/or Re-inset Of Flaps In Autologous Reconstruction Or Significant Capsular Revision 23 1 85.39 NA NA 1255 1255 Carrier H 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 31267 Nasal/sinus Endoscopy, Surgical, With Maxillary Antrostomy; With Removal Of Tissue From Maxillary Sinus 179 0 1 43.2 77.29 NA NA 1256 1256 Carrier H 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63048 Lam.,facetect,foraminot;ea Adtl.seg 169 0 1 72 94.97 NA NA 1257 1257 Carrier H 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 29888 Arthroscopically Aided Anter,cruciate Li 151 0 1 72 81.43 NA NA 1258 1258 Carrier H 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 31253 Nasal/sinus Endoscopy, Surgical With Ethmoidectomy; Total (anterior And Posterior), Incl Frontal Sinus Exploration, With Removal Of Tissue From Frontal Sinus, When Performed 66 0 1 24 74.48 NA NA 1259 1259 Carrier H 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 29874 Arthroscop Knee W Remov Loose Body 54 0 1 74.47 NA NA 1260 1260 Carrier H 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 31288 Endoscopy,surg, Wtih Sphenoidotomy; W Sphenoid Sinus Tissue Removal 49 0 1 85.66 NA NA 1261 1261 Carrier H 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 31259 Nasal/sinus Endoscopy, Surgical With Ethmoidectomy; Total (anterior And Posterior), Including Sphenoidotomy, With Removal Of Tissue From The Sphenoid Sinus 46 0 1 78.21 NA NA 1262 1262 Carrier H 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 31287 Endoscopy, Surgical, With Sphenoidotomy 44 0 1 24 98.71 NA NA 1263 1263 Carrier H 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27446 Arthropls,knee,cond/plat;medor Lat 44 0 1 61.5 76.36 NA NA 1264 1264 Carrier H 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 77386 Intensity Modulated Radiation Treatment Delivery (imrt), Includes Guidance And Tracking, When Performed; Complex 39 0 1 141.26 NA NA 1265 1265 Carrier I 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences 127 0.95 4.34 NA NA 1266 1266 Carrier I 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0399 Home sleep test/type III Porta 126 0.95 4.34 NA NA 1267 1267 Carrier I 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography 154 0.92 3.42 NA NA 1268 1268 Carrier I 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74176 Computed tomography, abdomen and pelvis; without contrast material 206 0.9 7.4 NA NA 1269 1269 Carrier I 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material 153 0.86 6.07 NA NA 1270 1270 Carrier I 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72148 Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material 117 0.85 17.35 8.48 NA NA 1271 1271 Carrier I 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 349 0.77 22.44 25.18 NA NA 1272 1272 Carrier I 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97112 Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities 134 0.76 161.21 24.25 NA NA 1273 1273 Carrier I 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97140 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes 350 0.75 22.44 24.49 NA NA 1274 1274 Carrier I 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 213 0.74 19.14 NA NA 1275 1275 Carrier I 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 74183 Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s), followed by with contrast material(s) and further sequences 22 1 4.1 NA NA 1276 1276 Carrier I 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29881 Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed 20 1 29.44 1.6 NA NA 1277 1277 Carrier I 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27447 Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) 15 1 6.52 NA NA 1278 1278 Carrier I 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72157 Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; thoracic 15 1 4.56 NA NA 1279 1279 Carrier I 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64493 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level 14 1 0.17 NA NA 1280 1280 Carrier I 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64494 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure) 12 1 0.18 NA NA 1281 1281 Carrier I 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 73222 Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) 10 1 9.42 NA NA 1282 1282 Carrier I 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft 10 1 7.16 NA NA 1283 1283 Carrier I 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58573 Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) 9 1 16.77 41.52 32.3 NA NA 1284 1284 Carrier I 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70496 Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing 9 1 2.29 NA NA 1285 1285 Carrier I 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63020 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, cervical 1 0 1 115.68 NA NA 1286 1286 Carrier I 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63045 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; cervical 3 0 0.67 53 NA NA 1287 1287 Carrier I 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 49568 Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) 2 0 0.5 118.09 NA NA 1288 1288 Carrier I 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 58353 Endometrial ablation, thermal, without hysteroscopic guidance 5 0 0.4 2.58 65.95 NA NA 1289 1289 Carrier I 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 29862 Arthroscopy, hip, surgical; with debridement/shaving of articular cartilage (chondroplasty), abrasion arthroplasty, and/or resection of labrum 3 0 0.33 35.73 NA NA 1290 1290 Carrier I 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 29875 Arthroscopy, knee, surgical; synovectomy, limited (eg, plica or shelf resection) (separate procedure) 3 0 0.33 38.49 NA NA 1291 1291 Carrier I 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 29824 Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure) 4 0 0.25 28.01 NA NA 1292 1292 Carrier I 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 49560 Repair initial incisional or ventral hernia; reducible 4 0 0.25 94.9 NA NA 1293 1293 Carrier I 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63030 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar 6 0 0.17 0.19 7.39 NA NA 1294 1294 Carrier I 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 29828 Arthroscopy, shoulder, surgical; biceps tenodesis 7 0 0.14 55.21 NA NA 1295 1295 Carrier J 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography 2275 0.96 2.9 504 NA NA 1296 1296 Carrier J 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0399 Home sleep test/type III Porta 1547 0.96 4.85 NA NA 1297 1297 Carrier J 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences 1375 0.95 6.85 3.9 NA NA 1298 1298 Carrier J 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74176 Computed tomography, abdomen and pelvis; without contrast material 2789 0.93 2.84 5.07 NA NA 1299 1299 Carrier J 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material 1955 0.87 0.21 6.06 NA NA 1300 1300 Carrier J 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72148 Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material 1473 0.85 0.29 6.88 NA NA 1301 1301 Carrier J 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 4410 0.79 20.98 30.65 NA NA 1302 1302 Carrier J 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 5491 0.78 15.33 31.52 NA NA 1303 1303 Carrier J 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97140 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes 5170 0.78 23.64 31.49 NA NA 1304 1304 Carrier J 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97112 Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities 3530 0.76 29.34 32.36 NA NA 1305 1305 Carrier J 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93312 Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report 91 1 0.3 17.8 NA NA 1306 1306 Carrier J 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70490 Computed tomography, soft tissue neck; without contrast material 43 1 5.07 NA NA 1307 1307 Carrier J 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72142 Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; with contrast material(s) 36 1 0.02 NA NA 1308 1308 Carrier J 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58552 Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) 30 1 71.66 NA NA 1309 1309 Carrier J 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72147 Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; with contrast material(s) 27 1 0 NA NA 1310 1310 Carrier J 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 78472 Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without additional quantitative processing 19 1 1.58 NA NA 1311 1311 Carrier J 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 75572 Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3D image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed) 18 1 2.18 19.6 NA NA 1312 1312 Carrier J 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29898 Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, extensive 18 1 0.27 0.03 27.3 NA NA 1313 1313 Carrier J 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77371 Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s) consisting of 1 session; multi-source Cobalt 60 based 17 1 2.16 60.64 36.7 NA NA 1314 1314 Carrier J 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70487 Computed tomography, maxillofacial area; with contrast material(s) 17 1 1.65 NA NA 1315 1315 Carrier J 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 29887 Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion with internal fixation 1 0 1 69.12 NA NA 1316 1316 Carrier J 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 37216 Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; without distal embolic protection 1 0 1 144.59 NA NA 1317 1317 Carrier J 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 37215 Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection 1 0 1 144.59 NA NA 1318 1318 Carrier J 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 0075T Transcatheter placement of extracranial vertebral artery stent(s), including radiologic supervision and interpretation, open or percutaneous; initial vessel 1 0 1 144.59 NA NA 1319 1319 Carrier J 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 67961 Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin 4 0 0.5 118.15 NA NA 1320 1320 Carrier J 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 81215 BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; known familial variant 2 0 0.5 60.51 NA NA 1321 1321 Carrier J 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43236 Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal injection(s), any substance 2 0 0.5 76.93 NA NA 1322 1322 Carrier J 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 99152 Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intraservice time, patient age 5 years or older 5 0 0.4 79.28 NA NA 1323 1323 Carrier J 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21121 Genioplasty; sliding osteotomy, single piece 5 0 0.4 76.91 NA NA 1324 1324 Carrier J 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 67917 Repair of ectropion; extensive (eg, tarsal strip operations) 6 0 0.33 108.64 NA NA 1325 1325 Carrier J 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21141 Reconstruction midface, LeFort I; single piece, segment movement in any direction (eg, for Long Face Syndrome), without bone graft 6 0 0.33 189.47 NA NA 1326 1326 Carrier J 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 58660 Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure) 3 0 0.33 50.22 NA NA 1327 1327 Carrier J 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27412 Autologous chondrocyte implantation, knee 3 0 0.33 71.84 NA NA 1328 1328 Carrier J 2020 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 20999 Unlisted procedure, musculoskeletal system, general 3 0 0.33 64.07 NA NA 1329 1329 Carrier K 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 ECHO, Complete with Doppler 666 1 NA NA 1330 1330 Carrier K 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 98941 Chiropractic Care 432 0.99 3.5 NA NA 1331 1331 Carrier K 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 98943 Chiropractic Care 220 0.99 2.75 213.9 NA NA 1332 1332 Carrier K 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year NA NA SUD Residential Adult 116 0.97 12.96 1.19 NA NA 1333 1333 Carrier K 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 71260 CT THORAX WITH CONTRAST 247 0.96 NA NA 1334 1334 Carrier K 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 MRI Brain WITH & WITHOUT CONTRAST 348 0.95 NA NA 1335 1335 Carrier K 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74177 CT ABDOMEN & PELVIS WITH CONTRAST 400 0.94 NA NA 1336 1336 Carrier K 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 MRI LOWER EXTREMITY JOINT WITHOUT CONTRAST 388 0.89 NA NA 1337 1337 Carrier K 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72148 MRI LUMBAR SPINE WITHOUT CONTRAST 275 0.81 NA NA 1338 1338 Carrier K 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73221 MRI UPPER EXTREMITY JOINT WITHOUT CONTRAST 204 0.78 NA NA 1339 1339 Carrier K 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA Psychological and Neuropsychological Test Administration 54 1 19.82 NA NA 1340 1340 Carrier K 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year NA 98942 Chiropractic Care 35 1 48 NA NA 1341 1341 Carrier K 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year NA 98940 Chiropractic Care 32 1 48 NA NA 1342 1342 Carrier K 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year NA 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ 29 1 0 1.38 NA NA 1343 1343 Carrier K 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA ABA Behavior Identification Assessments 27 1 5.97 NA NA 1344 1344 Carrier K 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA MH IOP Adolescent 26 1 0.92 NA NA 1345 1345 Carrier K 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA MH Residential Eating Disorder Adult 25 1 2.99 24.64 NA NA 1346 1346 Carrier K 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA ABA Direct Care Codes 25 1 2.63 NA NA 1347 1347 Carrier K 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year NA 87660 IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ 23 1 0 1.46 NA NA 1348 1348 Carrier K 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year NA 87480 IADNA CANDIDA SPECIES DIRECT PROBE TQ 23 1 0 1.46 NA NA 1349 1349 Carrier L 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ 57 1 6.52 NA NA 1350 1350 Carrier L 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 98940 Chiropractic Care 53 1 84 NA NA 1351 1351 Carrier L 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45378 COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD 76 0.99 15.2 7.75 NA NA 1352 1352 Carrier L 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE 73 0.99 18.16 7.47 NA NA 1353 1353 Carrier L 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 98941 Chiropractic Care 402 0.98 84 NA NA 1354 1354 Carrier L 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 98943 Chiropractic Care 206 0.97 84 NA NA 1355 1355 Carrier L 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 81479 UNLISTED MOLELCULAR PATHOLOGY PROCEDURE 54 0.96 6.06 35 NA NA 1356 1356 Carrier L 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 81420 FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS 48 0.65 31.54 NA NA 1357 1357 Carrier L 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95810 POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND 69 0.59 62.07 NA NA 1358 1358 Carrier L 2020 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95811 POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND 56 0.59 59.98 35 NA NA 1359 1359 Carrier L 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ 57 1 6.52 NA NA 1360 1360 Carrier L 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43239 EGD TRANSORAL BIOPSY SINGLE/MULTIPLE 47 1 1.31 7.38 NA NA 1361 1361 Carrier L 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43235 ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC 36 1 1.13 11.25 NA NA 1362 1362 Carrier L 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 45384 COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS 30 1 3.78 NA NA 1363 1363 Carrier L 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81374 HLA I LOW RESOLUTION ONE ANTIGEN EQUIVALENT EACH 19 1 1.06 NA NA 1364 1364 Carrier L 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43249 EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM 16 1 0.1 0.58 NA NA 1365 1365 Carrier L 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64493 NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL 13 1 21.36 NA NA 1366 1366 Carrier L 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81220 CFTR GENE ANALYSIS COMMON VARIANTS 13 1 0.13 NA NA 1367 1367 Carrier L 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58571 LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY 12 1 20.1 66.11 NA NA 1368 1368 Carrier L 2020 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58558 HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C 10 1 10.58 NA NA 1369 1369 Carrier M 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H2036 ALCOHOL AND/OR DRUG TREATMENT PROGRAM, PER DIEM 40 1 1.8 100.2 NA NA 1370 1370 Carrier M 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY, 60 MINUTES WITH PATIENT 39 0.97 1.85 217.85 NA NA 1371 1371 Carrier M 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 MENTAL HEALTH PARTIAL HOSPITALIZATION, TREATMENT, LESS THAN 24 HOURS 46 0.96 0.52 78.26 NA NA 1372 1372 Carrier M 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97156 FAMILY ADAPTIVE BEHAVIOR TREATMENT GUIDANCE, ADMINISTERED BY PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL (WITH OR WITHOUT THE PATIENT PRESENT),FACE- TO-FACE WITH GUARDIAN(S)/CAREGIVER(S), EACH 15 MINUTES 19 0.95 3.79 990.32 NA NA 1373 1373 Carrier M 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97153 ADAPTIVE BEHAVIOR TREATMENT BY PROTOCOL, ADMINISTERED BY TECHNICIAN UNDER THE DIRECTION OF A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, FACE-TO-FACE WITH ONE PATIENT, EACH 15 MINUTES 19 0.89 -195.79 1784.84 NA NA 1374 1374 Carrier M 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 BEHAVIOR IDENTIFICATION ASSESSMENT, ADMINISTERED BY A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, EACH 15 MINUTES OF THE PHYSICIANS OR OTHER QUALI FIED HEALTH CARE PROFESSIONALS TIME FACE-TO-FACE WITH PATIENT AND/OR GUARDIAN( S)/CAREGIVER(S) A 25 0.88 -148.8 744.96 NA NA 1375 1375 Carrier M 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97155 ADAPTIVE BEHAVIOR TREATMENT WITH PROTOCOL MODIFICATION, ADMINISTERED BY PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, WHICH MAY INCLUDE SIMULTANEOUS DIRECTION OF TECHNICIAN, FACE-TO-FACE WITH ONE PATIENT, EACH 15 MINUTES 23 0.87 -161.74 1562.09 NA NA 1376 1376 Carrier M 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; SUBSEQUENT MOTOR THRESHOLD RE-DETERMINATION WITH DELIVERY AND MANAGEMENT 20 0.65 3.6 102 NA NA 1377 1377 Carrier M 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; INITIAL, INCLUDING CORTICAL MAPPING, MOTOR THRESHOLD DETERMINATION, DELIVERY AND MANAGEMENT 26 0.62 2.77 216.92 NA NA 1378 1378 Carrier M 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; SUBSEQUENT DELIVERY AND MANAGEMENT, PER SESSION 28 0.61 2.57 294.86 NA NA 1379 1379 Carrier M 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H2036 ALCOHOL AND/OR DRUG TREATMENT PROGRAM, PER DIEM 40 1 1.8 100.2 NA NA 1380 1380 Carrier M 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY, 60 MINUTES WITH PATIENT 39 0.97 1.85 217.85 NA NA 1381 1381 Carrier M 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0035 MENTAL HEALTH PARTIAL HOSPITALIZATION, TREATMENT, LESS THAN 24 HOURS 46 0.96 0.52 78.26 NA NA 1382 1382 Carrier M 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97156 FAMILY ADAPTIVE BEHAVIOR TREATMENT GUIDANCE, ADMINISTERED BY PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL (WITH OR WITHOUT THE PATIENT PRESENT),FACE- TO-FACE WITH GUARDIAN(S)/CAREGIVER(S), EACH 15 MINUTES 19 0.95 3.79 990.32 NA NA 1383 1383 Carrier M 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97153 ADAPTIVE BEHAVIOR TREATMENT BY PROTOCOL, ADMINISTERED BY TECHNICIAN UNDER THE DIRECTION OF A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, FACE-TO-FACE WITH ONE PATIENT, EACH 15 MINUTES 19 0.89 -195.79 1784.84 NA NA 1384 1384 Carrier M 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97151 BEHAVIOR IDENTIFICATION ASSESSMENT, ADMINISTERED BY A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, EACH 15 MINUTES OF THE PHYSICIANS OR OTHER QUALI FIED HEALTH CARE PROFESSIONALS TIME FACE-TO-FACE WITH PATIENT AND/OR GUARDIAN( S)/CAREGIVER(S) A 25 0.88 -148.8 744.96 NA NA 1385 1385 Carrier M 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97155 ADAPTIVE BEHAVIOR TREATMENT WITH PROTOCOL MODIFICATION, ADMINISTERED BY PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, WHICH MAY INCLUDE SIMULTANEOUS DIRECTION OF TECHNICIAN, FACE-TO-FACE WITH ONE PATIENT, EACH 15 MINUTES 23 0.87 -161.74 1562.09 NA NA 1386 1386 Carrier M 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90869 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; SUBSEQUENT MOTOR THRESHOLD RE-DETERMINATION WITH DELIVERY AND MANAGEMENT 20 0.65 3.6 102 NA NA 1387 1387 Carrier M 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90867 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; INITIAL, INCLUDING CORTICAL MAPPING, MOTOR THRESHOLD DETERMINATION, DELIVERY AND MANAGEMENT 26 0.62 2.77 216.92 NA NA 1388 1388 Carrier M 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90868 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; SUBSEQUENT DELIVERY AND MANAGEMENT, PER SESSION 28 0.61 2.57 294.86 NA NA 1389 1389 Carrier A 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 13 1 15.5 18.2 NA NA 1390 1390 Carrier A 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97810 Acupuncture, 1 or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient 3 1 46.5 NA NA 1391 1391 Carrier A 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 19350 Nipple/areola reconstruction 2 1 50.5 NA NA 1392 1392 Carrier A 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 19303 Mastectomy, simple, complete 2 1 50.5 NA NA 1393 1393 Carrier A 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan 2 1 276.9 NA NA 1394 1394 Carrier A 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97811 Acupuncture, 1 or more needles; without electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure) 2 1 1.1 168 NA NA 1395 1395 Carrier A 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 Mental Health Partial Hospitalization, Treatment, Less Than 24 Hours 2 1 29.5 NA NA 1396 1396 Carrier A 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97156 Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes 2 1 276.9 393.6 NA NA 1397 1397 Carrier A 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97153 Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes 2 1 276.9 466.29 NA NA 1398 1398 Carrier A 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97155 Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes 2 1 276.9 576 NA NA 1399 1399 Carrier A 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual 17 0.82 23.7 NA NA 1400 1400 Carrier A 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H2036 Alcohol and/or other drug treatment program, per diem 8 0.75 6.8 NA NA 1401 1401 Carrier A 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90853 Group psychotherapy (other than of a multiple-family group) 2 0 2.9 22.1 NA NA 1402 1402 Carrier A 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 15877 Suction assisted lipectomy; trunk 2 0 50.5 461 NA NA 1403 1403 Carrier A 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 13 1 15.5 18.2 NA NA 1404 1404 Carrier A 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97810 Acupuncture, 1 or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient 3 1 46.5 NA NA 1405 1405 Carrier A 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19350 Nipple/areola reconstruction 2 1 50.5 NA NA 1406 1406 Carrier A 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97156 Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes 2 1 276.9 NA NA 1407 1407 Carrier A 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97811 Acupuncture, 1 or more needles; without electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure) 2 1 1.1 NA NA 1408 1408 Carrier A 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19303 Mastectomy, simple, complete 2 1 50.5 NA NA 1409 1409 Carrier A 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97151 Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan 2 1 276.9 NA NA 1410 1410 Carrier A 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0035 Mental Health Partial Hospitalization, Treatment, Less Than 24 Hours 2 1 29.5 NA NA 1411 1411 Carrier A 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97153 Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes 2 1 276.9 NA NA 1412 1412 Carrier A 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97155 Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes 2 1 276.9 NA NA 1413 1413 Carrier N 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 Mental Health Individual and Family Therapy 4 1 108.25 NA NA 1414 1414 Carrier N 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT S0201 Substance Abuse Partial Hospitalization Program 4 1 24 NA NA 1415 1415 Carrier N 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT S9480 Mental Health Intensive Outpatient Program 3 1 24 NA NA 1416 1416 Carrier N 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT H0015 Substance Abuse Intensive Outpatient Program 3 1 24 NA NA 1417 1417 Carrier N 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Transcranial Magnetic Stimulation (TMS) 2 1 24.5 NA NA 1418 1418 Carrier N 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT H0035 Psychiatric Treatment Partial Hospitalization 1 1 24 NA NA 1419 1419 Carrier N 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90837 Mental Health Individual and Family Therapy 4 1 108.25 NA NA 1420 1420 Carrier N 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT S0201 Substance Abuse Partial Hospitalization Program 4 1 24 NA NA 1421 1421 Carrier N 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT S9480 Mental Health Intensive Outpatient Program 3 1 24 NA NA 1422 1422 Carrier N 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT H0015 Substance Abuse Intensive Outpatient Program 3 1 24 NA NA 1423 1423 Carrier N 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90868 Transcranial Magnetic Stimulation (TMS) 2 1 24.5 NA NA 1424 1424 Carrier N 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT H0035 Psychiatric Treatment Partial Hospitalization 1 1 24 NA NA 1425 1425 Carrier B 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY WITH PATIENT AND FAMILY 60 MINUTES 10 1 0 156.67 0.11 NA NA 1426 1426 Carrier B 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96101 PSYHCOLOGICAL TESTING PER HOUR FACE TO FACE TIME WITH PATIENT 9 1 0 187.72 192.35 NA NA 1427 1427 Carrier B 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC S9480 INTENSIVE OUTPATIENT PSYCHIATRIC SERVICES PER DIEM 7 1 27.2 158.19 0 NA NA 1428 1428 Carrier B 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0004 BEHAVIORAL HEALTH COUNSELING AND THERAPY PER 15 MIN 6 1 0 52.62 0 NA NA 1429 1429 Carrier B 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90834 PSYCHOTHERAPY WITH PAIENT AND FAMILY 45 MINUTES 4 1 104.43 21.63 0.25 NA NA 1430 1430 Carrier B 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90870 ELECTROCONVULSIVE THERAPY; SINGLE SEIZURE 3 1 0 80.11 0 NA NA 1431 1431 Carrier B 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0015 INTENSIVE OUTPATIENT ALCOHOL AND/OR DRUG SERVICES ->=3HOURS A DAY/3DAYS A WEEK 2 1 0 118.37 0 NA NA 1432 1432 Carrier B 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 906 INTENSIVE BEHAVIORAL HEALTH TREATMENT SERVICES 15 0.93 0 95.29 0 NA NA 1433 1433 Carrier B 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90836 PSYCHOTHERAPY WITH PATIENT WITH EVALUTATION/MANAGEMENT LASTING 45 MIN 29 0.9 0 104.22 0.16 NA NA 1434 1434 Carrier B 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 905 INTENSIVE BEHAVIORAL HEALTH TREATMENT SERVICES PER DIEM 5 0.8 0 136.09 0 NA NA 1435 1435 Carrier B 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY WITH PATIENT AND FAMILY 60 MINUTES 10 1 0 156.67 0.11 NA NA 1436 1436 Carrier B 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96101 PSYHCOLOGICAL TESTINGG PER HOUR FACE TO FACE TIME WITH PATIENT 9 1 0 187.72 192.35 NA NA 1437 1437 Carrier B 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S9480 INTENSIVE OUTPATIENT PSYCHIATRIC SERVICES PER DIEM 7 1 27.2 158.19 0 NA NA 1438 1438 Carrier B 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0004 BEHAVIORAL HEALTH COUNSELING AND THERAPY PER 15 MIN 6 1 0 52.62 0 NA NA 1439 1439 Carrier B 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90834 PSYCHOTHERAPY WITH PAIENT AND FAMILY 45 MINUTES 4 1 104.43 21.63 0.25 NA NA 1440 1440 Carrier B 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90870 ELECTROCONVULSIVE THERAPY; SINGLE SEIZURE 3 1 0 80.11 0 NA NA 1441 1441 Carrier B 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0015 INTENSIVE OUTPATIENT ALCOHOL AND/OR DRUG SERVICES ->=3HOURS A DAY/3DAYS A WEEK 2 1 0 118.37 0 NA NA 1442 1442 Carrier B 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99212 OFFICE/OUTPATIENT VISIT ESTABLISHED PATIENT 1 1 0 289.85 0 NA NA 1443 1443 Carrier B 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96130 PSYCHOLOGICAL TESTING FACE TO FACE TIME WITH PATIENT FOR 1ST HOUR OF TREATMENT 1 1 0 198.1 0 NA NA 1444 1444 Carrier B 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0001 ALCOHOL AND/OR DRUG ASSESSMENT 1 1 0 145.13 0 NA NA 1445 1445 Carrier C 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY 60 MIN PATIENT 14129 0.99 46.32 193.87 NA NA 1446 1446 Carrier C 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90834 PSYCHOTHERAPY 45 MIN PATIENT 8109 0.99 51.5 97.9 NA NA 1447 1447 Carrier C 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90836 PSYCHOTHERAPY 45 MIN PATIENT WITH MEDICAL SVCS 4544 0.99 32.33 199.89 NA NA 1448 1448 Carrier C 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90853 GROUP PSYCHOTHERAPY 1210 0.99 74.93 113.09 NA NA 1449 1449 Carrier C 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90833 PSYCHOTHERAPY 30 MIN PATIENT WITH MEDICAL SVCS 206 0.98 176.38 NA NA 1450 1450 Carrier C 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 905 BH/INTENS OP/PSYCH 165 0.98 130.21 NA NA 1451 1451 Carrier C 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96130 PSYCHOLOGICAL TESTING EVAL BY PHYS OR QUAL PROF; FIRST HOUR 323 0.95 147.68 248.79 NA NA 1452 1452 Carrier C 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90791 PSYCHIATRIC DIAGNOSTIC EVAL W/O MEDICAL SERVICES 301 0.91 125.29 585.12 NA NA 1453 1453 Carrier C 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96132 NEUROPSYCHOLOGICAL TEST EVAL BY PHYS OR QUAL PROF; FIRST HOUR 175 0.87 65.84 442.04 NA NA 1454 1454 Carrier C 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 BEHAV IDENTIFICATION ASSESSMNT, ADM BY PHYS OR QUAL PROF, EA 15 MINS 214 0.79 53.58 648.05 NA NA 1455 1455 Carrier C 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96150 ASSESS HLTH/BEHAVE INIT 16 1 129.94 NA NA 1456 1456 Carrier C 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99492 INIT PSYCHIATRIC COLLABORATIVE CARE MGMT, FIRST 70 MINS/FIRST CAL MONTH 13 1 1047.05 NA NA 1457 1457 Carrier C 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97803 MED NUTRIT THRPY REASSESS PER 15 MIN 7 1 392.21 NA NA 1458 1458 Carrier C 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97802 MED NUTRIT THRPY INIT ASSESS 15 MIN 7 1 91.2 NA NA 1459 1459 Carrier C 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96156 HEALTH BEHAVIOR ASSESSMENT, OR RE-ASSESSMENT 4 1 637.48 NA NA 1460 1460 Carrier C 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96101 PSYCHOLOGICAL TESTING BILLED PER HR BY PHD 2 1 45.61 NA NA 1461 1461 Carrier C 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95819 EEG AWAKE & ASLEEP INCLUDE HYPERVENTILATION &/OR 2 1 137.98 NA NA 1462 1462 Carrier C 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96127 BRIEF EMOTION/BEHAVIOR ASSES, W/SCORING AND DOC, PER STNDARD INSTRUMNT 2 1 1061.95 NA NA 1463 1463 Carrier C 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96125 COGNITIVE TEST BY HC PRO 2 1 355.82 NA NA 1464 1464 Carrier C 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 0362T BHV ID SUPRT ASSMT EA 15 2 1 811.09 NA NA 1465 1465 Carrier C 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 128 ROOM AND BOARD 1 0 1 94.45 NA NA 1466 1466 Carrier C 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT J8999 ORAL PRESCRIPTION DRUG CHEMO 2 0 0.5 765.04 NA NA 1467 1467 Carrier C 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90868 TRANSCRANIAL MAG STIMJ TX DLVR & MGMT 144 0 0.02 48.06 462.93 NA NA 1468 1468 Carrier C 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97151 BEHAV IDENTIFICATION ASSESSMNT, ADM BY PHYS OR QUAL PROF, EA 15 MINS 214 0 0.01 53.58 648.05 NA NA 1469 1469 Carrier C 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90837 PSYCHOTHERAPY 60 MIN PATIENT 14129 0 0 46.32 193.87 NA NA 1470 1470 Carrier C 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90834 PSYCHOTHERAPY 45 MIN PATIENT 8109 0 0 51.5 97.9 NA NA 1471 1471 Carrier C 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90836 PSYCHOTHERAPY 45 MIN PATIENT WITH MEDICAL SVCS 4544 0 0 32.33 199.89 NA NA 1472 1472 Carrier D 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY 60 MIN PATIENT 832 1 23.30319625 190.66 NA NA 1473 1473 Carrier D 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90834 PSYCHOTHERAPY 45 MIN PATIENT 646 1 37.90055668 89.01 NA NA 1474 1474 Carrier D 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90836 PSYCHOTHERAPY 45 MIN PATIENT WITH MEDICAL SVCS 453 1 33.43685336 193.13 NA NA 1475 1475 Carrier D 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90853 GROUP PSYCHOTHERAPY 110 1 73.56166692 113.9 NA NA 1476 1476 Carrier D 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90791 PSYCHIATRIC DIAGNOSTIC EVAL W/O MEDICAL SERVICES 38 1 24.4785427 585.84 NA NA 1477 1477 Carrier D 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT S9480 PSYCH SVC INTENSIVE OUTPT 15 1 887.26 NA NA 1478 1478 Carrier D 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96130 PSYCHOLOGICAL TESTING EVAL BY PHYS OR QUAL PROF; FIRST HOUR 35 0.94 16.85305825 192.17 NA NA 1479 1479 Carrier D 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96132 NEUROPSYCHOLOGICAL TEST EVAL BY PHYS OR QUAL PROF; FIRST HOUR 82 0.93 44.40416865 452.8 NA NA 1480 1480 Carrier D 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 BEHAV IDENTIFICATION ASSESSMNT, ADM BY PHYS OR QUAL PROF, EA 15 MINS 68 0.84 27.44527833 277.07 NA NA 1481 1481 Carrier D 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 TRANSCRANIAL MAG STIMJ TX DLVR & MGMT 47 0.74 71.99097414 349.24 NA NA 1482 1482 Carrier D 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90853 GROUP PSYCHOTHERAPY 110 1 73.56166692 113.9 NA NA 1483 1483 Carrier D 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90791 PSYCHIATRIC DIAGNOSTIC EVAL W/O MEDICAL SERVICES 38 1 24.4785427 585.84 NA NA 1484 1484 Carrier D 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT S9480 PSYCH SVC INTENSIVE OUTPT 15 1 887.26 NA NA 1485 1485 Carrier D 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 905 BH/INTENS OP/PSYCH 14 1 200.31 NA NA 1486 1486 Carrier D 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT H2014 SKILLS TRAIN AND DEV, 15 MIN 11 1 693.3 NA NA 1487 1487 Carrier D 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99201 OFFICE VISIT E&M NEW SELF LIMIT/MINOR 10 9 1 1448.03 NA NA 1488 1488 Carrier D 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90833 PSYCHOTHERAPY 30 MIN PATIENT WITH MEDICAL SVCS 4 1 194.34 NA NA 1489 1489 Carrier D 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90870 ELECTROCONVULSIVE THERAPY 3 1 395.82 NA NA 1490 1490 Carrier D 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT H0020 ALCOHOL AND/OR DRUG SERVICES 3 1 651.14 NA NA 1491 1491 Carrier D 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99214 OFFICE VISIT E&M EST PT, MODERATE MDM, 30-39 MINS 3 1 13.84 NA NA 1492 1492 Carrier D 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90868 TRANSCRANIAL MAG STIMJ TX DLVR & MGMT 47 0 0.04 71.99097414 349.24 NA NA 1493 1493 Carrier D 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 96132 NEUROPSYCHOLOGICAL TEST EVAL BY PHYS OR QUAL PROF; FIRST HOUR 82 0 0.01 44.40416865 452.8 0 NA NA 1494 1494 Carrier E 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97153 ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN 51 1 24.5 216 NA NA 1495 1495 Carrier E 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0001 ALCOHOL AND/OR DRUG ASSESS 39 1 21.2 NA NA 1496 1496 Carrier E 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0020 ALCOHOL AND/OR DRUG SERVICES METHADONE ADMINISTRATION 34 1 19.2 NA NA 1497 1497 Carrier E 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN 20 1 15.5 600 NA NA 1498 1498 Carrier E 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90847 FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS 17 1 21.5 NA NA 1499 1499 Carrier E 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97156 FAMILY ADAPT BHV TX GDN PHYS/QHP EA 15 MIN 16 1 31.1 NA NA 1500 1500 Carrier E 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97155 ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN 14 1 33.6 NA NA 1501 1501 Carrier E 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES 305 0.99 25.9 NA NA 1502 1502 Carrier E 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION 735 0.97 26.3 NA NA 1503 1503 Carrier E 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90834 PSYCHOTHERAPY W/PATIENT 45 MINUTES 33 0.97 26.5 NA NA 1504 1504 Carrier E 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97153 ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN 51 1 24.5 NA NA 1505 1505 Carrier E 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0001 ALCOHOL AND/OR DRUG ASSESS 39 1 21.2 NA NA 1506 1506 Carrier E 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0020 ALCOHOL AND/OR DRUG SERVICES METHADONE ADMINISTRATION 34 1 19.2 NA NA 1507 1507 Carrier E 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97151 BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN 20 1 15.5 NA NA 1508 1508 Carrier E 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90847 FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS 17 1 21.5 NA NA 1509 1509 Carrier E 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97156 FAMILY ADAPT BHV TX GDN PHYS/QHP EA 15 MIN 16 1 31.1 NA NA 1510 1510 Carrier E 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97155 ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN 14 1 33.6 NA NA 1511 1511 Carrier E 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90899 UNLISTED PSYCHIATRIC SERVICE/PROCEDURE 13 1 7.3 NA NA 1512 1512 Carrier E 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90853 GROUP PSYCHOTHERAPY 13 1 53.5 NA NA 1513 1513 Carrier E 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97152 BEHAVIOR ID SUPPORT ASSMT BY 1 TECH EA 15 MIN 10 1 19.3 NA NA 1514 1514 Carrier F 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC S0201 Partial hospitalization services, less than 24 hours, per diem 16 0.88 23 72 NA NA 1515 1515 Carrier F 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 Mental health partial hospitalization, treatment, less than 24 hours 100 0.8 24 66 NA NA 1516 1516 Carrier F 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC S9480 Intensive outpatient psychiatric services, per diem 40 0.8 19 68 NA NA 1517 1517 Carrier F 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 20 0.8 3 55 NA NA 1518 1518 Carrier F 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 28 0.79 10 66 0 NA NA 1519 1519 Carrier F 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 23 0.78 10 62 NA NA 1520 1520 Carrier F 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0015 Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education 41 0.71 34 65 NA NA 1521 1521 Carrier F 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 Psychotherapy, 60 minutes with patient 22 0.45 32 91 18.3 NA NA 1522 1522 Carrier F 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96136 Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes 12 0.42 42 90 NA NA 1523 1523 Carrier F 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90853 Group psychotherapy (other than of a multiple-family group) 12 0.33 23 76 NA NA 1524 1524 Carrier F 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97156 Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes 11 1 35 95 NA NA 1525 1525 Carrier F 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97153 Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes 10 1 23 84 NA NA 1526 1526 Carrier F 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97151 Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan 9 1 16 92 NA NA 1527 1527 Carrier F 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0032 Mental health service plan development by nonphysician 6 1 85 NA NA 1528 1528 Carrier F 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H2019 Therapeutic behavioral services, per 15 minutes 6 1 85 NA NA 1529 1529 Carrier F 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97155 Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes 5 1 35 108 NA NA 1530 1530 Carrier F 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90836 Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) 1 1 98 NA NA 1531 1531 Carrier F 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90840 Psychotherapy for crisis; each additional 30 minutes (List separately in addition to code for primary service) 1 1 209 NA NA 1532 1532 Carrier F 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90686 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use 1 1 98 NA NA 1533 1533 Carrier F 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 1 1 75 NA NA 1534 1534 Carrier F 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90837 Psychotherapy, 60 minutes with patient 22 0 0.09 32 91 NA NA 1535 1535 Carrier F 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC H0035 Mental health partial hospitalization, treatment, less than 24 hours 100 0 0.01 24 66 NA NA 1536 1536 Carrier G 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT G0297 LOW DOSE CT SCAN FOR LUNG CANCER SCREENING 53 0.85 25.2 55.7 NA NA 1537 1537 Carrier G 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90870 ELECTROCONVULSIVE THERAPY 4 0.75 25.2 212.7 NA NA 1538 1538 Carrier G 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 THERAP REPETITIVE TMS TX SUBSEQ DELIVERY AND MNG 7 0.71 48.6 112 NA NA 1539 1539 Carrier G 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL and M 7 0.71 48.6 112 NA NA 1540 1540 Carrier G 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 19325 BREAST AUGMENTATION WITH IMPLANT 7 0.71 42.5 NA NA 1541 1541 Carrier G 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 REPET TMS TX SUBSEQ MOTR THRESHLD W/DELIV and MN 5 0.6 48.6 107.6 NA NA 1542 1542 Carrier G 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 55970 INTERSEX SURG MALE FEMALE 7 0.57 64 NA NA 1543 1543 Carrier G 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION 9 0.44 80.5 NA NA 1544 1544 Carrier G 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 80307 DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE 8 0.38 72.5 NA NA 1545 1545 Carrier G 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97530 THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN 5 0 16.3 NA NA 1546 1546 Carrier G 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81381 HLA I TYPING HIGH RESOLUTION 1 ALLELE/ALLELE GRP 3 1 0 NA NA 1547 1547 Carrier G 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT H0004 BEHAVIORAL HEALTH CNSL AND THERAPY PER 15 MINUTES 2 1 77.7 NA NA 1548 1548 Carrier G 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96164 HEALTH BEHAVIOR IVNTJ GROUP F2F 1ST 30 MIN 2 1 77.7 NA NA 1549 1549 Carrier G 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT H0035 MENTAL HEALTH PARTIAL HOSP TX LT 24 HOURS 2 1 29.7 25.6 NA NA 1550 1550 Carrier G 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 92523 EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION 2 1 175.3 NA NA 1551 1551 Carrier G 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96165 HEALTH BEHAVIOR IVNTJ GROUP F2F EA ADDL 15 MIN 2 1 77.7 NA NA 1552 1552 Carrier G 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19350 NIPPLE/AREOLA RECONSTRUCTION 2 1 110.7 NA NA 1553 1553 Carrier G 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96133 NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR 2 1 203.5 NA NA 1554 1554 Carrier G 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 17380 ELECTROLYSIS EPILATION EACH 30 MINUTES 1 1 99.8 NA NA 1555 1555 Carrier G 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70551 MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL 1 1 23.5 NA NA 1556 1556 Carrier G 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 96132 NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR 1 0 1 192.4 NA NA 1557 1557 Carrier G 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 92522 EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE 1 0 1 136.7 NA NA 1558 1558 Carrier G 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 92610 EVAL ORAL AND PHARYNGEAL SWLNG FUNCJ 1 0 1 136.7 NA NA 1559 1559 Carrier G 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 92523 EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION 2 0 0.5 175.3 NA NA 1560 1560 Carrier G 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 96133 NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR 2 0 0.5 203.5 NA NA 1561 1561 Carrier G 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT H0035 MENTAL HEALTH PARTIAL HOSP TX LT 24 HOURS 2 0 0.5 29.7 25.6 NA NA 1562 1562 Carrier G 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 96138 PSYCL/NRPSYCL TST TECH 2 Plus TST 1ST 30 MIN 3 0 0.33 203.5 NA NA 1563 1563 Carrier G 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 96121 NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR 3 0 0.33 203.5 NA NA 1564 1564 Carrier G 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 96139 PSYCL/NRPSYCL TST TECH 2 Plus TST EA ADDL 30 MIN 3 0 0.33 203.5 NA NA 1565 1565 Carrier G 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 96116 NEUROBEHAVIORAL STATUS XM PHYS/QHP 1ST HOUR 3 0 0.33 203.5 NA NA 1566 1566 Carrier H 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 Therapeutic Repetitive Transcranial Magnetic Simulation (tms) Treatment; Including Cortical Mapping, Motor Threshold Determination, Delivery And Mgmt 153 0.91 67 NA NA 1567 1567 Carrier H 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 Therapeutic Repetitive Transcranial Magnetic Stimulation (tms) Treatment; Subsequent Motor Threshold Re-determination With Delivery And Management 155 0.86 48 76 NA NA 1568 1568 Carrier H 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Therapeutic Repetitive Transcranial Magnetic Simulation (tms) Treatment; Initial, Including Cortical Mapping, Motor Threshold Determination, Subsequent Delivery And Mgmt. 170 0.58 48 77 146.3 NA NA 1569 1569 Carrier H 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90867 Therapeutic Repetitive Transcranial Magnetic Simulation (tms) Treatment; Including Cortical Mapping, Motor Threshold Determination, Delivery And Mgmt 153 0.91 67.34 NA NA 1570 1570 Carrier H 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90869 Therapeutic Repetitive Transcranial Magnetic Stimulation (tms) Treatment; Subsequent Motor Threshold Re-determination With Delivery And Management 155 0.86 48 76.46 NA NA 1571 1571 Carrier H 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90868 Therapeutic Repetitive Transcranial Magnetic Simulation (tms) Treatment; Initial, Including Cortical Mapping, Motor Threshold Determination, Subsequent Delivery And Mgmt. 170 0.58 48 77.34 NA NA 1572 1572 Carrier H 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90867 Therapeutic Repetitive Transcranial Magnetic Simulation (tms) Treatment; Including Cortical Mapping, Motor Threshold Determination, Delivery And Mgmt 153 0 0.33 67.34 NA NA 1573 1573 Carrier H 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90869 Therapeutic Repetitive Transcranial Magnetic Stimulation (tms) Treatment; Subsequent Motor Threshold Re-determination With Delivery And Management 155 0 0.22 48 76.46 NA NA 1574 1574 Carrier H 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90870 Electroconvulsive therapy (includes necessary monitoring) 5 0 0.2 17 92 NA NA 1575 1575 Carrier H 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90868 Therapeutic Repetitive Transcranial Magnetic Simulation (tms) Treatment; Initial, Including Cortical Mapping, Motor Threshold Determination, Subsequent Delivery And Mgmt. 170 0 0.1 48 77.34 NA NA 1576 1576 Carrier H 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC S0201 Partial hospitalization services, less than 24 hours, per diem 44 0 0.02 65 68 NA NA 1577 1577 Carrier I 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 Mental Health Partial Hospitalization, Treatment, Less Than 24 Hours 10 1 20.64 23.2 NA NA 1578 1578 Carrier I 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 8 1 37.06 NA NA 1579 1579 Carrier I 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 8 1 37.06 NA NA 1580 1580 Carrier I 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 8 1 37.06 NA NA 1581 1581 Carrier I 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H2036 Alcohol and/or other drug treatment program, per diem 6 1 57.31 NA NA 1582 1582 Carrier I 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 7 0.86 19.54 NA NA 1583 1583 Carrier I 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual 12 0.83 0.61 35.61 NA NA 1584 1584 Carrier I 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 2 0.5 72.67 NA NA 1585 1585 Carrier I 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97153 Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes 2 0.5 20.86 NA NA 1586 1586 Carrier I 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 81229 Cytogenomic constitutional (genome-wide) microarray analysis; interrogation of genomic regions for copy number and single nucleotide polymorphism (SNP) variants for chromosomal abnormalities 2 0.5 75.45 NA NA 1587 1587 Carrier I 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97155 Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes 2 0.5 20.86 NA NA 1588 1588 Carrier I 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97156 Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes 2 0.5 20.86 NA NA 1589 1589 Carrier I 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 2 0.5 72.02 352 NA NA 1590 1590 Carrier I 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0035 Mental Health Partial Hospitalization, Treatment, Less Than 24 Hours 10 1 20.64 23.2 NA NA 1591 1591 Carrier I 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 8 1 37.06 1.6 NA NA 1592 1592 Carrier I 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 8 1 37.06 NA NA 1593 1593 Carrier I 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 8 1 37.06 NA NA 1594 1594 Carrier I 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H2036 Alcohol and/or other drug treatment program, per diem 6 1 57.31 NA NA 1595 1595 Carrier I 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70553 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences 1 1 0 NA NA 1596 1596 Carrier I 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 98943 Chiropractic manipulative treatment (CMT); extraspinal, 1 or more regions 1 1 1.68 NA NA 1597 1597 Carrier I 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97140 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes 1 1 0.38 15.5 NA NA 1598 1598 Carrier I 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81244 FMR1 (fragile X mental retardation 1) (eg, fragile X mental retardation) gene analysis; characterization of alleles (eg, expanded size and promoter methylation status) 1 1 75.45 23 NA NA 1599 1599 Carrier I 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19303 Mastectomy, simple, complete 1 1 46.29 23.5 NA NA 1600 1600 Carrier I 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81321 PTEN (phosphatase and tensin homolog) (eg, Cowden syndrome, PTEN hamartoma tumor syndrome) gene analysis; full sequence analysis 1 1 75.45 NA NA 1601 1601 Carrier I 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97112 Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities 1 1 0.38 20.8 NA NA 1602 1602 Carrier I 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81323 PTEN (phosphatase and tensin homolog) (eg, Cowden syndrome, PTEN hamartoma tumor syndrome) gene analysis; duplication/deletion variant 1 1 75.45 8.7 NA NA 1603 1603 Carrier I 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97151 Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan 1 1 20.86 10.6 NA NA 1604 1604 Carrier I 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19350 Nipple/areola reconstruction 1 1 46.29 21.1 NA NA 1605 1605 Carrier I 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81243 FMR1 (fragile X mental retardation 1) (eg, fragile X mental retardation) gene analysis; evaluation to detect abnormal (eg, expanded) alleles 1 1 75.45 NA NA 1606 1606 Carrier I 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70551 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material 1 1 0 24 NA NA 1607 1607 Carrier I 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70450 Computed tomography, head or brain; without contrast material 1 1 0 10.6 NA NA 1608 1608 Carrier I 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 92522 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); 1 1 182.15 NA NA 1609 1609 Carrier I 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC H0035 Mental Health Partial Hospitalization, Treatment, Less Than 24 Hours 10 0 0 20.64 23.2 NA NA 1610 1610 Carrier J 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 235 0.99 28.44 17.34 NA NA 1611 1611 Carrier J 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H2036 Alcohol and/or other drug treatment program, per diem 105 0.92 42.57 NA NA 1612 1612 Carrier J 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 Mental Health Partial Hospitalization, Treatment, Less Than 24 Hours 96 0.92 35.94 60.64 NA NA 1613 1613 Carrier J 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 66 0.85 22.38 45.15 NA NA 1614 1614 Carrier J 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 57 0.81 25.39 38.91 NA NA 1615 1615 Carrier J 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 76 0.79 19.49 43.53 NA NA 1616 1616 Carrier J 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97155 Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes 48 0.75 74.9 NA NA 1617 1617 Carrier J 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual 248 0.74 57.33 NA NA 1618 1618 Carrier J 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97156 Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes 49 0.74 73.43 NA NA 1619 1619 Carrier J 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 92523 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language) 59 0.68 70.31 NA NA 1620 1620 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70553 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences 5 1 0 18.9 NA NA 1621 1621 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81229 Cytogenomic constitutional (genome-wide) microarray analysis; interrogation of genomic regions for copy number and single nucleotide polymorphism (SNP) variants for chromosomal abnormalities 5 1 16.24 NA NA 1622 1622 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70450 Computed tomography, head or brain; without contrast material 5 1 4.23 19.3 NA NA 1623 1623 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81243 FMR1 (fragile X mental retardation 1) (eg, fragile X mental retardation) gene analysis; evaluation to detect abnormal (eg, expanded) alleles 4 1 20.3 NA NA 1624 1624 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97814 Acupuncture, 1 or more needles; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure) 4 1 6.39 NA NA 1625 1625 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97813 Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient 4 1 6.39 NA NA 1626 1626 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 17380 Electrolysis epilation, each 30 minutes 3 1 126.07 NA NA 1627 1627 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 98943 Chiropractic manipulative treatment (CMT); extraspinal, 1 or more regions 3 1 0.84 NA NA 1628 1628 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC G0283 Electrical Stimulation (Unattended), To One Or More Areas For Indicati 3 1 35.97 0.1 NA NA 1629 1629 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81416 Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis, each comparator exome (eg, parents, siblings) (List separately in addition to code for primary procedure) 2 1 84.87 NA NA 1630 1630 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58571 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) 2 1 72.28 15.3 NA NA 1631 1631 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97124 Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion) 2 1 0.05 11.1 NA NA 1632 1632 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63650 Percutaneous implantation of neurostimulator electrode array, epidural 2 1 130.19 28.7 NA NA 1633 1633 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81415 Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis 2 1 84.87 NA NA 1634 1634 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64493 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level 2 1 211.34 NA NA 1635 1635 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 0362T Behavior identification supporting assessment, each 15 minutes of technicians' time face-to-face with a patient, requiring the following components: administration by the physician or other qualified health care professional who is on site; with the assistance of two or more technicians; for a patient who exhibits destructive behavior; completion in an environment that is customized to the patient's behavior. 2 1 107.44 NA NA 1636 1636 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64494 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure) 2 1 211.34 NA NA 1637 1637 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97164 Re-evaluation of physical therapy established plan of care, requiring these components: An examination including a review of history and use of standardized tests and measures is required; and Revised plan of care using a standardized patient assessment instrument and/or measurable assessment of functional outcome Typically, 20 minutes are spent face-to-face with the patient and/or family. 2 1 185.21 NA NA 1638 1638 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 17380 Electrolysis epilation, each 30 minutes 3 0 0.33 126.07 NA NA 1639 1639 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97152 Behavior identification-supporting assessment, administered by one technician under the direction of a physician or other qualified health care professional, face-to-face with the patient, each 15 minutes 11 0 0.09 103.21 NA NA 1640 1640 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97154 Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with two or more patients, each 15 minutes 12 0 0.08 45.83 NA NA 1641 1641 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 76 0 0.03 19.49 43.53 NA NA 1642 1642 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97153 Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes 46 0 0.02 77.58 NA NA 1643 1643 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97151 Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan 46 0 0.02 65.18 NA NA 1644 1644 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97155 Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes 48 0 0.02 74.9 NA NA 1645 1645 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97156 Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes 49 0 0.02 73.43 NA NA 1646 1646 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 57 0 0.02 25.39 38.91 NA NA 1647 1647 Carrier J 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 66 0 0.02 22.38 45.15 NA NA 1648 1648 Carrier K 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year NA NA Psychological and Neuropsychological Test Administration 54 1 19.82 NA NA 1649 1649 Carrier K 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year NA NA SUD IOP Adult 104 0.99 0.07 1.69 NA NA 1650 1650 Carrier K 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year NA NA SUD Partial Adult 103 0.99 1.38 15.18 NA NA 1651 1651 Carrier K 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year NA NA MH IOP Adult 93 0.99 9.08 NA NA 1652 1652 Carrier K 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year NA NA MH Partial Adult 90 0.98 0.4 2.48 35 NA NA 1653 1653 Carrier K 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year NA NA SUD Detox Residential Adult 54 0.98 0.66 4.09 NA NA 1654 1654 Carrier K 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year NA NA MH Residential Adult 44 0.98 1.92 14 NA NA 1655 1655 Carrier K 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year NA NA SUD Residential Adult 116 0.97 12.96 1.19 NA NA 1656 1656 Carrier K 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year NA NA MH Partial Eating Disorder Adult 32 0.97 6.9 12.18 NA NA 1657 1657 Carrier K 2020 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year NA NA Psychological Testing 67 0.93 25.38 NA NA 1658 1658 Carrier K 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA Psychological and Neuropsychological Test Administration 54 1 19.82 NA NA 1659 1659 Carrier K 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA ABA Behavior Identification Assessments 27 1 5.97 NA NA 1660 1660 Carrier K 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA MH IOP Adolescent 26 1 0.92 NA NA 1661 1661 Carrier K 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA MH Residential Eating Disorder Adult 25 1 2.99 24.64 NA NA 1662 1662 Carrier K 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA ABA Direct Care Codes 25 1 2.63 NA NA 1663 1663 Carrier K 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA MH IOP Eating Disorder Adult 24 1 7.84 NA NA 1664 1664 Carrier K 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA ABA Qualified Health Professional Services 24 1 2.73 NA NA 1665 1665 Carrier K 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA MH Residential Adolescent 23 1 0.05 6.66 NA NA 1666 1666 Carrier K 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA MH Partial Eating Disorder Adolescent 14 1 22.67 15.1 NA NA 1667 1667 Carrier K 2020 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA SUD Residential Adolescent 13 1 0.04 24.09 NA NA 1668 1668 Carrier K 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NA NA MH Partial Adolescent 20 0 0.95 40.45 NA NA 1669 1669 Carrier K 2020 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NA NA Transcranial Magnetic Stimulation (TMS) 17 0 0.59 44.03 NA NA 1670 1670 Carrier M 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2311 POWER WHEELCHAIR ACCESSORY, ELECTRONIC CONNECTION BETWEEN WHEELCHAIR CONTROLLER AND TWO OR MORE POWER SEATING SYSTEM MOTORS, INCLUDING ALL RELATED ELECTRONICS, INDICATOR FEATURE, MECHANICAL FUNCTION SELECTION SWITCH, AND FIXEDMOUNTING HARDWARE 2 1 72 0 2 NA NA 1671 1671 Carrier M 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0108 WHEELCHAIR COMPONENT OR ACCESSORY, NOT OTHERWISE SPECIFIED 2 1 72 0 2 NA NA 1672 1672 Carrier M 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0861 POWER WHEELCHAIR, GROUP 3 STANDARD, MULTIPLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS 2 1 72 0 2 NA NA 1673 1673 Carrier M 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC 92700 UNLISTED OTORHINOLARYNGOLOGICAL SERVICE OR PROCEDURE 1 1 48 0 1 NA NA 1674 1674 Carrier M 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0951 HEEL LOOP/HOLDER, WITH OR WITHOUT ANKLE STRAP, EACH 1 1 48 0 1 NA NA 1675 1675 Carrier M 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0953 WHEELCHAIR ACCESSORY, LATERAL THIGH OR KNEE SUPPORT, ANY TYPE INCLUDING FIXED MOUNTING HARDWARE, EACH 1 1 48 0 1 NA NA 1676 1676 Carrier M 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0955 WHEELCHAIR ACCESSORY, HEADREST, CUSHIONED, PREFABRICATED, INCLUDING FIXED HARDWARE, EACH 1 1 48 0 1 NA NA 1677 1677 Carrier M 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0973 WHEELCHAIR ACCESSORY, ADJUSTABLE HEIGHT, DETACHABLE ARMREST, COMPLETE ASSEMBLY, EACH 1 1 96 0 1 NA NA 1678 1678 Carrier M 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1012 WHEELCHAIR ACCESSORY, ADDITION TO POWER SEATING SYSTEM, CENTER MOUNT POWER ELEVATING LEG REST/PLATFORM, COMPLETE SYSTEM, ANY TYPE, EACH 1 1 48 0 1 NA NA 1679 1679 Carrier M 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1007 WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, COMBINATION TILT AND RECLINE, WITH MECHANICAL SHEAR REDUCTION 3 0.67 56 0 3 NA NA 1680 1680 Carrier M 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2311 POWER WHEELCHAIR ACCESSORY, ELECTRONIC CONNECTION BETWEEN WHEELCHAIR CONTROLLER AND TWO OR MORE POWER SEATING SYSTEM MOTORS, INCLUDING ALL RELATED ELECTRONICS, INDICATOR FEATURE, MECHANICAL FUNCTION SELECTION SWITCH, AND FIXEDMOUNTING HARDWARE 2 1 72 0 2 NA NA 1681 1681 Carrier M 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0108 WHEELCHAIR COMPONENT OR ACCESSORY, NOT OTHERWISE SPECIFIED 2 1 72 0 2 NA NA 1682 1682 Carrier M 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0861 POWER WHEELCHAIR, GROUP 3 STANDARD, MULTIPLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS 2 1 72 0 2 NA NA 1683 1683 Carrier M 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC 92700 UNLISTED OTORHINOLARYNGOLOGICAL SERVICE OR PROCEDURE 1 1 48 0 1 NA NA 1684 1684 Carrier M 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0951 HEEL LOOP/HOLDER, WITH OR WITHOUT ANKLE STRAP, EACH 1 1 48 0 1 NA NA 1685 1685 Carrier M 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0953 WHEELCHAIR ACCESSORY, LATERAL THIGH OR KNEE SUPPORT, ANY TYPE INCLUDING FIXED MOUNTING HARDWARE, EACH 1 1 48 0 1 NA NA 1686 1686 Carrier M 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0955 WHEELCHAIR ACCESSORY, HEADREST, CUSHIONED, PREFABRICATED, INCLUDING FIXED HARDWARE, EACH 1 1 48 0 1 NA NA 1687 1687 Carrier M 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0973 WHEELCHAIR ACCESSORY, ADJUSTABLE HEIGHT, DETACHABLE ARMREST, COMPLETE ASSEMBLY, EACH 1 1 96 0 1 NA NA 1688 1688 Carrier M 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1012 WHEELCHAIR ACCESSORY, ADDITION TO POWER SEATING SYSTEM, CENTER MOUNT POWER ELEVATING LEG REST/PLATFORM, COMPLETE SYSTEM, ANY TYPE, EACH 1 1 48 0 1 NA NA 1689 1689 Carrier M 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1007 WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, COMBINATION TILT AND RECLINE, WITH MECHANICAL SHEAR REDUCTION 3 0.67 56 0 3 NA NA 1690 1690 Carrier M 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E2361 POWER WHEELCHAIR ACCESSORY, 22NF SEALED LEAD ACID BATTERY, EACH, (E.G. GEL CELL, ABSORBED GLASSMAT) 1 0 1 96 0 1 NA NA 1691 1691 Carrier M 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E1007 WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, COMBINATION TILT AND RECLINE, WITH MECHANICAL SHEAR REDUCTION 1 0 0 24 0 1 NA NA 1692 1692 Carrier M 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E2300 WHEELCHAIR ACCESSORY, POWER SEAT ELEVATION SYSTEM, ANY TYPE 1 0 0 48 0 1 NA NA 1693 1693 Carrier M 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E2321 POWER WHEELCHAIR ACCESSORY, HAND CONTROL INTERFACE, REMOTE JOYSTICK, NONPROPORTIONAL, INCLUDING ALL RELATED ELECTRONICS, MECHANICAL STOP SWITCH, AND FIXED MOUNTING HARDWARE 1 0 0 96 0 1 NA NA 1694 1694 Carrier M 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC K0841 POWER WHEELCHAIR, GROUP 2 STANDARD, MULTIPLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS 1 0 0 24 0 1 NA NA 1695 1695 Carrier M 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC J9312 INJECTION, RITUXIMAB, 10 MG 12 1 42 0 12 NA NA 1696 1696 Carrier M 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96416 CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS INFUSION TECHNIQUE; INITIATION OF PROLONGED CHEMOTHERAPY INFUSION (MORE THAN 8 HOURS), REQUIRING USE OF A PORTABLE OR IMPLANTABLE PUMP 20 0.95 32.4 0 20 NA NA 1697 1697 Carrier M 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43775 LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; LONGITUDINAL GASTRECTOMY (IE, SLEEVE GASTRECTOMY) 14 0.93 96 0 14 NA NA 1698 1698 Carrier M 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22612 ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL ; LUMBAR (WITH LATERAL TRANSVERSE TECHNIQUE, WHEN PERFORMED) 9 0.78 72 0 9 NA NA 1699 1699 Carrier M 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22633 ARTHRODESIS, COMBINED POSTERIOR OR POSTEROLATERAL TECHNIQUE WITH POSTERIOR INTERBODY TECHNIQUE INCLUDING LAMINECTOMY AND/OR DISCECTOMY SUFFICIENT TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION), SINGLE INTERSPACE AND SEGMENT; LUMBAR 10 0.6 67.2 0 10 NA NA 1700 1700 Carrier M 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63047 LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT(S) (EG; SPINAL OR LATERAL RECESS STENOSIS) SINGLE VERTEBRAL SEGMENT; LUMBAR 12 0.58 196 0 12 NA NA 1701 1701 Carrier M 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20936 AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); LOCAL (EG, RIBS, SPINOUS PROCESS, OR LAMINAR FRAGMENTS) OBTAINED FROM SAME INCISION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 13 0.54 42.5 0 13 NA NA 1702 1702 Carrier M 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 INSERTION OF INTERBODY BIOMECHANICAL DEVICE(S) (EG, SYNTHETIC CAGE, MESH) WITH INTEGRAL ANTERIOR INSTRUMENTATION FOR DEVICE ANCHORING (EG, SCREWS, FLANGES), WHEN PERFORMED, TO INTERVERTEBRAL DISC SPACE IN CONJUNCTION WITH INTERBODY ARTHRODESIS, EACH INTE 22 0.5 41.5 0 22 NA NA 1703 1703 Carrier M 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20930 ALLOGRAFT, MORSELIZED, OR PLACEMENT OF OSTEOPROMOTIVE MATERIAL, FOR SPINE SURGERY ONLY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 14 0.5 34.3 0 15 NA NA 1704 1704 Carrier M 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22840 POSTERIOR NON-SEGMENTAL INSTRUMENTATION (EG, HARRINGTON ROD TECHNIQUE, PEDICLE FIXATION ACROSS ONE INTERSPACE, ATLANTOAXIAL TRANSARTICULAR SCREW FIXATION, SUBLAMINAR WIRING AT C1, FACET SCREW FIXATION) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PRO 13 0.46 60.9 0 13 NA NA 1705 1705 Carrier M 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC J9312 INJECTION, RITUXIMAB, 10 MG 12 1 42 0 12 NA NA 1706 1706 Carrier M 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC J9070 CYCLOPHOSPHAMIDE, 100 MG 9 1 72 0 9 NA NA 1707 1707 Carrier M 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC J9181 INJECTION, ETOPOSIDE, 10 MG 9 1 56 0 9 NA NA 1708 1708 Carrier M 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22614 SPINE FUSION, EXTRA SEGMENT 8 1 45 0 8 NA NA 1709 1709 Carrier M 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC J9000 INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG 8 1 63 0 8 NA NA 1710 1710 Carrier M 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96416 CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS INFUSION TECHNIQUE; INITIATION OF PROLONGED CHEMOTHERAPY INFUSION (MORE THAN 8 HOURS), REQUIRING USE OF A PORTABLE OR IMPLANTABLE PUMP 20 0.95 32.4 0 20 NA NA 1711 1711 Carrier M 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43775 LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; LONGITUDINAL GASTRECTOMY (IE, SLEEVE GASTRECTOMY) 14 0.93 96 0 14 NA NA 1712 1712 Carrier M 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 20936 AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); LOCAL (EG, RIBS, SPINOUS PROCESS, OR LAMINAR FRAGMENTS) OBTAINED FROM SAME INCISION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 13 0.54 42.5 0 13 NA NA 1713 1713 Carrier M 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22853 INSERTION OF INTERBODY BIOMECHANICAL DEVICE(S) (EG, SYNTHETIC CAGE, MESH) WITH INTEGRAL ANTERIOR INSTRUMENTATION FOR DEVICE ANCHORING (EG, SCREWS, FLANGES), WHEN PERFORMED, TO INTERVERTEBRAL DISC SPACE IN CONJUNCTION WITH INTERBODY ARTHRODESIS, EACH INTE 22 0.5 41.5 0 22 NA NA 1714 1714 Carrier M 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 20930 ALLOGRAFT, MORSELIZED, OR PLACEMENT OF OSTEOPROMOTIVE MATERIAL, FOR SPINE SURGERY ONLY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 14 0.5 34.3 0 14 NA NA 1715 1715 Carrier M 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22853 INSERTION OF INTERBODY BIOMECHANICAL DEVICE(S) (EG, SYNTHETIC CAGE, MESH) WITH INTEGRAL ANTERIOR INSTRUMENTATION FOR DEVICE ANCHORING (EG, SCREWS, FLANGES), WHEN PERFORMED, TO INTERVERTEBRAL DISC SPACE IN CONJUNCTION WITH INTERBODY ARTHRODESIS, EACH INTE 11 0 0.64 58.9 0 11 NA NA 1716 1716 Carrier M 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22840 POSTERIOR NON-SEGMENTAL INSTRUMENTATION (EG, HARRINGTON ROD TECHNIQUE, PEDICLE FIXATION ACROSS ONE INTERSPACE, ATLANTOAXIAL TRANSARTICULAR SCREW FIXATION, SUBLAMINAR WIRING AT C1, FACET SCREW FIXATION) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PRO 7 0 0.57 61.7 0 7 NA NA 1717 1717 Carrier M 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 20930 ALLOGRAFT, MORSELIZED, OR PLACEMENT OF OSTEOPROMOTIVE MATERIAL, FOR SPINE SURGERY ONLY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 7 0 0.43 51.4 0 7 NA NA 1718 1718 Carrier M 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 20936 AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); LOCAL (EG, RIBS, SPINOUS PROCESS, OR LAMINAR FRAGMENTS) OBTAINED FROM SAME INCISION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 6 0 0.5 72 0 6 NA NA 1719 1719 Carrier M 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63047 LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT(S) (EG; SPINAL OR LATERAL RECESS STENOSIS) SINGLE VERTEBRAL SEGMENT; LUMBAR 5 0 0.6 81.6 0 5 NA NA 1720 1720 Carrier M 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22633 ARTHRODESIS, COMBINED POSTERIOR OR POSTEROLATERAL TECHNIQUE WITH POSTERIOR INTERBODY TECHNIQUE INCLUDING LAMINECTOMY AND/OR DISCECTOMY SUFFICIENT TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION), SINGLE INTERSPACE AND SEGMENT; LUMBAR 4 0 0.75 108 0 4 NA NA 1721 1721 Carrier M 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22558 ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DESKECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION); LUMBAR 3 0 0.33 72 0 3 NA NA 1722 1722 Carrier M 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22612 Arthrodesis, posterior or posterolateral technique, single interspace; lumbar (with lateral transverse technique, when performed) 3 0 0.33 144 0 3 NA NA 1723 1723 Carrier M 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22216 REVISE, EXTRA SPINE SEGMENT 2 0 0.5 156 0 2 NA NA 1724 1724 Carrier M 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22612 ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL ; LUMBAR (WITH LATERAL TRANSVERSE TECHNIQUE, WHEN PERFORMED) 2 0 0.5 24 0 2 NA NA 1725 1725 Carrier M 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Internal RMH Residential Mental Health 8 1 9 8 NA NA 1726 1726 Carrier M 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Internal MEN Mental Health 2 1 0 2 NA NA 1727 1727 Carrier M 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Internal REH Rehabilitation 21 0.9 6.9 21 NA NA 1728 1728 Carrier M 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Internal RSA Residential Substance Abuse 5 0.8 14.4 5 NA NA 1729 1729 Carrier M 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Internal DAA Detoxification 2 0.5 24 2 NA NA 1730 1730 Carrier M 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Internal RMH Residential Mental Health 8 1 9 0 8 NA NA 1731 1731 Carrier M 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Internal MEN Mental Health 2 1 0 0 2 NA NA 1732 1732 Carrier M 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Internal REH Rehabilitation 21 0.9 6.9 0 21 NA NA 1733 1733 Carrier M 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Internal RSA Residential Substance Abuse 5 0.8 14.4 0 5 NA NA 1734 1734 Carrier M 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Internal DAA Detoxification 2 0.5 24 0 2 NA NA 1735 1735 Carrier M 2021 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Internal REH Rehabilitation 2 0 0 12 0 2 NA NA 1736 1736 Carrier M 2021 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Internal DAA Detoxification 1 0 0 48 0 1 NA NA 1737 1737 Carrier M 2021 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Internal RSA Residential Substance Abuse 1 0 0 0 0 1 NA NA 1738 1738 Carrier M 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 66984 EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION); WITHOUT ENDOSCOPIC CYCLOPHOTOCOAGULATION 101 1 0 0 101 NA NA 1739 1739 Carrier M 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC S4016 FROZEN IN VITRO FERTILIZATION CYCLE, CASE RATE 58 1 8.7 0 58 NA NA 1740 1740 Carrier M 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 89342 STORAGE, (PER YEAR); EMBRYO(S) 67 0.99 30.8 0 67 NA NA 1741 1741 Carrier M 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 89258 CRYOPRESERVATION; EMBRYO 68 0.97 30.4 0 68 NA NA 1742 1742 Carrier M 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC S4011 IN VITRO FERTILIZATION; INCLUDING BUT NOT LIMITED TO IDENTIFICATION 73 0.75 78.2 0 73 NA NA 1743 1743 Carrier M 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 19318 BREAST REDUCTION 75 0.73 22.4 0 75 NA NA 1744 1744 Carrier M 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 89253 ASSISTED EMBRYO HATCHING, MICROTECHNIQUES (ANY METHOD) 87 0.55 54.9 0 87 NA NA 1745 1745 Carrier M 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC S4022 ASSISTED OOCYTE FERTILIZATION, CASE RATE 82 0.37 53.3 0 82 NA NA 1746 1746 Carrier M 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 89291 BIOPSY, OOCYTE POLAR BODY OR EMBRYO BLASTOMERE, MICROTECHNIQUE (FOR PRE-IMPLANTATION GENETIC DIAGNOSIS); GREATER THAN 5 EMBRYOS 49 0.04 52.9 0 49 NA NA 1747 1747 Carrier M 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 89290 BIOPSY, OOCYTE POLAR BODY OR EMBRYO BLASTOMERE, MICROTECHNIQUE (FOR PRE-IMPLANTATION GENETIC DIAGNOSIS); LESS THAN OR EQUAL TO 5 EMBRYOS 48 0.04 54 0 48 NA NA 1748 1748 Carrier M 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 66984 EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION); WITHOUT ENDOSCOPIC CYCLOPHOTOCOAGULATION 101 1 0 0 101 NA NA 1749 1749 Carrier M 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S4016 FROZEN IN VITRO FERTILIZATION CYCLE, CASE RATE 58 1 8.7 0 58 NA NA 1750 1750 Carrier M 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 36475 ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, RADIOFREQUENCY; FIRST VEIN TREATED 44 1 9.8 0 44 NA NA 1751 1751 Carrier M 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 89342 STORAGE, (PER YEAR); EMBRYO(S) 67 0.99 30.8 0 67 NA NA 1752 1752 Carrier M 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 89258 CRYOPRESERVATION; EMBRYO 68 0.97 30.4 0 68 NA NA 1753 1753 Carrier M 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58322 ARTIFICIAL INSEMINATION; INTRA-UTERINE 31 0.9 37.9 0 31 NA NA 1754 1754 Carrier M 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S4011 IN VITRO FERTILIZATION; INCLUDING BUT NOT LIMITED TO IDENTIFICATION 73 0.75 78.2 0 73 NA NA 1755 1755 Carrier M 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19318 BREAST REDUCTION 75 0.73 22.4 0 75 NA NA 1756 1756 Carrier M 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 89253 ASSISTED EMBRYO HATCHING, MICROTECHNIQUES (ANY METHOD) 87 0.55 54.9 0 87 NA NA 1757 1757 Carrier M 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S4022 ASSISTED OOCYTE FERTILIZATION, CASE RATE 82 0.37 53.3 0 82 NA NA 1758 1758 Carrier M 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC S4022 ASSISTED OOCYTE FERTILIZATION, CASE RATE 52 0 0.02 36 0 52 NA NA 1759 1759 Carrier M 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 89291 BIOPSY, OOCYTE POLAR BODY OR EMBRYO BLASTOMERE, MICROTECHNIQUE (FOR PRE-IMPLANTATION GENETIC DIAGNOSIS); GREATER THAN 5 EMBRYOS 47 0 0 55.1 0 47 NA NA 1760 1760 Carrier M 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 89290 BIOPSY, OOCYTE POLAR BODY OR EMBRYO BLASTOMERE, MICROTECHNIQUE (FOR PRE-IMPLANTATION GENETIC DIAGNOSIS); LESS THAN OR EQUAL TO 5 EMBRYOS 46 0 0 56.3 0 46 NA NA 1761 1761 Carrier M 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 89253 ASSISTED EMBRYO HATCHING, MICROTECHNIQUES (ANY METHOD) 39 0 0.05 17.8 0 39 NA NA 1762 1762 Carrier M 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 19318 BREAST REDUCTION 20 0 0.2 34.8 0 20 NA NA 1763 1763 Carrier M 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC S4011 IN VITRO FERTILIZATION; INCLUDING BUT NOT LIMITED TO IDENTIFICATION 18 0 0.06 36 0 18 NA NA 1764 1764 Carrier M 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 30410 RHINOPLASTY, PRIMARY; COMPLETE, EXTERNAL PARTS INCLUDING BONY PYRAMID, LATERAL AND ALAR CARTILAGES, AND/OR ELEVATION OF NASAL TIP 8 0 0 45 0 8 NA NA 1765 1765 Carrier M 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 31256 NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY; 7 0 0.43 78.9 0 7 NA NA 1766 1766 Carrier M 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 15776 PUNCH GRAFT FOR HAIR TRANSPLANT; MORE THAN 15 PUNCH GRAFTS 6 0 0 12 0 6 NA NA 1767 1767 Carrier M 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21139 REDUCTION FOREHEAD; CONTOURING ONLY CONTOURING AND SET BACK OF ANTERIOR FRONTAL SINUS WALL 6 0 0 32 0 6 NA NA 1768 1768 Carrier M 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 MENTAL HEALTH PARTIAL HOSPITALIZATION, TREATMENT, LESS THAN 24 HOURS 50 1 14.4 0 50 NA NA 1769 1769 Carrier M 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY, 60 MINUTES WITH PATIENT 48 1 35.5 0 48 NA NA 1770 1770 Carrier M 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H2036 ALCOHOL AND/OR DRUG TREATMENT PROGRAM, PER DIEM 20 1 10.8 0 20 NA NA 1771 1771 Carrier M 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97153 ADAPTIVE BEHAVIOR TREATMENT BY PROTOCOL, ADMINISTERED BY TECHNICIAN UNDER THE DIRECTION OF A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, FACE-TO-FACE WITH ONE PATIENT, EACH 15 MINUTES 18 1 766.7 0 18 NA NA 1772 1772 Carrier M 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97155 ADAPTIVE BEHAVIOR TREATMENT WITH PROTOCOL MODIFICATION, ADMINISTERED BY PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, WHICH MAY INCLUDE SIMULTANEOUS DIRECTION OF TECHNICIAN, FACE-TO-FACE WITH ONE PATIENT, EACH 15 MINUTES 18 1 766.7 0 18 NA NA 1773 1773 Carrier M 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97156 FAMILY ADAPTIVE BEHAVIOR TREATMENT GUIDANCE, ADMINISTERED BY PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL (WITH OR WITHOUT THE PATIENT PRESENT),FACE- TO-FACE WITH GUARDIAN(S)/CAREGIVER(S), EACH 15 MINUTES 18 1 766.7 0 18 NA NA 1774 1774 Carrier M 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 BEHAVIOR IDENTIFICATION ASSESSMENT, ADMINISTERED BY A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, EACH 15 MINUTES OF THE PHYSICIANS OR OTHER QUALI FIED HEALTH CARE PROFESSIONALS TIME FACE-TO-FACE WITH PATIENT AND/OR GUARDIAN( S)/CAREGIVER(S) A 17 1 21.2 0 17 NA NA 1775 1775 Carrier M 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; SUBSEQUENT MOTOR THRESHOLD RE-DETERMINATION WITH DELIVERY AND MANAGEMENT 28 0.68 105.4 0 28 NA NA 1776 1776 Carrier M 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; INITIAL, INCLUDING CORTICAL MAPPING, MOTOR THRESHOLD DETERMINATION, DELIVERY AND MANAGEMENT 38 0.66 135.2 0 38 NA NA 1777 1777 Carrier M 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; SUBSEQUENT DELIVERY AND MANAGEMENT, PER SESSION 38 0.66 135.2 0 38 NA NA 1778 1778 Carrier M 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0035 MENTAL HEALTH PARTIAL HOSPITALIZATION, TREATMENT, LESS THAN 24 HOURS 50 1 14.4 0 50 NA NA 1779 1779 Carrier M 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY, 60 MINUTES WITH PATIENT 48 1 35.5 0 48 NA NA 1780 1780 Carrier M 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H2036 ALCOHOL AND/OR DRUG TREATMENT PROGRAM, PER DIEM 20 1 10.8 0 20 NA NA 1781 1781 Carrier M 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97153 ADAPTIVE BEHAVIOR TREATMENT BY PROTOCOL, ADMINISTERED BY TECHNICIAN UNDER THE DIRECTION OF A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, FACE-TO-FACE WITH ONE PATIENT, EACH 15 MINUTES 18 1 766.7 0 18 NA NA 1782 1782 Carrier M 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97155 ADAPTIVE BEHAVIOR TREATMENT WITH PROTOCOL MODIFICATION, ADMINISTERED BY PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, WHICH MAY INCLUDE SIMULTANEOUS DIRECTION OF TECHNICIAN, FACE-TO-FACE WITH ONE PATIENT, EACH 15 MINUTES 18 1 766.7 0 18 NA NA 1783 1783 Carrier M 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97156 FAMILY ADAPTIVE BEHAVIOR TREATMENT GUIDANCE, ADMINISTERED BY PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL (WITH OR WITHOUT THE PATIENT PRESENT),FACE- TO-FACE WITH GUARDIAN(S)/CAREGIVER(S), EACH 15 MINUTES 18 1 766.7 0 18 NA NA 1784 1784 Carrier M 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97151 BEHAVIOR IDENTIFICATION ASSESSMENT, ADMINISTERED BY A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, EACH 15 MINUTES OF THE PHYSICIANS OR OTHER QUALI FIED HEALTH CARE PROFESSIONALS TIME FACE-TO-FACE WITH PATIENT AND/OR GUARDIAN( S)/CAREGIVER(S) A 17 1 21.2 0 17 NA NA 1785 1785 Carrier M 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90869 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; SUBSEQUENT MOTOR THRESHOLD RE-DETERMINATION WITH DELIVERY AND MANAGEMENT 28 0.68 105.4 0 28 NA NA 1786 1786 Carrier M 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90867 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; INITIAL, INCLUDING CORTICAL MAPPING, MOTOR THRESHOLD DETERMINATION, DELIVERY AND MANAGEMENT 38 0.66 135.2 0 38 NA NA 1787 1787 Carrier M 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90868 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; SUBSEQUENT DELIVERY AND MANAGEMENT, PER SESSION 38 0.66 135.2 0 38 NA NA 1788 1788 Carrier M 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90867 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; INITIAL, INCLUDING CORTICAL MAPPING, MOTOR THRESHOLD DETERMINATION, DELIVERY AND MANAGEMENT 13 0 0 236.3 0 13 NA NA 1789 1789 Carrier M 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90868 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; SUBSEQUENT DELIVERY AND MANAGEMENT, PER SESSION 13 0 0 236.3 0 13 NA NA 1790 1790 Carrier M 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90869 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; SUBSEQUENT MOTOR THRESHOLD RE-DETERMINATION WITH DELIVERY AND MANAGEMENT 9 0 0 184 0 9 NA NA 1791 1791 Carrier M 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97152 BEHAVIOR IDENTIFICATIONSUPPORTING ASSESSMENT, ADMINISTERED BY ONE TECHNICIAN U NDER THE DIRECTION OF A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, FACE-TO-FACE WITH THE PATIENT, EACH 15 MINUTES 1 0 0 72 0 1 NA NA 1792 1792 Carrier M 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97158 GROUP ADAPTIVE BEHAVIOR TREATMENT WITH PROTOCOL MODIFICATION, ADMINISTERED BY PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, FACE-TO-FACE WITH MULTIPLE PATIENTS, EACH 15 MINUTES 1 0 0 3024 0 1 NA NA 1793 1793 Carrier A 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 4 1 108.2401342 4 NA NA 1794 1794 Carrier A 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9276 Disposable sensor, CGM sys 1 0 160.5394444 1 NA NA 1795 1795 Carrier A 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9277 External transmitter, CGM 1 0 160.5394444 1 NA NA 1796 1796 Carrier A 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 4 1 108.2401342 4 NA NA 1797 1797 Carrier A 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9276 Disposable sensor, CGM sys 1 0 160.5394444 1 NA NA 1798 1798 Carrier A 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9277 External transmitter, CGM 1 0 160.5394444 1 NA NA 1799 1799 Carrier A 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 9 1 8.702746913 9 NA NA 1800 1800 Carrier A 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2599 Accessory for speech generating device, not otherwise classified 2 1 105.9313889 2 NA NA 1801 1801 Carrier A 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 Continuous airway pressure (CPAP) device [may be used for either CPAP or APAP] 196 0.97 1.340782313 196 NA NA 1802 1802 Carrier A 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 14 0.86 19.04505952 14 NA NA 1803 1803 Carrier A 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0748 Elec Osteogen Stim Spinal 3 0.33 62.68567991 3 NA NA 1804 1804 Carrier A 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1399 Durable Medical Equipment Mi 11 0.18 182.9355853 11 NA NA 1805 1805 Carrier A 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0781 External Ambulatory Infus Pu 4 0 0.00438632 4 NA NA 1806 1806 Carrier A 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0978 Wheelchair Belt W/Airplane B 2 0 0.010277779 2 NA NA 1807 1807 Carrier A 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0950 Tray 2 0 0.010729166 2 NA NA 1808 1808 Carrier A 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1028 Wheelchair accessory, manual swingaway, retractable or removable mounting hardware 2 0 0.010413334 2 NA NA 1809 1809 Carrier A 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2510 Speech generating device, synthesized speech, permitting multiple methods 2 0 12.02839625 2 NA NA 1810 1810 Carrier A 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0960 Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware 2 0 0.010150973 2 NA NA 1811 1811 Carrier A 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0466 HOME VENT NON-INVASIVE INTER 2 0 17.2175 92.87083333 1 1 NA NA 1812 1812 Carrier A 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 9 1 8.702746913 9 NA NA 1813 1813 Carrier A 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2599 Accessory for speech generating device, not otherwise classified 2 1 105.9313889 2 NA NA 1814 1814 Carrier A 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0601 Continuous airway pressure (CPAP) device [may be used for either CPAP or APAP] 196 0.97 1.340782313 196 NA NA 1815 1815 Carrier A 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 14 0.86 19.04505952 14 NA NA 1816 1816 Carrier A 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0748 Elec Osteogen Stim Spinal 3 0.33 62.68567991 3 NA NA 1817 1817 Carrier A 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1399 Durable Medical Equipment Mi 11 0.18 182.9355853 11 NA NA 1818 1818 Carrier A 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0781 External Ambulatory Infus Pu 4 0 0.00438632 4 NA NA 1819 1819 Carrier A 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0978 Wheelchair Belt W/Airplane B 2 0 0.010277779 2 NA NA 1820 1820 Carrier A 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0950 Tray 2 0 0.010729166 2 NA NA 1821 1821 Carrier A 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1028 Wheelchair accessory, manual swingaway, retractable or removable mounting hardware 2 0 0.010413334 2 NA NA 1822 1822 Carrier A 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2510 Speech generating device, synthesized speech, permitting multiple methods 2 0 12.02839625 2 NA NA 1823 1823 Carrier A 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0960 Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware 2 0 0.010150973 2 NA NA 1824 1824 Carrier A 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0466 HOME VENT NON-INVASIVE INTER 2 0 17.2175 92.87083333 1 1 NA NA 1825 1825 Carrier A 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 7 1 52.77394383 7 NA NA 1826 1826 Carrier A 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) 6 1 67.90327581 6 NA NA 1827 1827 Carrier A 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar 5 1 70.2762026 5 NA NA 1828 1828 Carrier A 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 5 1 70.46072986 5 NA NA 1829 1829 Carrier A 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 8 0.88 66.6517052 8 NA NA 1830 1830 Carrier A 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96416 Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump 10 0 41.18195907 10 NA NA 1831 1831 Carrier A 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC J9250 Methotrexate Sodium Inj 6 0 34.9061865 6 NA NA 1832 1832 Carrier A 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 19364 Breast reconstruction; with free flap (eg, fTRAM, DIEP, SIEA, GAP flap) 5 0 13.92645522 5 NA NA 1833 1833 Carrier A 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 69990 Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure) 5 0 0.020715556 5 NA NA 1834 1834 Carrier A 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC S2068 Breast DIEP flag reconstruct 5 0 13.92634167 5 NA NA 1835 1835 Carrier A 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33929 Removal of a total replacement heart system (artificial heart) for heart transplantation (List separately in addition to code for primary procedure) 1 1 3.79888889 1 NA NA 1836 1836 Carrier A 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33976 Insertion of ventricular assist device; extracorporeal, biventricular 1 1 3.79888889 1 NA NA 1837 1837 Carrier A 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33927 Implantation of a total replacement heart system (artificial heart) with recipient cardiectomy 1 1 3.79888889 1 NA NA 1838 1838 Carrier A 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33945 Heart transplant, with or without recipient cardiectomy 1 1 3.79888889 1 NA NA 1839 1839 Carrier A 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33979 Insertion of ventricular assist device, implantable intracorporeal, single ventricle 1 1 3.79888889 1 NA NA 1840 1840 Carrier A 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33361 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach 1 1 0.004444445 1 NA NA 1841 1841 Carrier A 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 7 1 52.77394383 7 NA NA 1842 1842 Carrier A 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) 6 1 67.90327581 6 NA NA 1843 1843 Carrier A 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar 5 1 70.2762026 5 NA NA 1844 1844 Carrier A 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 5 1 70.46072986 5 NA NA 1845 1845 Carrier A 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) 4 1 76.09473587 4 NA NA 1846 1846 Carrier A 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22585 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); each additional interspace (List separately in addition to code for primary procedure) 2 1 57.4230399 2 NA NA 1847 1847 Carrier A 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63048 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; each additional segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure) 2 1 57.4230399 2 NA NA 1848 1848 Carrier A 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 23472 Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total shoulder)) 2 1 12.81386847 2 NA NA 1849 1849 Carrier A 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22614 Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure) 2 1 57.4230399 2 NA NA 1850 1850 Carrier A 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22856 Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); single interspace, cervical 1 1 22.43535278 1 NA NA 1851 1851 Carrier A 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22800 Arthrodesis, posterior, for spinal deformity, with or without cast; up to 6 vertebral segments 1 1 25.19059361 1 NA NA 1852 1852 Carrier A 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar 1 1 44.73411944 1 NA NA 1853 1853 Carrier A 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27132 Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft 1 1 36.80007583 1 NA NA 1854 1854 Carrier A 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63252 Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; thoracolumbar 1 1 0.030555556 1 NA NA 1855 1855 Carrier A 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15769 Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia) 1 1 71.77944444 1 NA NA 1856 1856 Carrier A 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33340 Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, when performed, and radiological supervision and interpretation 1 1 1.785277778 1 NA NA 1857 1857 Carrier A 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22630 Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar 1 1 25.19059361 1 NA NA 1858 1858 Carrier A 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 20931 Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure) 1 1 16.89200917 1 NA NA 1859 1859 Carrier A 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 Room and board, Semi-Private, Psychiatric 4 1 1.234166666 1.459653055 1 3 NA NA 1860 1860 Carrier A 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1002 Residential treatment, Substance Use Disorder 13 0.92 62.60147669 13 NA NA 1861 1861 Carrier A 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0019 Alcohol And/Or Drug Services 1 0 102.2166667 1 NA NA 1862 1862 Carrier A 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1001 Residential treatment, Psychiatric 1 0 138.8416667 1 NA NA 1863 1863 Carrier A 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 Room and board, Semi-Private, Psychiatric 4 1 1.234166666 1.459653055 1 3 NA NA 1864 1864 Carrier A 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1002 Residential treatment, Substance Use Disorder 13 0.92 62.60147669 13 NA NA 1865 1865 Carrier A 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0019 Alcohol And/Or Drug Services 1 0 102.2166667 1 NA NA 1866 1866 Carrier A 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1001 Residential treatment, Psychiatric 1 0 138.8416667 1 NA NA 1867 1867 Carrier A 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0399 Home sleep test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation 145 0.94 9.725153257 145 NA NA 1868 1868 Carrier A 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 ECHO, transthoracic w/doppler, complete 251 0.93 6.987740448 720 251 1 NA NA 1869 1869 Carrier A 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74176 CT abd & pelvis 226 0.93 12.2330689 226 NA NA 1870 1870 Carrier A 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 MRI, lower extremity any joint; wo contr 211 0.92 0.108611112 8.666618187 1 210 NA NA 1871 1871 Carrier A 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73221 MRI, any joint of upper extremity; wo co 114 0.87 0.153055555 11.97213207 672 1 113 1 NA NA 1872 1872 Carrier A 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72148 MRI of lumbar spine 159 0.84 12.34567115 159 NA NA 1873 1873 Carrier A 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97140 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes 474 0.71 40.14867806 40.97692555 3 471 NA NA 1874 1874 Carrier A 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 496 0.7 40.14867806 37.51292904 3 493 NA NA 1875 1875 Carrier A 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 246 0.69 30.694312 39.348981 3 243 NA NA 1876 1876 Carrier A 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97112 Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities 258 0.68 16.51276292 43.91067717 624 2 256 1 NA NA 1877 1877 Carrier A 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft 22 1 8.486309407 22 NA NA 1878 1878 Carrier A 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64494 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure) 18 1 0.031796595 18 NA NA 1879 1879 Carrier A 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72157 MRI of thoracic spine 17 1 1.824656863 17 NA NA 1880 1880 Carrier A 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 74174 ct angio abd&pelv w/o&w/dye 16 1 7.785902778 16 NA NA 1881 1881 Carrier A 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70552 Contrast MRI of brain 15 1 11.70940741 15 NA NA 1882 1882 Carrier A 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93303 ECHO, transthoracic, complete cng 14 1 0.014484127 14 NA NA 1883 1883 Carrier A 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70543 MRI orb/fc/nck w/o cntrst flwd cntr 14 1 12.11799603 14 NA NA 1884 1884 Carrier A 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29882 Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral) 13 1 41.81070067 13 NA NA 1885 1885 Carrier A 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 73720 MRI, lower extremity other than joint; w 13 1 5.170683761 13 NA NA 1886 1886 Carrier A 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93312 ECHO, transesophageal, heart, compl 12 1 0.0000694 12 NA NA 1887 1887 Carrier A 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29888 Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction 12 1 34.0108765 12 NA NA 1888 1888 Carrier A 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70496 CTA, head, w/o cntrst flwd by cntrst 12 1 7.942286325 12 NA NA 1889 1889 Carrier A 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64636 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure) 12 1 32.99390504 12 NA NA 1890 1890 Carrier A 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 72148 MRI of lumbar spine 159 0 0.02 12.34567115 159 NA NA 1891 1891 Carrier A 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64483 Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, single level 71 0 0.04 0.437153611 27.52914773 1 70 NA NA 1892 1892 Carrier A 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27096 Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed 34 0 0.06 28.75976059 34 NA NA 1893 1893 Carrier A 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64635 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint 15 0 0.07 28.19355546 15 NA NA 1894 1894 Carrier A 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar 10 0 0.1 0.044166667 25.80615524 1 9 NA NA 1895 1895 Carrier A 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63030 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar 8 0 0.13 0.195765222 109.3666737 2 6 NA NA 1896 1896 Carrier A 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63048 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; each additional segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure) 5 0 0.2 29.84955181 5 NA NA 1897 1897 Carrier A 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 12 1 18.82247263 12 NA NA 1898 1898 Carrier A 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H2036 Alcohol and/or other drug treatment program, per diem 5 1 13.01069444 5 NA NA 1899 1899 Carrier A 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 8 0.75 101.5087823 8 NA NA 1900 1900 Carrier A 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97112 Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities 4 0.75 46.18055993 4 NA NA 1901 1901 Carrier A 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 71271 CT THORAX LW DOSE LNG CA SCR C- 31 0.74 9.081451613 31 NA NA 1902 1902 Carrier A 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 6 0.67 34.4736869 6 NA NA 1903 1903 Carrier A 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 6 0.67 34.44148148 6 NA NA 1904 1904 Carrier A 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 6 0.67 34.4736869 6 NA NA 1905 1905 Carrier A 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual 18 0.33 65.46100057 648 18 1 NA NA 1906 1906 Carrier A 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 92523 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language) 4 0.25 125.2505176 4 NA NA 1907 1907 Carrier A 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90834 Psychotherapy, 45 minutes with patient 4 0 13.71211111 11.89154565 1 3 NA NA 1908 1908 Carrier A 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90853 Group psychotherapy (other than of a multiple-family group) 4 0 13.71211028 4.345258982 1 3 NA NA 1909 1909 Carrier A 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77385 Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; simple 1 1 0.010277777 1 NA NA 1910 1910 Carrier A 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 12 1 18.82247263 12 NA NA 1911 1911 Carrier A 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H2036 Alcohol and/or other drug treatment program, per diem 5 1 13.01069444 5 NA NA 1912 1912 Carrier A 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S9131 Physical therapy, in the home, per diem 2 1 23.16153292 2 NA NA 1913 1913 Carrier A 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97124 Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion) 2 1 1.439357917 2 NA NA 1914 1914 Carrier A 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70553 MRI of brain and further sequences 2 1 44.52694444 2 NA NA 1915 1915 Carrier A 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70551 MRI of brain 2 1 0 2 NA NA 1916 1916 Carrier A 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77301 Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications 3 1 0.010277777 60.31208333 1 2 NA NA 1917 1917 Carrier A 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81229 Cytogenomic constitutional (genome-wide) microarray analysis; interrogation of genomic regions for copy number and single nucleotide polymorphism (SNP) variants for chromosomal abnormalities 1 1 0.009444446 1 NA NA 1918 1918 Carrier A 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97032 Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes 1 1 0.178888889 1 NA NA 1919 1919 Carrier A 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77386 Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex 1 1 23.92027778 1 NA NA 1920 1920 Carrier A 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97026 Application of a modality to 1 or more areas; infrared 1 1 0.178888889 1 NA NA 1921 1921 Carrier A 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77338 Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per IMRT plan 2 1 0.010277777 23.92027778 1 1 NA NA 1922 1922 Carrier A 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC G6015 RADIATION TX DELIVERY IMRT 2 1 0.010555555 96.70388889 1 1 NA NA 1923 1923 Carrier A 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 71271 CT THORAX LW DOSE LNG CA SCR C- 31 0 0.03 9.081451613 31 NA NA 1924 1924 Carrier N 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0784 EXT AMB INFUSN PUMP INSULIN 7 1 96 56 1 6 0 NA NA 1925 1925 Carrier N 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0766 ELEC STIM CANCER TREATMENT 2 1 0 36 0 2 0 NA NA 1926 1926 Carrier N 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L8619 COCH IMP EXT PROC/CONTR RPLC 1 1 0 96 0 1 0 NA NA 1927 1927 Carrier N 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L8685 IMPLT NROSTM PLS GEN SNG REC 1 1 0 24 0 1 0 NA NA 1928 1928 Carrier N 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L8680 IMPLT NEUROSTIM ELCTR EACH 1 1 0 24 0 1 0 NA NA 1929 1929 Carrier N 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L8614 COCHLEAR DEVICE 1 1 0 168 0 1 0 NA NA 1930 1930 Carrier N 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44145 PARTIAL REMOVAL OF COLON 1 1 0 1 NA NA 1931 1931 Carrier N 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 15734 MUSCLE-SKIN GRAFT TRUNK 1 1 0 1 NA NA 1932 1932 Carrier N 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 21085 PREPARE FACE/ORAL PROSTHESIS 1 1 24 1 NA NA 1933 1933 Carrier N 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58543 LSH UTERUS ABOVE 250 G 1 1 0 1 NA NA 1934 1934 Carrier N 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44207 L COLECTOMY/COLOPROCTOSTOMY 1 1 0 1 NA NA 1935 1935 Carrier N 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 32667 THORACOSCOPY W/W RESECT ADDL 1 1 0 1 NA NA 1936 1936 Carrier N 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 61304 OPEN SKULL FOR EXPLORATION 1 1 24 1 NA NA 1937 1937 Carrier N 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 47379 LAPAROSCOPE PROCEDURE LIVER 1 1 48 1 NA NA 1938 1938 Carrier N 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58954 TAH RAD DEBULK/LYMPH REMOVE 1 1 0 1 NA NA 1939 1939 Carrier N 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22633 ARTHRD CMBN 1NTRSPC LUMBAR 5 0.6 91 5 NA NA 1940 1940 Carrier N 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 49560 Repair initial incisional or ventral hernia; reducible 0 NA NA 1941 1941 Carrier N 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44145 PARTIAL REMOVAL OF COLON 1 1 0 1 NA NA 1942 1942 Carrier N 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15734 MUSCLE-SKIN GRAFT TRUNK 1 1 0 1 NA NA 1943 1943 Carrier N 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 21085 PREPARE FACE/ORAL PROSTHESIS 1 1 24 1 NA NA 1944 1944 Carrier N 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58543 LSH UTERUS ABOVE 250 G 1 1 0 1 NA NA 1945 1945 Carrier N 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44207 L COLECTOMY/COLOPROCTOSTOMY 1 1 0 1 NA NA 1946 1946 Carrier N 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 32667 THORACOSCOPY W/W RESECT ADDL 1 1 0 1 NA NA 1947 1947 Carrier N 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 61304 OPEN SKULL FOR EXPLORATION 1 1 24 1 NA NA 1948 1948 Carrier N 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 47379 LAPAROSCOPE PROCEDURE LIVER 1 1 48 1 NA NA 1949 1949 Carrier N 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58954 TAH RAD DEBULK/LYMPH REMOVE 1 1 0 1 NA NA 1950 1950 Carrier N 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63047 LAM FACETEC & FORAMOT LUMBAR 1 1 24 1 NA NA 1951 1951 Carrier N 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year NA NA Substance Abuse Residential 3 1 0 3 0 NA NA 1952 1952 Carrier N 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year NA NA Mental Health Inpatient 1 1 0 1 0 NA NA 1953 1953 Carrier N 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA Substance Abuse Residential 3 1 0 3 0 NA NA 1954 1954 Carrier N 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA Mental Health Inpatient 1 1 0 1 0 NA NA 1955 1955 Carrier N 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT Q5103 INJECTION, INFLECTRA 15 1 32 14 3 12 0 NA NA 1956 1956 Carrier N 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95806 SLEEP STUDY UNATT&RESP EFFT 41 0.976 0 7.6 0 41 0 NA NA 1957 1957 Carrier N 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 92507 SPEECH/HEARING THERAPY 53 0.943 120 167.1 2 51 0 NA NA 1958 1958 Carrier N 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95810 POLYSOM 6/> YRS 4/> PARAM 28 0.929 0 57.4 0 28 0 NA NA 1959 1959 Carrier N 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64615 CHEMODENERV MUSC MIGRAINE 22 0.909 0 38.2 0 22 0 NA NA 1960 1960 Carrier N 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT J0585 INJECTION,ONABOTULINUMTOXINA 40 0.85 24 48 1 39 0 NA NA 1961 1961 Carrier N 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64999 NERVOUS SYSTEM SURGERY 11 0.818 0 113.5 0 11 0 NA NA 1962 1962 Carrier N 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95811 POLYSOM 6/>YRS CPAP 4/> PARM 19 0.789 0 73.3 0 19 0 NA NA 1963 1963 Carrier N 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 MRI (eg, proton) ANY JOINT OF LOWER EXTREMITY 16 0.75 0 69 0 16 0 NA NA 1964 1964 Carrier N 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT J1745 INFLIXIMAB NOT BIOSIMIL 10MG 14 0.429 0 90.9 0 14 0 NA NA 1965 1965 Carrier N 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT Q5103 INJECTION, INFLECTRA 15 1 32 14 3 12 0 NA NA 1966 1966 Carrier N 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT G0299 HHS/HOSPICE OF RN EA 15 MIN 10 1 0 12 0 10 0 NA NA 1967 1967 Carrier N 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95800 SLP STDY UNATTENDED 9 1 0 0 0 9 0 NA NA 1968 1968 Carrier N 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J9035 BEVACIZUMAB INJECTION 9 1 0 2.7 0 9 0 NA NA 1969 1969 Carrier N 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT Q5121 INJ. AVSOLA, 10 MG 7 1 0 0 0 7 0 NA NA 1970 1970 Carrier N 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 36475 ENDOVENOUS RF 1ST VEIN 6 1 0 72 0 6 0 NA NA 1971 1971 Carrier N 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J0178 AFLIBERCEPT INJECTION 6 1 0 400 0 6 0 NA NA 1972 1972 Carrier N 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT G0399 HOME SLEEP TEST/TYPE 3 PORTA 6 1 0 0 0 6 0 NA NA 1973 1973 Carrier N 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT S0122 INJ MENOTROPINS 75 IU 6 1 0 0 6 0 0 NA NA 1974 1974 Carrier N 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT S0126 INJ FOLLITROPIN ALFA 75 IU 6 1 0 0 6 0 0 NA NA 1975 1975 Carrier N 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT J1557 GAMMAPLEX INJECTION 3 0 0.33 24 0 1 0 NA NA 1976 1976 Carrier N 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 67904 REPAIR EYELID DEFECT 1 0 1 24 0 1 0 NA NA 1977 1977 Carrier N 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Transcranial Magnetic Stimulation (TMS) 4 1 24 0 4 0 NA NA 1978 1978 Carrier N 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT S9480 Mental Health Intensive Outpatient Program 3 1 24 0 3 0 NA NA 1979 1979 Carrier N 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT H0035 Psychiatric Treatment Partial Hospitalization 2 1 24 0 2 0 NA NA 1980 1980 Carrier N 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT H0015 Substance Abuse Intensive Outpatient Program 2 1 24 0 2 0 NA NA 1981 1981 Carrier N 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 Mental Health Individual and Family Therapy 1 1 69.25 0 1 0 NA NA 1982 1982 Carrier N 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90868 Transcranial Magnetic Stimulation (TMS) 4 1 24 0 4 0 NA NA 1983 1983 Carrier N 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT S9480 Mental Health Intensive Outpatient Program 3 1 24 0 3 0 NA NA 1984 1984 Carrier N 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT H0035 Psychiatric Treatment Partial Hospitalization 2 1 24 0 2 0 NA NA 1985 1985 Carrier N 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT H0015 Substance Abuse Intensive Outpatient Program 2 1 24 0 2 0 NA NA 1986 1986 Carrier N 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90837 Mental Health Individual and Family Therapy 1 1 69.25 0 1 0 NA NA 1987 1987 Carrier B 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9274 EXTERNAL AMBULATORY INSULIN DELIVERY SYSTEM 11 1 87.54 0 1 10 0 NA NA 1988 1988 Carrier B 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9277 EXTERNAL TRANSMITTER CONTINOUS GLUCOSE MONITOR DAILY 83 0.94 48.6 106.08 0 2 81 0 NA NA 1989 1989 Carrier B 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9276 DISPOSABLE SENSOR FOR CONTINOUS GLUCOSE MONITORING SYSTEM DAILY 21 0.9 72.62 85.73 0 1 20 0 NA NA 1990 1990 Carrier B 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 EXTERNAL AMBULATORY INFUSION PUMP, INSULIN 9 0.89 79.04 0 0 9 0 NA NA 1991 1991 Carrier B 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9278 EXTERNAL RECEIVER FOR CONTINOUS GLUCOSE MONITORING 29 0.86 119.73 0 0 29 0 NA NA 1992 1992 Carrier B 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0553 CONTINOUS GLUCOSE MONITORING SYSTEM SUPPLIES MONTH AT A TIME 12 0.5 157.41 0 0 12 0 NA NA 1993 1993 Carrier B 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0554 THERAPEUTIC CONTINOUS GLUCOSE MONITORING RECEIVER/MONITOR MONTHLY 7 0.29 137.89 0 0 7 0 NA NA 1994 1994 Carrier B 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9274 EXTERNAL AMBULATORY INSULIN DELIVERY SYSTEM 11 1 87.54 0 1 10 0 NA NA 1995 1995 Carrier B 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9277 EXTERNAL TRANSMITTER CONTINOUS GLUCOSE MONITOR DAILY 83 0.94 48.6 106.08 0 2 81 0 NA NA 1996 1996 Carrier B 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9276 DISPOSABLE SENSOR FOR CONTINOUS GLUCOSE MONITORING SYSTEM DAILY 21 0.9 72.62 85.73 0 1 20 0 NA NA 1997 1997 Carrier B 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 EXTERNAL AMBULATORY INFUSION PUMP, INSULIN 9 0.89 79.04 0 0 9 0 NA NA 1998 1998 Carrier B 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9278 EXTERNAL RECEIVER FOR CONTINOUS GLUCOSE MONITORING 29 0.86 119.73 0 0 29 0 NA NA 1999 1999 Carrier B 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0553 CONTINOUS GLUCOSE MONITORING SYSTEM SUPPLIES MONTH AT A TIME 12 0.5 157.41 0 0 12 0 NA NA 2000 2000 Carrier B 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0554 THERAPEUTIC CONTINOUS GLUCOSE MONITORING RECEIVER/MONITOR MONTHLY 7 0.29 137.89 0 0 7 0 NA NA 2001 2001 Carrier B 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2402 NEGATIVE PRESSURE WOUND PUMP 20 1 21.48 148.93 1 19 0 NA NA 2002 2002 Carrier B 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0935 PASSIVE MOTION EXERCISE DEVICE 12 1 120.87 0 12 0 NA NA 2003 2003 Carrier B 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0001 STANDARD WHEELCHAIR 9 1 29.66 82.34 4 5 0 NA NA 2004 2004 Carrier B 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE 491 0.98 43.82 101.64 3 487 0 NA NA 2005 2005 Carrier B 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1390 PORTABLE OXYGEN CONCENTRATOR 152 0.97 11.9 75.63 13 138 0 NA NA 2006 2006 Carrier B 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0470 BI-PAP RESPIRATORY ASSIST DEVICE WITH OUT BACKUP 30 0.97 60.75 123.58 2 28 0 NA NA 2007 2007 Carrier B 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0471 BI-PAP RESPIRATORY ASSIST DEVICE WITH BACKUP 19 0.95 69.86 85.64 2 17 0 NA NA 2008 2008 Carrier B 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0781 AMBULATORY INFUSION PUMP 1 OR MULTIPLE CHANNELS PATIENT WEARS 72 0.88 98.8 0.04 0 72 1 NA NA 2009 2009 Carrier B 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0466 HOME VENT TYPE USED NON-INVASIVE 17 0.82 21.4 121.07 1 16 0 NA NA 2010 2010 Carrier B 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0108 OTHER ACCESSORY 10 0.8 143.61 0 10 0 NA NA 2011 2011 Carrier B 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0001 STANDARD WHEELCHAIR 9 1 29.66 82.34 0 4 5 0 NA NA 2012 2012 Carrier B 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1399 DURABLE MEDICAL EQUPMENT MISCELLANEOUS 5 1 112.21 0 0 5 0 NA NA 2013 2013 Carrier B 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4222 SUPPLIES EXTERNAL DRUG INFUSION PUMP PER CASSETTE/BAG 4 1 152.56 0 0 4 0 NA NA 2014 2014 Carrier B 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2510 SPEECH GENERATING DEVICE/SYNTHIZED SPEECH, PERMITTING MULTIPLE METHODS OF MESSAGE FORMULATION 3 1 101.37 0 0 3 0 NA NA 2015 2015 Carrier B 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0007 EXTRA HEAVY-DUTY WHEELCHAIR 2 1 84.45 0 0 2 0 NA NA 2016 2016 Carrier B 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4221 SUPPLIES-MAINTAINCE DRUG INFUSION CATHETERS PER WEEK 1 1 69.45 0 0 1 0 NA NA 2017 2017 Carrier B 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC V5260 HEARING AID, DIGITAL, BINAURAL, ITE 1 1 112.25 0 0 1 0 NA NA 2018 2018 Carrier B 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2359 POWER WHEELCHAIR ACCESSORY, GROUP 34 SEALED LEAD ACID BATTERY 1 1 193.22 0 0 1 0 NA NA 2019 2019 Carrier B 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4425 OSTOMY POUCH, DRAINABLE USE ON BARRIAR WITH NON-LOCKING FLANGE W NON-LOCKING FLANGE-2 PIECE SYSTEM 1 1 153.35 0 0 1 0 NA NA 2020 2020 Carrier B 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9279 MONITOR FEATURE/DEVICE, STAND-ALONE OR INTEGRAT, ANY TYPE, NOT OTHERWISE CLASSIFIED 1 1 124.4 0 0 1 0 NA NA 2021 2021 Carrier B 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0466 HOME VENT TYPE USED NON-INVASIVE 17 0 0.06 21.4 121.07 0 1 16 0 NA NA 2022 2022 Carrier B 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0486 ORAL DEVICE/APPLIANCE TO REDUCE UP/AIRWAY COLLAPSIBILITY ADJUSTABLE ORTHOTIC 3 0 0.33 0 248.67 0 0 3 0 NA NA 2023 2023 Carrier B 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0652 PNEUMATIC COMPRESS SEGMENTAL W ITH GRADIENT PRESS 3 0 0.33 0 392.91 0 0 3 0 NA NA 2024 2024 Carrier B 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0668 SEGMENTAL PNEUMATIC-USE W/COMPRESSOR FULL ARM 2 0 0.5 0 408.82 0 0 2 0 NA NA 2025 2025 Carrier B 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44207 LAPORSCOPY REMOVAL OF PART OF THE COLON 11 1 2.18 97.98 0 1 10 0 NA NA 2026 2026 Carrier B 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 TOTAL ABDOMINAL HYSTERECTOMY 9 1 86.77 0 0 9 0 NA NA 2027 2027 Carrier B 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20936 AUTOGRAFT TO BONE DURING SPINAL SURGERY 16 0.94 45.44 0 0 16 0 NA NA 2028 2028 Carrier B 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22840 INSTRUMENTATION INSERTED TO CORRECT A SPINAL SPACE 12 0.92 32.84 0 0 12 0 NA NA 2029 2029 Carrier B 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22614 SPINAL FUSION TO JOIN TWO VERTEBRAE 9 0.89 58.92 0 0 9 0 NA NA 2030 2030 Carrier B 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year cPT 22853 METALLIC MESH BETWEEN VERTEBRAE 17 0.88 44.27 0 0 17 0 NA NA 2031 2031 Carrier B 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20930 BONE GRAFT MATERIAL ATTACHED TO SPINE 16 0.88 47.91 0 0 16 0 NA NA 2032 2032 Carrier B 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 SPINAL FUSION TO JOIN TWO VERTEBRAE IN LOW BACK 7 0.86 61.72 0 0 7 0 NA NA 2033 2033 Carrier B 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22612 LUMBAR SPINE FUSION 9 0.78 51.61 0 0 9 0 NA NA 2034 2034 Carrier B 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63047 SINGLE VERTEBRAE LAMINECTOMY SURGERY 7 0.71 49.16 0 0 7 0 NA NA 2035 2035 Carrier B 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44213 LAPAROSCOPIC PROCEDURE DONE DURING A PARTIAL COLECTOMY 6 1 2.18 132.15 0 1 5 0 NA NA 2036 2036 Carrier B 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC J9070 CYCLOPHOSPHAMIDE 100MG 4 1 125.57 0 0 4 0 NA NA 2037 2037 Carrier B 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 52332 INSPECTION OF INSIDE OF BLADDER WITH A SCOPE 1 1 65.9 0 0 1 0 NA NA 2038 2038 Carrier B 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 0538T T-LYMPHOCYTES FROZEN FOR TRANSPORT 1 1 29.18 0 0 1 0 NA NA 2039 2039 Carrier B 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 0539T LABORTATORY RECEIPT AND PREP OF T-LYMPHOCYTES 1 1 29.18 0 0 1 0 NA NA 2040 2040 Carrier B 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 49255 OMENTECTOMY/EPIPLOECTOMY-RESECTION OMENTUM 1 1 42.68 0 0 1 0 NA NA 2041 2041 Carrier B 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 0569T REPAIR OF MITRAL VLAVE DEFECT WITH PROTHESIS 1 1 95.57 0 0 1 0 NA NA 2042 2042 Carrier B 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58548 LAPAROSCOPIC REMOVAL OF UTERUS, FALLOPIAN TUBES, OVARIES, AND LIGAMENTS 1 1 71.63 0 0 1 0 NA NA 2043 2043 Carrier B 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 0570T REPAIR OF TRICUSPIC VALVE WITH PROSTHIC DEVICE 1 1 95.8 0 0 1 0 NA NA 2044 2044 Carrier B 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 61781 INTRACRANIAL SCAN PERFORMED DURING INTERCRANIAL SURGERY 1 1 19.48 0 1 0 0 NA NA 2045 2045 Carrier B 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22857 LUMBAR ARTIFICAL DISKECTOMY 1 0 1 0 59.23 0 0 1 0 NA NA 2046 2046 Carrier B 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1001 BEHAVIORAL HEALTH ACCOMODATIONS-RESIDENTIAL TREATMENT PSYCHIATRIC 4 1 0 206.78 0 0 4 0 NA NA 2047 2047 Carrier B 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 126 SEMI-PRIVATE DETOXIFICATION BED INPATIENT 2 1 0 2.45 0 0 2 0 NA NA 2048 2048 Carrier B 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1002 BEHAVIORAL HEALTH ACCOMODATIONS-RELATED TO CHEMICAL DEPENDANCY 1 1 0 54 0 0 1 0 NA NA 2049 2049 Carrier B 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 SEMI-PRIVATE PYSCHIATRIC INPATIENT STAY 43 0.95 0 26.15 0 0 41 0 NA NA 2050 2050 Carrier B 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1001 BEHAVIORAL HEALTH ACCOMODATIONS-RESIDENTIAL TREATMENT PSYCHIATRIC 4 1 0 206.78 0 0 4 0 NA NA 2051 2051 Carrier B 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 126 SEMI-PRIVATE DETOXIFICATION BED INPATIENT 2 1 0 2.45 0 0 2 0 NA NA 2052 2052 Carrier B 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1002 BEHAVIORAL HEALTH ACCOMODATIONS-RELATED TO CHEMICAL DEPENDANCY 1 1 0 54 0 0 1 0 NA NA 2053 2053 Carrier B 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 SEMI-PRIVATE PYSCHIATRIC INPATIENT STAY 43 0.95 0 26.15 0 0 41 0 NA NA 2054 2054 Carrier B 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC Q5101 INJ FILGRASTIM G-CSF BIOSIMULATOR 61 1 15.6 56.91 20 39 0 NA NA 2055 2055 Carrier B 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 551 SKILLED NURSE VISIT IN HOME 148 0.99 64.88 101.9 10 137 0 NA NA 2056 2056 Carrier B 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT J3489 ZOLEDRONIC ACID 1MG 64 0.97 13.66 52.46 18 45 0 NA NA 2057 2057 Carrier B 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64483 ANESTHETIC AGEN AND/OR STERIOD INJECTION FOR TRANSFORAMINAL EPIDURAL INJECTION INTO A SINGLE LEVEL 79 0.9 143.4 0 79 0 NA NA 2058 2058 Carrier B 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95811 SLEEP STUDY GREATER THAN 6 YRS OLD WITH CPAP MACHINE 163 0.8 71.41 152.17 1 162 0 NA NA 2059 2059 Carrier B 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95810 SLEEP STUDY GREATER THAN 6 YRS OLD 180 0.78 23.73 153.51 1 179 0 NA NA 2060 2060 Carrier B 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC J0585 INJECTION,ONABOTULINUMTOXINA 113 0.76 26.15 146.46 4 105 0 NA NA 2061 2061 Carrier B 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99212 OFFICE/OUTPATIENT ESTABLISHED MEMBER LASTING 10-19 MIN 201 0.63 70.64 124.25 0.05 16 181 4 NA NA 2062 2062 Carrier B 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0480 DEFINITIVE DRUG TEST OF CLASSES 1-7 63 0.4 175.29 0 63 0 NA NA 2063 2063 Carrier B 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0481 DEFINITIVE DRUG TEST OF CLASSES 8-14 64 0.39 175.26 0 64 0 NA NA 2064 2064 Carrier B 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC Q5118 INJECTION BEVACIZUMAB-BVCR BIOSIMILAR 10 MILLIGRAM (ZIRABEV) 26 1 24.06 82.62 0 5 20 0 NA NA 2065 2065 Carrier B 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC J9299 INJECTION NIVOLUMAB 1 MILLIGRAM 19 1 4.06 113.87 0 6 13 0 NA NA 2066 2066 Carrier B 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC J9022 INJECTION ATEZOLIZUMAB 10 MILLIGRAM 11 1 10.01 76.68 0 3 8 0 NA NA 2067 2067 Carrier B 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81208 BCR/ABL1 GENETIC TEST FOR CHROMOSOME 22 3 1 176.89 0 0 3 0 NA NA 2068 2068 Carrier B 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81257 HBA1/HBA2 GENETIC TEST FOR ALPHA THALASSEMIA 3 1 69.44 0 0 3 0 NA NA 2069 2069 Carrier B 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC J2182 INJECTION MEPOLIZUMAB 1MILLIGRAM 2 1 129.42 0 0 2 0 NA NA 2070 2070 Carrier B 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81256 HFE GENE (HEMOCHROMATOSIS GENE) TEST FOR CHANGES 2 1 97.74 0 0 2 0 NA NA 2071 2071 Carrier B 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC J0694 INJECTION CEFOXITIN SODIUM 1 GRAM 1 1 22.23 0 0 1 0 NA NA 2072 2072 Carrier B 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81261 IGH GENETIC TEST FOR LYMPHOID NEOPLASMS 1 1 117.75 0 0 1 0 NA NA 2073 2073 Carrier B 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC G0491 DIALYSIS ACUTE KIDNEY WITHOUT END STAGE RENAL DISEASE 1 1 5.65 0 1 0 0 NA NA 2074 2074 Carrier B 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21209 OSTEOPLASTY FACIAL BONES; REDUCTION 1 0 1 0 270.06 0 1 0 NA NA 2075 2075 Carrier B 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 77067 SCREENING MAMMOGRAPHY 3 0 1 0 0 0 0 NA NA 2076 2076 Carrier B 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 99213 OFFICE/OUTPATIENT VISIT ESTABLISHED 1 0 1 0 0 0 0 NA NA 2077 2077 Carrier B 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 83605 TEST FOR AMOUNTS OF LACTATE 1 0 1 0 0 0 0 NA NA 2078 2078 Carrier B 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 88304 LEVEL III-SURGICAL PATH GROSS/MICROSCOPIC EXAM 1 0 1 0 0 0 0 NA NA 2079 2079 Carrier B 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 23350 INJECTION PROCEDURE TO THE SHOULDER JOINT 1 0 1 0 0 0 0 NA NA 2080 2080 Carrier B 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 77065 DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED 1 0 1 0 0 0 0 NA NA 2081 2081 Carrier B 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 11104 PUNCH BIOPSY SKIN SINGLE LESION 1 0 1 0 1.17 0 0 1 NA NA 2082 2082 Carrier B 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 80053 COMPREHENSIVE METABOLIC PANEL 1 0 1 0 0.07 0 0 1 NA NA 2083 2083 Carrier B 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90837 PSYCHO THERAPY FOR LESS THAN 60 MINUTES 1 0 1 0 0.04 0 0 3 NA NA 2084 2084 Carrier B 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96101 PSYCHOLOGICAL TESTING PER HOUR FACE TO FACE TIME WITH PATIENT 10 1 0 204.01 0 0 10 0 NA NA 2085 2085 Carrier B 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC S9480 INTENSIVE OUTPATIENT PSYCHIATRIC SERVICES PER DIEM 4 1 0 113.31 0 0 3 0 NA NA 2086 2086 Carrier B 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 912 PARTIAL HOSPITALIZATION PSYCHIATRIC PROGRAM 3 1 0 159.13 0 0 3 0 NA NA 2087 2087 Carrier B 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC S0201 PARTIAL HOSPITALZTION SERVICES <24 HR-PER DIEM 2 1 0 74.53 0 0 2 0 NA NA 2088 2088 Carrier B 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 905 INTENSIVE BEHAVIORAL HEALTH TREATMENT SERVICES 2 1 0 31.89 0 0 2 0 NA NA 2089 2089 Carrier B 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90870 ELECTRIC CONVULSIVE THERAPY 2 1 0 445.4 0 0 2 0 NA NA 2090 2090 Carrier B 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0020 ALCOHOL AND/OR DRUG SERVICES;METHADONE ADMINISTRATION/SERVICE 1 1 0 200.57 0 0 1 0 NA NA 2091 2091 Carrier B 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY SESSION UNDER 60 MINUTES 1 1 0 98.12 0 0 1 0 NA NA 2092 2092 Carrier B 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0015 INTENSIVE OUTPATIENT PROGRAM FOR CHEMICAL DEPENDENCY TREATMENT 1 1 0 136.87 0 0 1 0 NA NA 2093 2093 Carrier B 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 906 PROFESSIONAL FEE FOR PSYCHOLOGY 24 0.92 0 176.91 0 0 24 0 NA NA 2094 2094 Carrier B 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96101 PSYCHOLOGICAL TESTING PER HOUR FACE TO FACE TIME WITH PATIENT 10 1 0 204.01 0 0 10 0 NA NA 2095 2095 Carrier B 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S9480 INTENSIVE OUTPT PSYCH SERV PER DIEM 4 1 0 113.31 0 0 3 0 NA NA 2096 2096 Carrier B 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 912 PARTIAL HOSPITALIZATION PSYCHIATRIC PROGRAM 3 1 0 159.13 0 0 3 0 NA NA 2097 2097 Carrier B 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90870 ELECTRIC CONVULSIVE THERAPY 2 1 0 445.4 0 0 2 0 NA NA 2098 2098 Carrier B 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S0201 PARTIAL HOSPITALZTION SERVICES <24 HR-PER DIEM 2 1 0 74.53 0 0 2 0 NA NA 2099 2099 Carrier B 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 905 INTENSIVE BEHAVIORAL HEALTH TREATMENT SERVICES 2 1 0 31.89 0 0 2 0 NA NA 2100 2100 Carrier B 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0020 ALCOHOL AND/OR DRUG SERVICES;METHADONE ADMINISTRATION/SERVICE 1 1 0 200.57 0 0 1 0 NA NA 2101 2101 Carrier B 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96130 PSYCHOLOGICAL TESTING EVALUATION SERVICES PHYSICIAN/QUALIFIED HEALTH PROFESSIONAL FOR THE FIRST HOUR 1 1 0 236.25 0 0 1 0 NA NA 2102 2102 Carrier B 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY SESSION UNDER 60 MINUTES 1 1 0 98.12 0 0 1 0 NA NA 2103 2103 Carrier B 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0015 INTENSIVE OUTPATIENT PROGRAM FOR CHEMICAL DEPENDENCY TREATMENT 1 1 0 136.87 0 0 1 0 NA NA 2104 2104 Carrier C 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A4230 INFUS SET INSULIN PUMP NON NEEDLE 473 0.992 2 53 411 62 NA NA 2105 2105 Carrier C 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT 97802 MED NUTRIT THRPY INIT ASSESS 15 MIN 718 0.976 1 20 15 703 NA NA 2106 2106 Carrier C 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 OFFICE VISIT E&M EST PT, MODERATE MDM, 30-39 MINS 2160 0.965 5 19 161 1999 NA NA 2107 2107 Carrier C 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT J9035 INJ BEVACIZUMAB 10 MG 128 0.961 6 43 55 73 NA NA 2108 2108 Carrier C 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year Revenue 120 ROOM AND BOARD 117 0.957 11 117 0 NA NA 2109 2109 Carrier C 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A5500 DIAB ONLY FIT CSTM PREP&SPL SHOE MX DNSITY INSRT PER SHOE 260 0.931 6 47 7 253 NA NA 2110 2110 Carrier C 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT G0108 DIAB MGMT TRN PER INDIV 85 0.929 3 47 25 60 NA NA 2111 2111 Carrier C 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A9276 SENSOR;INVSV DISP INTRSTL CONT GLU MON SYS 1U=1D 629 0.859 6 99 373 256 NA NA 2112 2112 Carrier C 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT E0784 EXTERN AMBUL INSULIN INFUS PUMP 186 0.839 19 85 22 164 NA NA 2113 2113 Carrier C 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT K0553 SUPPLY ALLOWANCE FOR THERAPEUTIC CONTINUOUS GLUCOSE MONITOR (CGM), INCLUDES ALL SUPPLIES AND ACCESSORIES 827 0.801 7 83 426 401 NA NA 2114 2114 Carrier C 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95250 GLUCOSE MONITORING 72 HRS MD OR OTH QUAL, EQUIP PROV, REC/STORAGE GL 73 1 1 7 3 70 NA NA 2115 2115 Carrier C 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A5501 DIABETIC CUSTOM MOLDED SHOE 23 1 47 0 23 NA NA 2116 2116 Carrier C 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 11042 DEBRIDE SKIN & SUBQ TISSUE 16 1 0 28 1 15 NA NA 2117 2117 Carrier C 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 11721 DEBRIDE NAIL(S) ANY METHOD(S) 6+ 9 1 75 0 9 NA NA 2118 2118 Carrier C 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L4205 REPAIR ORTHOTIC DEV LABOR PER 15 MIN 10 1 0 20 3 7 NA NA 2119 2119 Carrier C 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 92014 COMPREHENSIVE EYE EXAM ESTABLISHED PT 1+ VISITS 9 1 9 28 2 7 NA NA 2120 2120 Carrier C 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93924 NON-INVASIVE STUDY LE ARTERY POST T 9 1 0 39 2 7 NA NA 2121 2121 Carrier C 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99204 OFFICE VISIT E&M NEW PT MODERATE MDM, 45-59 MINS 8 1 25 42 2 6 NA NA 2122 2122 Carrier C 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 92134 OCT MACULAR/RETINA W/INTERP & REPORT; UNIL/BILAT 12 1 10 30 10 2 NA NA 2123 2123 Carrier C 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 762 MISC SERVICES 22 1 13 22 0 NA NA 2124 2124 Carrier C 2021 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT K0553 SUPPLY ALLOWANCE FOR THERAPEUTIC CONTINUOUS GLUCOSE MONITOR (CGM), INCLUDES ALL SUPPLIES AND ACCESSORIES 827 0 0.009 7 83 426 401 NA NA 2125 2125 Carrier C 2021 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A9276 SENSOR;INVSV DISP INTRSTL CONT GLU MON SYS 1U=1D 629 0 0.006 6 99 373 256 NA NA 2126 2126 Carrier C 2021 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0784 EXTERN AMBUL INSULIN INFUS PUMP 186 0 0.022 19 85 22 164 NA NA 2127 2127 Carrier C 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L3660 SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND 559 0.998 7 0 559 NA NA 2128 2128 Carrier C 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0603 DME ELECTRIC BREAST PUMP KIT PURCHASE 2191 0.995 1 30 2103 88 NA NA 2129 2129 Carrier C 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0114 CRUTCHES METAL UNDERARM PAIR 658 0.994 3 14 41 617 NA NA 2130 2130 Carrier C 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L4361 PNEUMATIC, WALKING BOOT 632 0.989 1 12 9 623 NA NA 2131 2131 Carrier C 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT A7034 NASAL APPLICATION DEVICE 3691 0.984 2 8 209 3482 NA NA 2132 2132 Carrier C 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0439 STATIONARY LIQUID 02 539 0.974 5 27 226 313 NA NA 2133 2133 Carrier C 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0143 WALKER, FOLDING, WHEELED, ADJUSTABLE OR FIXED HEIGHT 690 0.973 10 28 354 336 NA NA 2134 2134 Carrier C 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0604 DME ELECTRIC BREAST PUMP KIT RENTAL 1252 0.957 2 28 669 583 NA NA 2135 2135 Carrier C 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0118 CRUTCH SUBSTITUTE, LOWER LEG PLATFORM, WITH OR WITHOUT WHEELS, EACH 574 0.953 4 40 290 284 NA NA 2136 2136 Carrier C 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0601 CPAP DEVICE 4746 0.916 4 43 1485 3261 NA NA 2137 2137 Carrier C 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L3260 POST-OP SHOE CANVAS 268 1 0 7 4 264 NA NA 2138 2138 Carrier C 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L1846 KO W ADJ FLEX/EXT ROTAT MOLD 108 1 0 7 12 96 NA NA 2139 2139 Carrier C 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0849 TRACTION EQUIP,CERVICAL,FREE STAND,TRACTION FORCE OTHER THAN MANDIBLE 75 1 1 20 2 73 NA NA 2140 2140 Carrier C 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L7520 REPAIR PROSTH DEV LABOR PER 15 MIN 72 1 5 45 9 63 NA NA 2141 2141 Carrier C 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0156 SEAT ATTACHMENT, WALKER 111 1 2 26 52 59 NA NA 2142 2142 Carrier C 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L4386 WALKING BOOT, PREFAB, NONPNEUMATIC 46 1 3 33 1 45 NA NA 2143 2143 Carrier C 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0484 OSCILLATORY POSITIVE EXPIRATORY PRESSURE DEV, NONELEC, ANY TYPE, EACH 47 1 1 32 10 37 NA NA 2144 2144 Carrier C 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0100 CANES OF ANY MATERIAL 48 1 0 13 18 30 NA NA 2145 2145 Carrier C 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4338 INDWELLING CATH LATEX 117 1 1 6 102 15 NA NA 2146 2146 Carrier C 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0165 COMMODE CHAIR STATIONARY 42 1 1 29 28 14 NA NA 2147 2147 Carrier C 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT K0739 REPAIR OR NONROUTN SVC DME OTHER THAN O2 EQUIP,REQ TECH SKILL,PER 15 MINS 215 0 0.005 11 87 50 165 0 NA NA 2148 2148 Carrier C 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A6549 GRADIENT COMPRESSION STOCKING/SLEEVE NOS 165 0 0.012 34 89 11 154 0 NA NA 2149 2149 Carrier C 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0766 ELECT STIMULATION DEV USED FOR CANCER TX, INCL ALL ACCESS, ANY TYPE 29 0 0.069 22 117.5 5 24 0 NA NA 2150 2150 Carrier C 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L5700 REPLACE SOCKET BEL KNEE PT MODEL 20 0 0.05 13 133 1 19 0 NA NA 2151 2151 Carrier C 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L5673 ADDTN TO LOW EXTRMTY BELOW/ABOVE KNEE,CUSTOM FAB,USE W/LOCKING MECH 19 0 0.053 0 80 1 18 0 NA NA 2152 2152 Carrier C 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT B4105 IN-LINE CARTRIDGE CONTAINING DIGESTIVE ENZYME(S) ENTERAL FEEDING; EA 2 0 0.5 74.5 0 2 0 NA NA 2153 2153 Carrier C 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E1028 WHEELCHAIR ACCESS, MANUAL SWINGAWAY, MULT POWER OPTION, POSITION ACCESS 2 0 0 311.5 0 2 0 NA NA 2154 2154 Carrier C 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21089 UNLISTED MAXILLOFACIAL PROSTH PROC 1 0 1 98 0 1 0 NA NA 2155 2155 Carrier C 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT K0848 PWR WHEELCHAIR, GRP 3 STNDRD, SLING/SOLID SEAT/BACK,CAP UP TO/INCL 300 LBS 1 0 1 306 0 1 0 NA NA 2156 2156 Carrier C 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A4427 OSTOMY POUCH, DRAINABLE; USE ON BARRIER W LOCKING 1 0 1 74 1 0 0 NA NA 2157 2157 Carrier C 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 367 SURGERY 72 1 77 0 72 NA NA 2158 2158 Carrier C 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 59400 FULL ROUT OBSTE CARE,VAGINAL DELIV 120 0.983 4 29 6 114 NA NA 2159 2159 Carrier C 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 120 ROOM AND BOARD 13731 0.976 12 37 13688 43 NA NA 2160 2160 Carrier C 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 TOTAL ABDOM HYSTERECTOMY 34 0.971 3 20 17 17 NA NA 2161 2161 Carrier C 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 59510 FULL ROUT OBSTE CARE,CESAREAN DELIV 97 0.949 7 42 13 84 NA NA 2162 2162 Carrier C 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43644 LAP GASTRIC BYPASS/ROUX-EN-Y 33 0.909 72 0 33 NA NA 2163 2163 Carrier C 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44204 COLECTOMY LAP PARTIAL W/ ANAST 51 0.882 4 24 8 43 NA NA 2164 2164 Carrier C 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 ARTHRODESIS ANT INTERBODY W/ DISKECTOMY LU 26 0.654 23 160 2 24 NA NA 2165 2165 Carrier C 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 OFFICE VISIT E&M EST PT, MODERATE MDM, 30-39 MINS 31 0.645 26 76 7 24 NA NA 2166 2166 Carrier C 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 128 ROOM AND BOARD 174 0.489 13 53 173 1 NA NA 2167 2167 Carrier C 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 367 SURGERY 72 1 77 0 72 NA NA 2168 2168 Carrier C 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 32663 THORACOSCOPY SURG W/ LOBECTOMY TOTAL/SEGMEN 10 1 0 33 1 9 NA NA 2169 2169 Carrier C 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 55970 INTERSEX SURG MALE TO FEMALE 9 1 67 0 9 NA NA 2170 2170 Carrier C 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33427 VAL-PLASTY MITRAL VAL W/BYPASS RAD CONS W/WO RING 8 1 7 0 8 NA NA 2171 2171 Carrier C 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44620 CLOSE ENTEROSTOMY LARGE/SMALL INTESTINE 10 1 3 22 3 7 NA NA 2172 2172 Carrier C 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 45380 COLONOSCOPY W/ BX SINGLE/MULT 9 1 1 18 2 7 NA NA 2173 2173 Carrier C 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44207 LAP SURG; COLECT PART W/ANASTOM W/COLOPROCTOST 14 1 2 8 10 4 NA NA 2174 2174 Carrier C 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58210 RAD ABD HYST W/ BILAT PEL LYMPHADENECTOMY 8 1 10 42 4 4 NA NA 2175 2175 Carrier C 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33361 REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH 7 1 13 128 6 1 NA NA 2176 2176 Carrier C 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 762 MISC SERVICES 23 1 0 23 0 NA NA 2177 2177 Carrier C 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 120 ROOM AND BOARD 13731 0 0 12 37 13688 43 0 NA NA 2178 2178 Carrier C 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 50220 NEPHREC W/ PART URETERECT OPEN W/ RIB RESECT 12 0 0.083 11 37 2 10 0 NA NA 2179 2179 Carrier C 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 128 ROOM AND BOARD 174 0 0.023 13 53 173 1 0 NA NA 2180 2180 Carrier C 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 126 ROOM AND BOARD 239 0.992 51 239 0 NA NA 2181 2181 Carrier C 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 900 OTHER THERAPY SERV 368 0.97 24 2 367 1 NA NA 2182 2182 Carrier C 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 128 ROOM AND BOARD 378 0.968 25 378 0 NA NA 2183 2183 Carrier C 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 ROOM AND BOARD 867 0.967 11 90 863 4 NA NA 2184 2184 Carrier C 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 126 ROOM AND BOARD 239 0.992 51 239 0 NA NA 2185 2185 Carrier C 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 900 OTHER THERAPY SERV 368 0.97 24 2 367 1 NA NA 2186 2186 Carrier C 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 128 ROOM AND BOARD 378 0.968 25 378 0 NA NA 2187 2187 Carrier C 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 ROOM AND BOARD 867 0.967 11 90 863 4 NA NA 2188 2188 Carrier C 2021 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 124 ROOM AND BOARD 867 0 0.002 11 90 863 4 NA NA 2189 2189 Carrier C 2021 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 900 OTHER THERAPY SERV 368 0 0.005 24 2 367 1 NA NA 2190 2190 Carrier C 2021 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 128 ROOM AND BOARD 378 0 0.003 25 378 0 NA NA 2191 2191 Carrier C 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue NA MISC SERVICES 6340 0.988 11 45 6339 1 NA NA 2192 2192 Carrier C 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 76380 CT SCAN LIMITED OR LOCALIZED F/U STUDY 2458 0.978 3 17 691 1767 NA NA 2193 2193 Carrier C 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 COLONOSCOPY W/ BX SINGLE/MULT 10887 0.977 2 11 495 10392 NA NA 2194 2194 Carrier C 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73218 MRI, UPPER EXTREMITY 3263 0.973 4 17 478 2785 NA NA 2195 2195 Carrier C 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43235 UPPER GI ENDO DX (SEP PROC) 3180 0.969 2 12 407 2773 NA NA 2196 2196 Carrier C 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97124 THERA PROC 1+ AREAS EA 15 MIN MASSAGE 11498 0.959 2 5 259 11239 NA NA 2197 2197 Carrier C 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 OFFICE VISIT E&M EST PT, MODERATE MDM, 30-39 MINS 108237 0.95 7 19 11935 96302 NA NA 2198 2198 Carrier C 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97802 MED NUTRIT THRPY INIT ASSESS 15 MIN 2884 0.949 8 27 138 2746 NA NA 2199 2199 Carrier C 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97110 THERA PROC 1+ AREAS EA 15 MIN THERA EXERCISES 14314 0.909 10 24 740 13574 NA NA 2200 2200 Carrier C 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99202 OFFICE VISIT E&M NEW PT STRAIGHTFORWARD MDM, 15-29 MINS 3472 0.885 14 44 549 2923 NA NA 2201 2201 Carrier C 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 76885 ECHOGRAPHY OF INFANT HIPS, DYNAMIC 217 1 105 62 10 207 NA NA 2202 2202 Carrier C 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT S9098 HOME PHOTOTHERAPY VISIT 77 1 32 0 77 NA NA 2203 2203 Carrier C 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96160 ADM OF HEALTH RISK ASSESS PATIENT FOCUS W/SCORE 76 1 14 0 76 NA NA 2204 2204 Carrier C 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19083 BX BREAST W/ DEVICE IMAGING PERC; FIRST LESION, W/ US GUIDE 87 1 3 19 21 66 NA NA 2205 2205 Carrier C 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 11102 TANGENTIAL BIOPSY OF SKIN; FIRST LESION 75 1 1 12 9 66 NA NA 2206 2206 Carrier C 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 57420 COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT; 53 1 0 7 4 49 NA NA 2207 2207 Carrier C 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 31622 BRONCHOSCOPY RIGID/FLEX W/WO CELL WASH (SEP PROC) 56 1 8 35 18 38 NA NA 2208 2208 Carrier C 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 20670 REM IMPLANT SUPERFICIAL (SEP PROC) 50 1 1 26 13 37 NA NA 2209 2209 Carrier C 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58301 REM IUD COMPLICATED W/DEVICE (NOT HEMOSTAT) 45 1 6 21 8 37 NA NA 2210 2210 Carrier C 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 65855 TRABECULOPLASTY LASER SURG 1+ SESSIONS 48 1 9 22 15 33 NA NA 2211 2211 Carrier C 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 53854 TRANSURETHRAL DESTRUCT PROSTAT TISSUE;BY RADIOFRQ WATER THERMOTHERPY 7 0 0.286 166 0 7 0 NA NA 2212 2212 Carrier C 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 15830 EXCISION, EXCESS SKIN & SUBQU TISSUE, ABDOMEN 6 0 0.333 25 121 1 5 0 NA NA 2213 2213 Carrier C 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 42145 PALATOPHARYNGOPLASTY 5 0 0.4 164 0 5 0 NA NA 2214 2214 Carrier C 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43499 UNLISTED PROC ESOPHAGUS 3 0 0.333 133 0 3 0 NA NA 2215 2215 Carrier C 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 99201.276 REF PLASTIC SURGERY 2 0 0.5 63 0 2 0 NA NA 2216 2216 Carrier C 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT J7050 NORMAL SALINE SOL INFUS 250 ML 2 0 0.5 242 0 2 0 NA NA 2217 2217 Carrier C 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 77522 PROTON TRMT, SIMPLE W/COMP 5 0 0.4 28 309 4 1 0 NA NA 2218 2218 Carrier C 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 66183 INSERTION ANT SEG AQUEOUS DEVICE W/O EXTRAOCULAR RES EXTERNAL APPROACH 2 0 0.5 48 289 1 1 0 NA NA 2219 2219 Carrier C 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 85390 FIBRINOLYSINS OR COAGULOPATHY 1 0 1 140 1 0 0 NA NA 2220 2220 Carrier C 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 99421 ONLINE DIGITAL EM SVC, EST PT, FOR UP TO 7 DAYS, CUMULATIVE TIME; 5-10 MINS 1 0 1 25 1 0 0 NA NA 2221 2221 Carrier C 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90834 PSYCHOTHERAPY 45 MIN PATIENT 1237 0.993 7 19 4 1233 NA NA 2222 2222 Carrier C 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90833 PSYCHOTHERAPY 30 MIN PATIENT WITH MEDICAL SVCS 124 0.992 47 57 1 123 NA NA 2223 2223 Carrier C 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90836 PSYCHOTHERAPY 45 MIN PATIENT WITH MEDICAL SVCS 4188 0.991 18 64 46 4142 NA NA 2224 2224 Carrier C 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90853 GROUP PSYCHOTHERAPY 1067 0.99 445 32 13 1054 NA NA 2225 2225 Carrier C 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96130 PSYCHOLOGICAL TESTING EVAL BY PHYS OR QUAL PROF; FIRST HOUR 401 0.983 29 44 5 396 NA NA 2226 2226 Carrier C 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY 60 MIN PATIENT 20864 0.981 30 39 220 20644 NA NA 2227 2227 Carrier C 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96132 NEUROPSYCHOLOGICAL TEST EVAL BY PHYS OR QUAL PROF; FIRST HOUR 176 0.926 50 105 9 167 NA NA 2228 2228 Carrier C 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90791 PSYCHIATRIC DIAGNOSTIC EVAL W/O MEDICAL SERVICES 631 0.859 41 106 49 582 NA NA 2229 2229 Carrier C 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 TRANSCRANIAL MAG STIMJ TX DLVR & MGMT 167 0.832 85 0 167 NA NA 2230 2230 Carrier C 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90792 PSYCHIATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES 129 0.791 110 81 3 126 NA NA 2231 2231 Carrier C 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT S9480 PSYCH SVC INTENSIVE OUTPT 36 1 111 101 1 35 NA NA 2232 2232 Carrier C 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96156 HEALTH BEHAVIOR ASSESSMENT, OR RE-ASSESSMENT 12 1 26 0 12 NA NA 2233 2233 Carrier C 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90832 PSYCHOTHERAPY 30 MIN PATIENT 7 1 1 132 1 6 NA NA 2234 2234 Carrier C 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97803 MED NUTRIT THRPY REASSESS PER 15 MIN 6 1 15 0 6 NA NA 2235 2235 Carrier C 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97802 MED NUTRIT THRPY INIT ASSESS 15 MIN 5 1 110 0 5 NA NA 2236 2236 Carrier C 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99214.101 REF MENTAL HEALTH INTERNAL (FOR MH PROVIDERS ONLY) 3 1 220 0 3 NA NA 2237 2237 Carrier C 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96137 PSYCHOLOGICAL OR NEUROPSYCHOLOGICAL TEST BY PHYS,2 OR MORE;ADDL 30 MINS 2 1 159 0 2 NA NA 2238 2238 Carrier C 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96158 HEALTH BEHAVIOR INTERVENTION, INDIVIDUAL, FACE-TO-FACE; INITIAL 30 MINS 2 1 2 0 2 NA NA 2239 2239 Carrier C 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90807 IND PSYCHOTHERAPY OFFICE 45-50 MIN W/ E & M 1 1 281 0 1 NA NA 2240 2240 Carrier C 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 126 ROOM AND BOARD 1 1 0 1 0 NA NA 2241 2241 Carrier C 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90837 PSYCHOTHERAPY 60 MIN PATIENT 20864 0 0.001 30 39 220 20644 0 NA NA 2242 2242 Carrier C 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90836 PSYCHOTHERAPY 45 MIN PATIENT WITH MEDICAL SVCS 4188 0 0.001 18 64 46 4142 0 NA NA 2243 2243 Carrier C 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 96132 NEUROPSYCHOLOGICAL TEST EVAL BY PHYS OR QUAL PROF; FIRST HOUR 176 0 0.006 50 105 9 167 0 NA NA 2244 2244 Carrier C 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90792 PSYCHIATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES 129 0 0.031 110 82 3 126 0 NA NA 2245 2245 Carrier C 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97153 ADAPTIVE BEHAV TX BY PROTOCOL, ADM BY TECH/SUP BY PHYS, EA 15 MINS 49 0 0.02 30 201 1 48 0 NA NA 2246 2246 Carrier C 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 99201 OFFICE VISIT E&M NEW SELF LIMIT/MINOR 10 24 0 0.042 257 0 24 0 NA NA 2247 2247 Carrier C 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 99215 OFFICE VISIT E&M EST PT, HIGH MDM, 40-54 MINS 2 0 0.5 123 113 1 1 0 NA NA 2248 2248 Carrier D 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 OFFICE VISIT E&M EST PT, MODERATE MDM, 30-39 MINS 566 0.991 5 16 38 528 NA NA 2249 2249 Carrier D 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A4230 INFUS SET INSULIN PUMP NON NEEDLE 88 0.989 3 59 73 15 NA NA 2250 2250 Carrier D 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT 97802 MED NUTRIT THRPY INIT ASSESS 15 MIN 165 0.988 3 22 8 157 NA NA 2251 2251 Carrier D 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A5500 DIAB ONLY FIT CSTM PREP&SPL SHOE MX DNSITY INSRT PER SHOE 73 0.986 1 38 1 72 NA NA 2252 2252 Carrier D 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT J9035 INJ BEVACIZUMAB 10 MG 64 0.984 9 28 15 49 NA NA 2253 2253 Carrier D 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year Revenue 120 ROOM AND BOARD 44 0.977 14 44 0 NA NA 2254 2254 Carrier D 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT J0178 INJ AFLIBERCEPT (EYLEA) 1 MG 53 0.925 15 47 13 40 NA NA 2255 2255 Carrier D 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A9276 SENSOR;INVSV DISP INTRSTL CONT GLU MON SYS 1U=1D 293 0.802 8 114 163 130 NA NA 2256 2256 Carrier D 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT E0784 EXTERN AMBUL INSULIN INFUS PUMP 85 0.741 29 129 8 77 NA NA 2257 2257 Carrier D 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT K0553 SUPPLY ALLOWANCE FOR THERAPEUTIC CONTINUOUS GLUCOSE MONITOR (CGM), INCLUDES ALL SUPPLIES AND ACCESSORIES 391 0.706 12 97 212 179 NA NA 2258 2258 Carrier D 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT G0108 DIAB MGMT TRN PER INDIV 26 1 3 38 5 21 NA NA 2259 2259 Carrier D 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99202 OFFICE VISIT E&M NEW PT STRAIGHTFORWARD MDM, 15-29 MINS 16 1 1 24 2 14 NA NA 2260 2260 Carrier D 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95249 GLUCOSE MONITORING 72 HRS, PT PROVIDED EQUIP, TRAINING AND RECORDING 10 1 27 0 10 NA NA 2261 2261 Carrier D 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue NA OTHER THERAPY SERV 10 1 0 23 1 9 NA NA 2262 2262 Carrier D 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99201 OFFICE VISIT E&M NEW SELF LIMIT/MINOR 10 9 1 46 0 9 NA NA 2263 2263 Carrier D 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95250 GLUCOSE MONITORING 72 HRS MD OR OTH QUAL, EQUIP PROV, REC/STORAGE GL 7 1 17 0 7 NA NA 2264 2264 Carrier D 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 11719 TRIMMING NONDYSTROPHIC NAILS ANY NUMBER 6 1 49 0 6 NA NA 2265 2265 Carrier D 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A5513 FOR DIAB ONLY MX DNSITY INSRT CSTM MOLD CSTM EA 6 1 29 0 6 NA NA 2266 2266 Carrier D 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A9274 EXTERNAL AMB INSULIN DEL SYSTEM DISPOSABLE EA 12 1 4 61 9 3 NA NA 2267 2267 Carrier D 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue NA MISC SERVICES 17 1 16 17 0 NA NA 2268 2268 Carrier D 2021 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT K0553 SUPPLY ALLOWANCE FOR THERAPEUTIC CONTINUOUS GLUCOSE MONITOR (CGM), INCLUDES ALL SUPPLIES AND ACCESSORIES 391 0 0.01 12 97 212 179 0 NA NA 2269 2269 Carrier D 2021 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A9276 SENSOR;INVSV DISP INTRSTL CONT GLU MON SYS 1U=1D 293 0 0.01 8 114 163 130 0 NA NA 2270 2270 Carrier D 2021 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0784 EXTERN AMBUL INSULIN INFUS PUMP 85 0 0.047 29 129 8 77 0 NA NA 2271 2271 Carrier D 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L3908 WRIST SPLINT W/WO COCK-UP 235 0.996 15 0 235 NA NA 2272 2272 Carrier D 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0603 DME ELECTRIC BREAST PUMP KIT PURCHASE 731 0.995 1 45 692 39 NA NA 2273 2273 Carrier D 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0114 CRUTCHES METAL UNDERARM PAIR 364 0.992 0 17 3 361 NA NA 2274 2274 Carrier D 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L4361 PNEUMATIC, WALKING BOOT 335 0.991 15 0 335 NA NA 2275 2275 Carrier D 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT A7034 NASAL APPLICATION DEVICE 877 0.986 2 21 28 849 NA NA 2276 2276 Carrier D 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L3660 SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND 281 0.986 21 0 281 NA NA 2277 2277 Carrier D 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0439 STATIONARY LIQUID 02 205 0.981 5 38 88 117 NA NA 2278 2278 Carrier D 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0143 WALKER, FOLDING, WHEELED, ADJUSTABLE OR FIXED HEIGHT 196 0.98 3 35 97 99 NA NA 2279 2279 Carrier D 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0604 DME ELECTRIC BREAST PUMP KIT RENTAL 293 0.966 2 33 138 155 NA NA 2280 2280 Carrier D 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0601 CPAP DEVICE 1843 0.96 3 40 357 1486 NA NA 2281 2281 Carrier D 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L1833 WARRIOR WRAP WITH HINGES/FLEX STOP 97 1 0 13 1 96 NA NA 2282 2282 Carrier D 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L3670 SHLDER IMMOB W/ABDUCTION PILLOW 91 1 1 16 2 89 NA NA 2283 2283 Carrier D 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L1830 KO IMMOBILIZER CANVAS LONGIT 78 1 20 0 78 NA NA 2284 2284 Carrier D 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L1812 KNEE ORTHOSIS, ELAST W/JOINTS, PREFAB,OFF-THE-SHELF 44 1 17 0 44 NA NA 2285 2285 Carrier D 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L4205 REPAIR ORTHOTIC DEV LABOR PER 15 MIN 45 1 5 40 4 41 NA NA 2286 2286 Carrier D 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L4387 WALKING BOOT, PREFAB, NONPNEUMATIC 33 1 12 0 33 NA NA 2287 2287 Carrier D 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0570 DME NEBULIZE HOME/PORTABLE 49 1 3 27 22 27 NA NA 2288 2288 Carrier D 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT V2624 POLISHING ARTIFICAL EYE 24 1 41 0 24 NA NA 2289 2289 Carrier D 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L0650 LSO SAGITTAL-CORONAL CONTROL, SACROCOCCYG JUCT TO T-9 VERT, PREFAB 22 1 29 0 22 NA NA 2290 2290 Carrier D 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4388 DRAINABLE PCH W EX WEAR BARR 69 1 3 29 55 14 NA NA 2291 2291 Carrier D 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0601 CPAP DEVICE 1843 0 0.001 3 40 357 1486 0 NA NA 2292 2292 Carrier D 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0114 CRUTCHES METAL UNDERARM PAIR 364 0 0.003 0 17 3 361 0 NA NA 2293 2293 Carrier D 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT K0739 REPAIR OR NONROUTN SVC DME OTHER THAN O2 EQUIP,REQ TECH SKILL,PER 15 MINS 52 0 0.019 19 119 14 38 0 NA NA 2294 2294 Carrier D 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0760 OSTEOGEN U/S STIMLTOR 31 0 0.032 24 149 7 24 0 NA NA 2295 2295 Carrier D 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0652 PNEUMATIC COMPRESS SEGMNT W GRAD 21 0 0.048 114 188 1 20 0 NA NA 2296 2296 Carrier D 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT K0823 POWER WC, GROUP 2 STD, CAPTAINS, PT WT UP TO/INCLUDE 300 LBS 3 0 0.333 138 0 3 0 NA NA 2297 2297 Carrier D 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E8000 GAIT TRAINER, PEDIATRIC SIZE, POSTERIOR SUPPORT INCL ALL ACCESSORIES & COMP 1 0 1 100 0 1 0 NA NA 2298 2298 Carrier D 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 59400 FULL ROUT OBSTE CARE,VAGINAL DELIV 23 1 0 78 3 20 NA NA 2299 2299 Carrier D 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 367 SURGERY 12 1 83 0 12 NA NA 2300 2300 Carrier D 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96416 CHEMO ADMIN IV INFUS >8 HRS W/PORT/IMPLANTED PUMP 12 1 12 32 2 10 NA NA 2301 2301 Carrier D 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 TOTAL ABDOM HYSTERECTOMY 13 1 5 16 4 9 NA NA 2302 2302 Carrier D 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 120 ROOM AND BOARD 5942 0.969 17 72 5906 36 NA NA 2303 2303 Carrier D 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 59510 FULL ROUT OBSTE CARE,CESAREAN DELIV 31 0.968 1 22 8 23 NA NA 2304 2304 Carrier D 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 ARTHRODESIS ANT INTERBODY W/ DISKECTOMY LU 25 0.88 187 0 25 NA NA 2305 2305 Carrier D 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43644 LAP GASTRIC BYPASS/ROUX-EN-Y 22 0.864 72 0 22 NA NA 2306 2306 Carrier D 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43775 LAP SLEEVE GASTRECTOMY 22 0.546 109 0 22 NA NA 2307 2307 Carrier D 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 128 ROOM AND BOARD 72 0.361 27 72 0 NA NA 2308 2308 Carrier D 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 59400 FULL ROUT OBSTE CARE,VAGINAL DELIV 23 1 1 79 3 20 NA NA 2309 2309 Carrier D 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 367 SURGERY 12 1 83 0 12 NA NA 2310 2310 Carrier D 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96416 CHEMO ADMIN IV INFUS >8 HRS W/PORT/IMPLANTED PUMP 12 1 12 32 2 10 NA NA 2311 2311 Carrier D 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58150 TOTAL ABDOM HYSTERECTOMY 13 1 5 16 4 9 NA NA 2312 2312 Carrier D 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44207 LAP SURG; COLECT PART W/ANASTOM W/COLOPROCTOST 11 1 7 41 2 9 NA NA 2313 2313 Carrier D 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44204 COLECTOMY LAP PARTIAL W/ ANAST 11 1 0 3 3 8 NA NA 2314 2314 Carrier D 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33405 REPLACE PROSTH AORTIC VALVE, OPEN, W/BYPASS NON-HOMO 9 1 3 17 1 8 NA NA 2315 2315 Carrier D 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 32650 THORACOSCOPY SURG W/ PLEURODESIS (MECHANICA 10 1 1 2 3 7 NA NA 2316 2316 Carrier D 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19364 BREAST RECONSTRUCTION; WITH FREE FLAP 9 1 10 100 2 7 NA NA 2317 2317 Carrier D 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99221 INITIAL HOSPITAL CARE,LEVL I 9 1 1 23 3 6 NA NA 2318 2318 Carrier D 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 120 ROOM AND BOARD 5942 0 0 17 72 5906 36 0 NA NA 2319 2319 Carrier D 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43775 LAP SLEEVE GASTRECTOMY 22 0 0.091 109 0 22 0 NA NA 2320 2320 Carrier D 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 128 ROOM AND BOARD 72 0 0.042 27 72 0 0 NA NA 2321 2321 Carrier D 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 912 OTHER THERAPY SERV 1 1 10 0 1 NA NA 2322 2322 Carrier D 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 900 OTHER THERAPY SERV 237 0.987 13 237 0 NA NA 2323 2323 Carrier D 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 ROOM AND BOARD 445 0.984 9 445 0 NA NA 2324 2324 Carrier D 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 126 ROOM AND BOARD 146 0.98 28 146 0 NA NA 2325 2325 Carrier D 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 128 ROOM AND BOARD 373 0.979 51 373 0 NA NA 2326 2326 Carrier D 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 912 OTHER THERAPY SERV 1 1 10 0 1 NA NA 2327 2327 Carrier D 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 900 OTHER THERAPY SERV 237 0.987 13 237 0 NA NA 2328 2328 Carrier D 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 ROOM AND BOARD 445 0.984 9 445 0 NA NA 2329 2329 Carrier D 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 126 ROOM AND BOARD 146 0.98 28 146 0 NA NA 2330 2330 Carrier D 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 128 ROOM AND BOARD 373 0.979 51 373 0 NA NA 2331 2331 Carrier D 2021 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 124 ROOM AND BOARD 445 0 0.002 9 445 0 NA NA 2332 2332 Carrier D 2021 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 128 ROOM AND BOARD 373 0 0.003 51 373 0 NA NA 2333 2333 Carrier D 2021 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 900 OTHER THERAPY SERV 237 0 0.004 13 237 0 NA NA 2334 2334 Carrier D 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 76380 CT SCAN LIMITED OR LOCALIZED F/U STUDY 1369 0.995 2 13 437 932 NA NA 2335 2335 Carrier D 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 COLONOSCOPY W/ BX SINGLE/MULT 2194 0.993 7 13 222 1972 NA NA 2336 2336 Carrier D 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73218 MRI, UPPER EXTREMITY 1862 0.99 3 14 315 1547 NA NA 2337 2337 Carrier D 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 OFFICE VISIT E&M EST PT, MODERATE MDM, 30-39 MINS 24318 0.988 5 19 2303 22015 NA NA 2338 2338 Carrier D 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97124 THERA PROC 1+ AREAS EA 15 MIN MASSAGE 1760 0.983 34 11 38 1722 NA NA 2339 2339 Carrier D 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 762 MISC SERVICES 2761 0.982 15 2761 0 NA NA 2340 2340 Carrier D 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97110 THERA PROC 1+ AREAS EA 15 MIN THERA EXERCISES 2679 0.981 6 15 114 2565 NA NA 2341 2341 Carrier D 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99202 OFFICE VISIT E&M NEW PT STRAIGHTFORWARD MDM, 15-29 MINS 663 0.977 6 31 90 573 NA NA 2342 2342 Carrier D 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 71250 COMPUTED TOMOGRAPHY, THORAX, DIAGNOSTIC; W/O CONTRAST MATERIAL 651 0.836 12 47 136 515 NA NA 2343 2343 Carrier D 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72158 MRI LUMBAR W/WO CONTRST SPINE 884 0.396 26 120 149 735 NA NA 2344 2344 Carrier D 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93241 EXT ECG RECORD >48 HRS UP TO 7 DAYS BY CONT RHYTHM, INCL REC/SCAN W/INTERP & REP 142 1 1 22 9 133 NA NA 2345 2345 Carrier D 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 94010 SPIROMETRY W/GRAPHIC RECORD/VITAL CAPACITY/FLOW 121 1 7 11 9 112 NA NA 2346 2346 Carrier D 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 66984 EXTRACAPSULAR CAT REM W/ INSERT LENS PROSTHESIS; W/O ECP 127 1 1 31 16 111 NA NA 2347 2347 Carrier D 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 17311 MOHS HD, NCK, HND, FEET, GEN 1ST STGE UP TO 5 BLCK 134 1 2 14 34 100 NA NA 2348 2348 Carrier D 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93797 OPEN CARDIAC REHAB W/O CONT EKG MONITORING 84 1 13 122 7 77 NA NA 2349 2349 Carrier D 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93242 EXT ECG RECORD >48 HRS UP TO 7 DAYS BY CONT RHYTHM RECORDING/STORAGE 71 1 11 36 5 66 NA NA 2350 2350 Carrier D 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 26540 REPAIR COLLAT LIGAMENT METACARPOPHALANGEAL/IP JNT 75 1 9 23 19 56 NA NA 2351 2351 Carrier D 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93270 EVENT MONITOR - HOOKUP RECORD & DISCON ONLY 85 1 3 13 31 54 NA NA 2352 2352 Carrier D 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97597 DEBRIDEMENT, OPEN WOUND, ASSESSMENT, ONGOING CARE, PER SESSION, FIRST 20 SQ CM OR LESS 70 1 2 21 22 48 NA NA 2353 2353 Carrier D 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77412 RAD TX DELIVERY CUSTOM BLOCK 5 MEV 90 1 3 16 46 44 NA NA 2354 2354 Carrier D 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43644 LAP GASTRIC BYPASS/ROUX-EN-Y 4 0 0.25 171 0 4 0 NA NA 2355 2355 Carrier D 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 77522 PROTON TRMT, SIMPLE W/COMP 4 0 0.25 98 131 1 3 0 NA NA 2356 2356 Carrier D 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 29916 ARTHROSCOPY HIP W/LABRAL REPAIR 4 0 0.25 4 77 1 3 0 NA NA 2357 2357 Carrier D 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 53854 TRANSURETHRAL DESTRUCT PROSTAT TISSUE;BY RADIOFRQ WATER THERMOTHERPY 3 0 0.333 87 0 3 0 NA NA 2358 2358 Carrier D 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 11606 EXC MALIG LES TRUNK ARMS/LEGS >4.0 CM 4 0 0.25 35 82 2 2 0 NA NA 2359 2359 Carrier D 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 67908 REP BLEPHAROPTOSIS CONJU 2 0 0.5 202 0 2 0 NA NA 2360 2360 Carrier D 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 77280 THERAPEUTIC RADIOLOGY FIELD SIMPLE 3 0 0.333 2 142 2 1 0 NA NA 2361 2361 Carrier D 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43210 EGD, FLEX, TRNSORAL; W EG FUNDOPLASTY, PARTIAL /COMPLETE, INC DUODENOSCOSPY 1 0 1 105 0 1 0 NA NA 2362 2362 Carrier D 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27299 UNLISTED PROC PELVIS/HIP JNT 1 0 1 125 0 1 0 NA NA 2363 2363 Carrier D 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 88381 MICRODISSECTION; MANUAL 1 0 1 44 1 0 0 NA NA 2364 2364 Carrier D 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90853 GROUP PSYCHOTHERAPY 153 1 26 0 153 NA NA 2365 2365 Carrier D 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90834 PSYCHOTHERAPY 45 MIN PATIENT 248 0.992 6 0 248 NA NA 2366 2366 Carrier D 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90836 PSYCHOTHERAPY 45 MIN PATIENT WITH MEDICAL SVCS 641 0.988 13 48 8 633 NA NA 2367 2367 Carrier D 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY 60 MIN PATIENT 2794 0.987 8 25 38 2756 NA NA 2368 2368 Carrier D 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96130 PSYCHOLOGICAL TESTING EVAL BY PHYS OR QUAL PROF; FIRST HOUR 64 0.953 1 65 2 62 NA NA 2369 2369 Carrier D 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96132 NEUROPSYCHOLOGICAL TEST EVAL BY PHYS OR QUAL PROF; FIRST HOUR 81 0.926 13 199 4 77 NA NA 2370 2370 Carrier D 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 OFFICE VISIT E&M EST PT, MODERATE MDM, 30-39 MINS 23 0.913 139 1 22 NA NA 2371 2371 Carrier D 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90792 PSYCHIATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES 26 0.885 96 0 26 NA NA 2372 2372 Carrier D 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90791 PSYCHIATRIC DIAGNOSTIC EVAL W/O MEDICAL SERVICES 120 0.883 44 127 12 108 NA NA 2373 2373 Carrier D 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 TRANSCRANIAL MAG STIMJ TX DLVR & MGMT 77 0.831 86 0 77 NA NA 2374 2374 Carrier D 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90853 GROUP PSYCHOTHERAPY 153 1 26 0 153 NA NA 2375 2375 Carrier D 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90870 ECT (W/ MONITORING) SINGLE SEIZURE 13 1 109 0 13 NA NA 2376 2376 Carrier D 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT H0020 ALCOHOL AND/OR DRUG SERVICES 13 1 106 0 13 NA NA 2377 2377 Carrier D 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90833 PSYCHOTHERAPY 30 MIN PATIENT WITH MEDICAL SVCS 7 1 14 0 7 NA NA 2378 2378 Carrier D 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90806.102 REF MENTAL HEALTH EXTERNAL 5 1 63 0 5 NA NA 2379 2379 Carrier D 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96156 HEALTH BEHAVIOR ASSESSMENT, OR RE-ASSESSMENT 2 1 65 0 2 NA NA 2380 2380 Carrier D 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90832 PSYCHOTHERAPY 30 MIN PATIENT 1 1 317 0 1 NA NA 2381 2381 Carrier D 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96116 NEUROBEHAVIORAL STATUS EXAM, PHYS OR QUAL PROF, FIRST HOUR 1 1 308 0 1 NA NA 2382 2382 Carrier D 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96138 PSYCHOLOGICAL OR NEUROPSYCHOLOGICAL TEST BY TECH,2 OR MORE;FIRST 30 MINS 1 1 74 0 1 NA NA 2383 2383 Carrier D 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96159 HEALTH BEHAVIOR INTERVENTION, INDIVIDUAL, FACE-TO-FACE; EA ADDL 15 MINS 1 1 8 0 1 NA NA 2384 2384 Carrier D 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90837 PSYCHOTHERAPY 60 MIN PATIENT 2794 0 0 8 25 38 2756 0 NA NA 2385 2385 Carrier D 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 96132 NEUROPSYCHOLOGICAL TEST EVAL BY PHYS OR QUAL PROF; FIRST HOUR 81 0 0.025 13 199 4 77 0 NA NA 2386 2386 Carrier D 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90868 TRANSCRANIAL MAG STIMJ TX DLVR & MGMT 77 0 0.039 86 0 77 0 NA NA 2387 2387 Carrier D 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT S9480 PSYCH SVC INTENSIVE OUTPT 6 0 0.167 1 358 1 5 0 NA NA 2388 2388 Carrier D 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT G2082 VISIT FOR EVAL/MGMT EST PT REQ SUPERVISOIN MD, UP TO 56 MG OF ESKETAMINE NASAL, SELF ADMIM 5 0 0.2 74 0 5 0 NA NA 2389 2389 Carrier E 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4230 INFUS INSULIN PUMP NON NEEDL 37 1 93.8 55.3 1 36 NA NA 2390 2390 Carrier E 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4232 SYRINGE W/NEEDLE INSULIN 3CC 21 1 97.1 21 NA NA 2391 2391 Carrier E 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 EXT AMB INFUSN PUMP INSULIN 19 1 114.6 19 NA NA 2392 2392 Carrier E 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9276 SENSOR;INVSV DISP INTRSTL CONT GLU MON SYS 1U=1D 6 1 28.9 6 NA NA 2393 2393 Carrier E 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A6257 TRANSPARENT FILM STERL 16 SQ IN OR LESS EA DRESS 1 1 23.9 1 NA NA 2394 2394 Carrier E 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0553 SUPPLY ALLOW FOR TX CGM1 MO SPL = 1 U OF SERVICE 158 0.96 27.7 158 NA NA 2395 2395 Carrier E 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0554 RECEIVER DEDICATED FOR USE W/THERAPEUTIC GCM SYS 36 0.81 35.4 33.7 33 3 NA NA 2396 2396 Carrier E 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT 95250 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous 51 0.33 27.4 51 NA NA 2397 2397 Carrier E 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4230 INFUS INSULIN PUMP NON NEEDL 37 1 93.8 55.3 1 36 NA NA 2398 2398 Carrier E 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4232 SYRINGE W/NEEDLE INSULIN 3CC 21 1 97.1 21 NA NA 2399 2399 Carrier E 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 EXT AMB INFUSN PUMP INSULIN 19 1 114.6 19 NA NA 2400 2400 Carrier E 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9276 SENSOR;INVSV DISP INTRSTL CONT GLU MON SYS 1U=1D 6 1 28.9 6 NA NA 2401 2401 Carrier E 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A6257 TRANSPARENT FILM STERL 16 SQ IN OR LESS EA DRESS 1 1 23.9 1 NA NA 2402 2402 Carrier E 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0553 SUPPLY ALLOW FOR TX CGM1 MO SPL = 1 U OF SERVICE 158 0.96 27.7 158 NA NA 2403 2403 Carrier E 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0554 RECEIVER DEDICATED FOR USE W/THERAPEUTIC GCM SYS 36 0.81 35.4 33.7 33 3 NA NA 2404 2404 Carrier E 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95250 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous 51 0.33 27.4 51 NA NA 2405 2405 Carrier E 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0570 NEBULIZER WITH COMPRESSOR 78 1 9.5 8.7 74.3 11 66 1 NA NA 2406 2406 Carrier E 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0202 PHOTOTHERAPY LIGHT W/ PHOTOM 34 1 0.6 26.5 22.5 4 28 2 NA NA 2407 2407 Carrier E 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC B9002 ENTERAL NUTRITION INFUSION PUMP ANY TYPE 42 1 16 22.9 33 9 NA NA 2408 2408 Carrier E 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0143 WALKER FOLDING WHEELED W/O S 161 0.99 0.4 14.5 13.2 1 156 4 NA NA 2409 2409 Carrier E 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1390 OXYGEN CONCENTRATOR 191 0.98 5.8 26.8 17.5 22 145 24 NA NA 2410 2410 Carrier E 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0001 STANDARD WHEELCHAIR 34 0.97 35.7 0 32 2 NA NA 2411 2411 Carrier E 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A5500 DIAB ONLY FIT CSTM PREP&SPL SHOE MX DNSITY INSRT PER SHOE 78 0.97 52.1 33.2 44 34 NA NA 2412 2412 Carrier E 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0730 TENS DEVICE 4/MORE LEADS MULTI NERVE STIMULATION 84 0.94 45.7 52.6 82 2 NA NA 2413 2413 Carrier E 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0604 BREAST PUMP HEAVY DUTY HOSP GRADE PISTON OP 141 0.92 3.6 24.4 36 14 125 2 NA NA 2414 2414 Carrier E 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A6530 GRADIENT COMPRESSION STK BELW KNEE 18-30 MMHG EA 38 0.63 117.7 35.3 29 9 NA NA 2415 2415 Carrier E 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0570 NEBULIZER WITH COMPRESSOR 78 1 9.5 8.7 74.3 11 66 1 NA NA 2416 2416 Carrier E 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0691 UV LIGHT TX SYS BULB/LAMP TIMER; TX 2 SQ FT/LESS 26 1 20.1 30.9 25 1 NA NA 2417 2417 Carrier E 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A7005 NONDISPOSABLE NEBULIZER SET 22 1 0.7 21 0.1 1 20 1 NA NA 2418 2418 Carrier E 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0202 PHOTOTHERAPY LIGHT W/ PHOTOM 34 1 0.6 26.5 22.5 4 28 2 NA NA 2419 2419 Carrier E 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2402 NEG PRESS WOUND THERAPY PUMP 26 1 3 13.9 28 3 21 2 NA NA 2420 2420 Carrier E 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8015 EXT BREASTPROSTHESIS GARMENT 18 1 62.7 20.2 14 4 NA NA 2421 2421 Carrier E 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC B9002 ENTERAL NUTRITION INFUSION PUMP ANY TYPE 42 1 16 22.9 33 9 NA NA 2422 2422 Carrier E 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L1846 KNEE ORTHOSIS DOUBLE UPRIGHT THIGH & CALF CUSTOM 19 1 291.8 57.9 2 17 NA NA 2423 2423 Carrier E 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A6212 FOAM DRESS STERL PAD SZ 16 SQ/> W/ADHES BORDR EA 26 1 65.7 26 NA NA 2424 2424 Carrier E 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0693 UV LT TX SYS PANL W/BULBS/LAMPS TIMER 6 FT PANEL 21 1 19.9 21 NA NA 2425 2425 Carrier E 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC A6530 GRADIENT COMPRESSION STK BELW KNEE 18-30 MMHG EA 37 0 0.03 92.3 37 NA NA 2426 2426 Carrier E 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC D0303 D0303NON-TRAUMATIC BRAIN INJURY WITH MOTOR >26.15 & MOTOR <35.05.,COMORBIDITY IN TIER 3 1 1 0 1 NA NA 2427 2427 Carrier E 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 50360 RENAL ALLOTRANSPLANTATION, IMPLANTATION OF GRAFT 3 1 20.2 35.1 1 2 NA NA 2428 2428 Carrier E 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99223 INITIAL HOSPITAL CARE/DAY 70 MINUTES 2 1 0.1 2 NA NA 2429 2429 Carrier E 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC D0106 D0106STROKE WITH MOTOR >30.05 & MOTOR <34.25.,COMORBIDITY IN TIER 3 1 1 25.2 1 NA NA 2430 2430 Carrier E 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC D0102 D0102STROKE WITH MOTOR >44.45 & MOTOR <51.05 & COGNITIVE >18.5.,COMORBIDITY IN TIER 3 1 1 0 1 NA NA 2431 2431 Carrier E 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC C0302 C0302NON-TRAUMATIC BRAIN INJURY WITH MOTOR >35.05 & MOTOR <41.05.,COMORBIDITY IN TIER 2 1 1 0 1 NA NA 2432 2432 Carrier E 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC A0502 A0502NON-TRAUMATIC SPINAL CORD INJURY WITH MOTOR >40.15 & MOTOR <51.35.,WITHOUT COMORBI 1 1 0.1 1 NA NA 2433 2433 Carrier E 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC A0302 AMBULANCE BASIC EMERGENY ALL 1 1 0 1 NA NA 2434 2434 Carrier E 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC A0301 A0301NON-TRAUMATIC BRAIN INJURY WITH MOTOR >41.05.,WITHOUT COMORBIDITIES 1 1 2 1 NA NA 2435 2435 Carrier E 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC A0106 A0106STROKE WITH MOTOR >30.05 & MOTOR <34.25.,WITHOUT COMORBIDITIES 1 1 52.1 1 NA NA 2436 2436 Carrier E 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC D0303 D0303NON-TRAUMATIC BRAIN INJURY WITH MOTOR >26.15 & MOTOR <35.05.,COMORBIDITY IN TIER 3 1 1 0 1 NA NA 2437 2437 Carrier E 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 50360 RENAL ALLOTRANSPLANTATION, IMPLANTATION OF GRAFT 3 1 20.2 35.1 1 2 NA NA 2438 2438 Carrier E 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99223 INITIAL HOSPITAL CARE/DAY 70 MINUTES 2 1 0.1 2 NA NA 2439 2439 Carrier E 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC D0106 D0106STROKE WITH MOTOR >30.05 & MOTOR <34.25.,COMORBIDITY IN TIER 3 1 1 25.2 1 NA NA 2440 2440 Carrier E 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC D0102 D0102STROKE WITH MOTOR >44.45 & MOTOR <51.05 & COGNITIVE >18.5.,COMORBIDITY IN TIER 3 1 1 0 1 NA NA 2441 2441 Carrier E 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC C0302 C0302NON-TRAUMATIC BRAIN INJURY WITH MOTOR >35.05 & MOTOR <41.05.,COMORBIDITY IN TIER 2 1 1 0 1 NA NA 2442 2442 Carrier E 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A0502 A0502NON-TRAUMATIC SPINAL CORD INJURY WITH MOTOR >40.15 & MOTOR <51.35.,WITHOUT COMORBI 1 1 0.1 1 NA NA 2443 2443 Carrier E 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A0302 AMBULANCE BASIC EMERGENY ALL 1 1 0 1 NA NA 2444 2444 Carrier E 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A0301 A0301NON-TRAUMATIC BRAIN INJURY WITH MOTOR >41.05.,WITHOUT COMORBIDITIES 1 1 2 1 NA NA 2445 2445 Carrier E 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A0106 A0106STROKE WITH MOTOR >30.05 & MOTOR <34.25.,WITHOUT COMORBIDITIES 1 1 52.1 1 NA NA 2446 2446 Carrier E 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 99238 HOSPITAL DISCHARGE DAY MANAGEMENT 30 MIN/< 1 1 92.6 1 NA NA 2447 2447 Carrier E 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 21126 REFERRAL PORTLAND, REFERRALS EXTERNAL 1 1 30.9 1 NA NA 2448 2448 Carrier E 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 128 ROOM & BOARD, SEMIPRIVATE TWO-BED - REHABILITATION 3 1 19.2 53.4 2 1 NA NA 2449 2449 Carrier E 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 126 ROOM & BOARD, SEMIPRIVATE TWO-BED - DETOXIFICATION 9 1 80.2 49.1 5 4 NA NA 2450 2450 Carrier E 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 194 SUBACUTE CARE, LEVEL IV 7 1 45.5 7 NA NA 2451 2451 Carrier E 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1001 BEHAVIORAL HEALTH ACCOMMODATIONS, RESIDENTIAL TREATMENT, PSYCHIATRIC 11 1 39.4 11 NA NA 2452 2452 Carrier E 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 ROOM & BOARD, SEMIPRIVATE TWO-BED - PSYCHIATRIC 48 1 14.2 8.2 24 24 NA NA 2453 2453 Carrier E 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1002 BEHAVIORAL HEALTH ACCOMMODATIONS, RESIDENTIAL TREATMENT, CHEM DEP 29 0.93 127.5 75.2 62.4 1 6 22 NA NA 2454 2454 Carrier E 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES 5 0.8 32.2 58.5 3 2 NA NA 2455 2455 Carrier E 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99238 HOSPITAL DISCHARGE DAY MANAGEMENT 30 MIN/< 1 1 92.6 1 NA NA 2456 2456 Carrier E 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 21126 REFERRAL PORTLAND, REFERRALS EXTERNAL 1 1 30.9 1 NA NA 2457 2457 Carrier E 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 128 ROOM & BOARD, SEMIPRIVATE TWO-BED - REHABILITATION 3 1 19.2 53.4 2 1 NA NA 2458 2458 Carrier E 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 126 ROOM & BOARD, SEMIPRIVATE TWO-BED - DETOXIFICATION 9 1 80.2 49.1 5 4 NA NA 2459 2459 Carrier E 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 194 SUBACUTE CARE, LEVEL IV 7 1 45.5 7 NA NA 2460 2460 Carrier E 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1001 BEHAVIORAL HEALTH ACCOMMODATIONS, RESIDENTIAL TREATMENT, PSYCHIATRIC 11 1 39.4 11 NA NA 2461 2461 Carrier E 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 ROOM & BOARD, SEMIPRIVATE TWO-BED - PSYCHIATRIC 48 1 14.2 8.2 24 24 NA NA 2462 2462 Carrier E 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1002 BEHAVIORAL HEALTH ACCOMMODATIONS, RESIDENTIAL TREATMENT, CHEM DEP 29 0.93 127.5 75.2 62.4 1 6 22 NA NA 2463 2463 Carrier E 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES 5 0.8 32.2 58.5 3 2 NA NA 2464 2464 Carrier E 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ 101 1 21.6 3.8 99 2 NA NA 2465 2465 Carrier E 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99203 OFFICE/OUTPATIENT NEW LOW MDM 30-44 MINUTES 433 1 5.6 39.2 35.2 8 399 26 NA NA 2466 2466 Carrier E 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97162 PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS 99 0.99 0.5 34.2 31.9 3 92 4 NA NA 2467 2467 Carrier E 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45378 COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD 120 0.98 27.8 10 119 1 NA NA 2468 2468 Carrier E 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97161 PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS 919 0.98 3.4 38.6 26.8 13 866 40 NA NA 2469 2469 Carrier E 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 98940 CHIROPRACTIC MANIPULATIVE TX SPINAL 1-2 REGIONS 194 0.97 45.1 194 NA NA 2470 2470 Carrier E 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97810 ACUPUNCTURE 1/> NDLES W/O ELEC STIMJ INIT 15 MIN 372 0.96 42.6 1 371 1 NA NA 2471 2471 Carrier E 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99213 OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN 103 0.96 35.2 43.8 98 5 NA NA 2472 2472 Carrier E 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99204 OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES 95 0.96 7.9 37.5 20.3 4 85 6 NA NA 2473 2473 Carrier E 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99211 OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP 123 0.9 3.2 36.6 24 4 118 1 NA NA 2474 2474 Carrier E 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97110 THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES 76 1 0.8 35.4 4.9 3 72 1 NA NA 2475 2475 Carrier E 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70551 MRI BRAIN NO CONTRAST 30 1 6.3 44.7 27.3 17 12 1 NA NA 2476 2476 Carrier E 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ 101 1 21.6 3.8 99 2 NA NA 2477 2477 Carrier E 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 73721 MRI RIGHT KNEE NO CONTRAST 36 1 6.3 38.6 0.4 28 6 2 NA NA 2478 2478 Carrier E 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 74177 CT ABD AND PELVIS W CONTRAST 28 1 13.4 50.2 7 19 1 8 NA NA 2479 2479 Carrier E 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S9131 PT IN THE HOME PER DIEM 59 1 9.3 59 NA NA 2480 2480 Carrier E 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 87635 IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ 36 1 24.9 36 NA NA 2481 2481 Carrier E 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97813 ACUPUNCTURE 1/> NDLS W/ELEC STIMJ 1ST 15 MIN 35 1 43.5 35 NA NA 2482 2482 Carrier E 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 98941 CHIROPRACTIC MANIPULATIVE TX SPINAL 3-4 REGIONS 28 1 44.9 28 NA NA 2483 2483 Carrier E 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70553 MRI BRAIN WO/W CONTRAST 60 1 10.5 35.9 37 23 NA NA 2484 2484 Carrier E 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97810 ACUPUNCTURE 1/> NDLES W/O ELEC STIMJ INIT 15 MIN 372 0 0.01 42.6 1 371 1 NA NA 2485 2485 Carrier E 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21126 REFERRAL PORTLAND, REFERRALS EXTERNAL 37 0 0.03 2.6 73.2 56.7 3 29 5 NA NA 2486 2486 Carrier E 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 99202 OFFICE/OUTPATIENT NEW SF MDM 15-29 MINUTES 62 0 0.02 46.9 43.5 3 59 NA NA 2487 2487 Carrier E 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90834 PSYCHOTHERAPY W/PATIENT 45 MINUTES 31 1 56.7 69.8 30 1 NA NA 2488 2488 Carrier E 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES 27 1 35.8 0.8 26 1 NA NA 2489 2489 Carrier E 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0001 ALCOHOL AND/OR DRUG ASSESS 25 1 43.9 6.4 24 1 NA NA 2490 2490 Carrier E 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90899 UNLISTED PSYCHIATRIC SERVICE/PROCEDURE 21 1 45.2 6.3 20 1 NA NA 2491 2491 Carrier E 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0020 ALCOHOL AND/OR DRUG SERVICES METHADONE ADMINISTRATION 35 1 39.9 14 15 20 NA NA 2492 2492 Carrier E 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN 22 1 37.6 22 NA NA 2493 2493 Carrier E 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97155 ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN 19 1 64.7 19 NA NA 2494 2494 Carrier E 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES 459 0.99 50.9 44.6 456 3 NA NA 2495 2495 Carrier E 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION 1322 0.98 39.8 61.3 1311 11 NA NA 2496 2496 Carrier E 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97153 ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN 52 0.98 62.4 52 NA NA 2497 2497 Carrier E 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90834 PSYCHOTHERAPY W/PATIENT 45 MINUTES 31 1 56.7 69.8 30 1 NA NA 2498 2498 Carrier E 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES 27 1 35.8 0.8 26 1 NA NA 2499 2499 Carrier E 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0001 ALCOHOL AND/OR DRUG ASSESS 25 1 43.9 6.4 24 1 NA NA 2500 2500 Carrier E 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90899 UNLISTED PSYCHIATRIC SERVICE/PROCEDURE 21 1 45.2 6.3 20 1 NA NA 2501 2501 Carrier E 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 912 BEHAVIORAL HEALTH TREATMENTS/SVCS, PARTIAL HOSPITAL - LESS INTENSIVE 8 1 47.5 79.7 6 2 NA NA 2502 2502 Carrier E 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0020 ALCOHOL AND/OR DRUG SERVICES METHADONE ADMINISTRATION 35 1 39.9 14 15 20 NA NA 2503 2503 Carrier E 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97151 BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN 22 1 37.6 22 NA NA 2504 2504 Carrier E 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97155 ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN 19 1 64.7 19 NA NA 2505 2505 Carrier E 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97156 FAMILY ADAPT BHV TX GDN PHYS/QHP EA 15 MIN 18 1 44.7 18 NA NA 2506 2506 Carrier E 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0005 ALCOHOL AND/OR DRUG SERVICES GROUP COUNSELING BY CLINICIAN 6 1 39.3 6 NA NA 2507 2507 Carrier E 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION 1322 0 0.001 39.8 61.3 1311 11 NA NA 2508 2508 Carrier F 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year NA NA Test Strips 28 0.61 5.76 32.61 6 22 NA NA 2509 2509 Carrier F 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA Test Strips 28 0.61 5.76 32.61 6 22 NA NA 2510 2510 Carrier F 2021 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NA NA Test Strips 28 0 0 5.76 32.61 6 22 NA NA 2511 2511 Carrier F 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0486 Oral device/appliance used to reduce upper airway collapsibility, adjustable or nonadjustable, custom fabricated, includes fitting and adjustment 7 1 112 0 7 NA NA 2512 2512 Carrier F 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with interstitial continuous glucose monitoring system, 1 unit = 1 day supply 33 0.91 19 122 4 29 NA NA 2513 2513 Carrier F 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L1852 Knee orthosis (KO), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf 10 0.9 133 0 10 NA NA 2514 2514 Carrier F 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9277 Transmitter; external, for use with interstitial continuous glucose monitoring system 18 0.89 36 114 3 15 NA NA 2515 2515 Carrier F 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0747 Osteogenesis stimulator, electrical, noninvasive, other than spinal applications 8 0.86 111 0 8 NA NA 2516 2516 Carrier F 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4230 Infusion set for external insulin pump, nonneedle cannula type 10 0.8 26 159 2 8 NA NA 2517 2517 Carrier F 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 External ambulatory infusion pump, insulin 13 0.69 28 150 5 8 NA NA 2518 2518 Carrier F 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1399 Durable medical equipment, miscellaneous 8 0.63 52 153 1 7 NA NA 2519 2519 Carrier F 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0603 Breast pump, electric (AC and/or DC), any type 13 0.15 186 0 13 NA NA 2520 2520 Carrier F 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 Continuous positive airway pressure (CPAP) device 8 0.13 110 0 8 NA NA 2521 2521 Carrier F 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0486 Oral device/appliance used to reduce upper airway collapsibility, adjustable or nonadjustable, custom fabricated, includes fitting and adjustment 7 1 112 0 7 NA NA 2522 2522 Carrier F 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L1846 Knee orthosis (KO), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated 6 1 23 88 1 5 NA NA 2523 2523 Carrier F 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L2820 Addition to lower extremity orthosis, soft interface for molded plastic, below knee section 5 1 116 0 5 NA NA 2524 2524 Carrier F 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L1970 Ankle-foot orthosis (AFO), plastic with ankle joint, custom fabricated 5 1 63 107 1 4 NA NA 2525 2525 Carrier F 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A6550 Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories 4 1 119 0 4 NA NA 2526 2526 Carrier F 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A7000 Canister, disposable, used with suction pump, each 4 1 119 0 4 NA NA 2527 2527 Carrier F 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2402 Negative pressure wound therapy electrical pump, stationary or portable 4 1 118 0 4 NA NA 2528 2528 Carrier F 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0766 Electrical stimulation device used for cancer treatment, includes all accessories, any type 4 1 50 104 1 3 NA NA 2529 2529 Carrier F 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L0650 Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf 4 1 63 112 1 3 NA NA 2530 2530 Carrier F 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L1851 Knee orthosis (KO), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf 4 1 108 0 4 NA NA 2531 2531 Carrier F 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L2999 Lower extremity orthoses, not otherwise specified 2 0 0.5 99 0 2 NA NA 2532 2532 Carrier F 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L2755 Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only 2 0 0.5 99 0 2 NA NA 2533 2533 Carrier F 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC B4152 Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit 1 0 1 122 0 1 NA NA 2534 2534 Carrier F 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 11 0.82 24 94 1 10 NA NA 2535 2535 Carrier F 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace, lumbar; 14 0.71 25 54 3 11 NA NA 2536 2536 Carrier F 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 27 0.7 24 61 3 24 NA NA 2537 2537 Carrier F 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 121 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Medical/Surgical/GYN 244 0.67 30 65 57 187 NA NA 2538 2538 Carrier F 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure) 18 0.67 25 57 2 16 NA NA 2539 2539 Carrier F 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar 15 0.67 23 48 3 12 NA NA 2540 2540 Carrier F 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22614 Arthrodesis, posterior or posterolateral technique, single interspace; each additional interspace (List separately in addition to code for primary procedure) 12 0.67 25 56 2 10 NA NA 2541 2541 Carrier F 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 14 0.64 24 65 2 12 NA NA 2542 2542 Carrier F 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20936 Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure) 16 0.63 25 55 2 14 NA NA 2543 2543 Carrier F 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) 17 0.59 25 34 3 14 NA NA 2544 2544 Carrier F 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); 8 1 33 46 3 5 NA NA 2545 2545 Carrier F 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 32663 Thoracoscopy, surgical; with lobectomy (single lobe) 6 1 17 85 2 4 NA NA 2546 2546 Carrier F 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22214 Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; lumbar 5 1 25 96 1 4 NA NA 2547 2547 Carrier F 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33427 Valvuloplasty, mitral valve, with cardiopulmonary bypass; radical reconstruction, with or without ring 5 1 42 67 1 4 NA NA 2548 2548 Carrier F 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 20937 Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial incision) (List separately in addition to code for primary procedure) 4 1 76 110 1 3 NA NA 2549 2549 Carrier F 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 61781 Stereotactic computer-assisted (navigational) procedure; cranial, intradural (List separately in addition to code for primary procedure) 4 1 6 89 1 3 NA NA 2550 2550 Carrier F 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15769 Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia) 3 1 95 0 3 NA NA 2551 2551 Carrier F 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19364 Breast reconstruction; with free flap (eg, fTRAM, DIEP, SIEA, GAP flap) 3 1 29 105 1 2 NA NA 2552 2552 Carrier F 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22216 Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; each additional vertebral segment (List separately in addition to primary procedure) 3 1 25 64 1 2 NA NA 2553 2553 Carrier F 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22600 Arthrodesis, posterior or posterolateral technique, single interspace; cervical below C2 segment 3 1 24 96 1 2 NA NA 2554 2554 Carrier F 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43848 Revision, open, of gastric restrictive procedure for morbid obesity, other than adjustable gastric restrictive device (separate procedure) 2 0 1 86 0 2 NA NA 2555 2555 Carrier F 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 49255 Omentectomy, epiploectomy, resection of omentum (separate procedure) 2 0 1 5 27 1 1 NA NA 2556 2556 Carrier F 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 49205 Excision or destruction, open, intra-abdominal tumors, cysts or endometriomas, 1 or more peritoneal, mesenteric, or retroperitoneal primary or secondary tumors; largest tumor greater than 10.0 cm diameter 1 0 1 5 1 0 NA NA 2557 2557 Carrier F 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 44005 Enterolysis (freeing of intestinal adhesion) (separate procedure) 1 0 1 5 1 0 NA NA 2558 2558 Carrier F 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 96549 Unlisted chemotherapy procedure 1 0 1 6 1 0 NA NA 2559 2559 Carrier F 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0018 Behavioral health; short-term residential (nonhospital residential treatment program), without room and board, per diem 1 1 26 1 0 NA NA 2560 2560 Carrier F 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple 538 0.95 33 111 75 463 NA NA 2561 2561 Carrier F 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 471 0.94 35 112 70 401 NA NA 2562 2562 Carrier F 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64483 Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, single level 140 0.91 34 113 18 122 NA NA 2563 2563 Carrier F 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 92250 Fundus photography with interpretation and report 134 0.9 33 109 26 108 NA NA 2564 2564 Carrier F 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation 138 0.89 34 112 40 98 NA NA 2565 2565 Carrier F 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 29881 Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed 83 0.89 30 105 9 74 NA NA 2566 2566 Carrier F 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft 114 0.82 28 119 15 99 NA NA 2567 2567 Carrier F 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 128 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Rehabilitation 4 0.25 21 4 0 NA NA 2568 2568 Carrier F 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 Mental health partial hospitalization, treatment, less than 24 hours 2 0 26 5 1 1 NA NA 2569 2569 Carrier F 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Psychiatric 1 0 5 0 1 NA NA 2570 2570 Carrier F 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27096 Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed 57 1 36 110 5 52 NA NA 2571 2571 Carrier F 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 36471 Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg 29 1 102 0 29 NA NA 2572 2572 Carrier F 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43238 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s), (includes endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures) 23 1 30 105 4 19 NA NA 2573 2573 Carrier F 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 69990 Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure) 20 1 47 115 1 19 NA NA 2574 2574 Carrier F 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 36482 Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; first vein treated 14 1 98 0 14 NA NA 2575 2575 Carrier F 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64633 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint 12 1 75 120 1 11 NA NA 2576 2576 Carrier F 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 66982 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; without endoscopic cyclophotocoagulation 14 1 16 104 4 10 NA NA 2577 2577 Carrier F 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93460 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed 14 1 34 96 5 9 NA NA 2578 2578 Carrier F 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43242 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis) 11 1 17 112 3 8 NA NA 2579 2579 Carrier F 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 31267 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus 11 1 30 113 4 7 NA NA 2580 2580 Carrier F 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0018 Behavioral health; short-term residential (nonhospital residential treatment program), without room and board, per diem 1 1 26 1 0 NA NA 2581 2581 Carrier F 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 128 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Rehabilitation 4 0.25 21 4 0 NA NA 2582 2582 Carrier F 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64718 Neuroplasty and/or transposition; ulnar nerve at elbow 4 0 0.25 79 0 4 NA NA 2583 2583 Carrier F 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 77065 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral 3 0 0.33 24 156 1 2 NA NA 2584 2584 Carrier F 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 55970 Intersex surgery; male to female 2 0 0.5 108 0 2 NA NA 2585 2585 Carrier F 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 54520 Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach 2 0 0.5 108 0 2 NA NA 2586 2586 Carrier F 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 67971 Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage 2 0 0.5 171 0 2 NA NA 2587 2587 Carrier F 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43999 Unlisted procedure, stomach 1 0 1 91 0 1 NA NA 2588 2588 Carrier F 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 67917 Repair of ectropion; extensive (eg, tarsal strip operations) 1 0 1 223 0 1 NA NA 2589 2589 Carrier F 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27329 Radical resection of tumor (eg, sarcoma), soft tissue of thigh or knee area; less than 5 cm 1 0 1 27 1 0 NA NA 2590 2590 Carrier F 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC S9480 Intensive outpatient psychiatric services, per diem 31 0.94 15 60 5 26 NA NA 2591 2591 Carrier F 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97153 Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes 20 0.9 18 65 1 19 NA NA 2592 2592 Carrier F 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0015 Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education 49 0.86 166 40 10 39 NA NA 2593 2593 Carrier F 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 Mental health partial hospitalization, treatment, less than 24 hours 108 0.85 24 66 20 88 NA NA 2594 2594 Carrier F 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97156 Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes 25 0.84 29 91 5 20 NA NA 2595 2595 Carrier F 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan 25 0.84 27 66 7 18 NA NA 2596 2596 Carrier F 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC S0201 Partial hospitalization services, less than 24 hours, per diem 19 0.79 33 82 2 17 NA NA 2597 2597 Carrier F 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 29 0.72 17 48 1 28 NA NA 2598 2598 Carrier F 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 25 0.68 17 48 1 24 NA NA 2599 2599 Carrier F 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 16 0.63 17 58 1 15 NA NA 2600 2600 Carrier F 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90870 Electroconvulsive therapy (includes necessary monitoring) 2 1 62 0 2 NA NA 2601 2601 Carrier F 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99442 Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion 2 1 0 0 2 NA NA 2602 2602 Carrier F 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 0373T Adaptive behavior treatment with protocol modification, each 15 minutes of technicians' time face-to-face with a patient, requiring the following components: administration by the physician or other qualified health care professional who is on site; with the assistance of two or more technicians; for a patient who exhibits destructive behavior; completion in an environment that is customized to the patient's behavior. 1 1 95 0 1 NA NA 2603 2603 Carrier F 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90887 Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient 1 1 23 0 1 NA NA 2604 2604 Carrier F 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96372 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular 1 1 16 0 1 NA NA 2605 2605 Carrier F 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter. 1 1 0 0 1 NA NA 2606 2606 Carrier F 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99443 Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion 1 1 0 0 1 NA NA 2607 2607 Carrier F 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0012 Alcohol and/or drug services; subacute detoxification (residential addiction program outpatient) 1 1 28 0 1 NA NA 2608 2608 Carrier F 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S0013 Esketamine, nasal spray, 1 mg 1 1 25 1 0 NA NA 2609 2609 Carrier F 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97158 Group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, face-to-face with multiple patients, each 15 minutes 23 0.87 35 77 8 15 NA NA 2610 2610 Carrier F 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC H0035 Mental health partial hospitalization, treatment, less than 24 hours 120 0 0.008 25 48 17 103 NA NA 2611 2611 Carrier F 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97156 Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes 85 0 0.012 32 99 19 66 NA NA 2612 2612 Carrier F 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97155 Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes 80 0 0.013 32 103 20 60 NA NA 2613 2613 Carrier G 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A5514 DIAB ONLY MX DEN INSRT DIRECT CARV CUSTOM FAB EA 3 1 15.4 3 NA NA 2614 2614 Carrier G 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A9274 EXTERNAL AMB INSULIN DEL SYSTEM DISPOSABLE EA 1 1 140.3 1 NA NA 2615 2615 Carrier G 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT E0784 EXTERNAL AMBULATORY INFUSION PUMP INSULIN 23 0.83 23.9 39.6 5 18 NA NA 2616 2616 Carrier G 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A4230 INFUS SET EXT INSULIN PUMP NONNDLE CANNULA TYPE 5 0.8 6.4 69.2 1 4 NA NA 2617 2617 Carrier G 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A4232 SYRINGE W/NDLE EXTERNAL INSULIN PUMP STERILE 3CC 4 0.75 6.4 62.1 1 3 NA NA 2618 2618 Carrier G 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A5500 DIAB ONLY FIT CSTM PREP AND SPL SHOE MX DNSITY INSRT 2 0 2 NA NA 2619 2619 Carrier G 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT L3000 FT INSRT MOLD PT MDL UCB TYPE BERKLY SHELL EA 1 0 1 NA NA 2620 2620 Carrier G 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A5514 DIAB ONLY MX DEN INSRT DIRECT CARV CUSTOM FAB EA 3 1 15.4 3 NA NA 2621 2621 Carrier G 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A9274 EXTERNAL AMB INSULIN DEL SYSTEM DISPOSABLE EA 1 1 140.3 1 NA NA 2622 2622 Carrier G 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0784 EXTERNAL AMBULATORY INFUSION PUMP INSULIN 23 0.83 23.9 39.6 5 18 NA NA 2623 2623 Carrier G 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4230 INFUS SET EXT INSULIN PUMP NONNDLE CANNULA TYPE 5 0.8 6.4 69.2 1 4 NA NA 2624 2624 Carrier G 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4232 SYRINGE W/NDLE EXTERNAL INSULIN PUMP STERILE 3CC 4 0.75 6.4 62.1 1 3 NA NA 2625 2625 Carrier G 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A5500 DIAB ONLY FIT CSTM PREP AND SPL SHOE MX DNSITY INSRT 2 0 2 NA NA 2626 2626 Carrier G 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L3000 FT INSRT MOLD PT MDL UCB TYPE BERKLY SHELL EA 1 0 1 NA NA 2627 2627 Carrier G 2021 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0784 EXTERNAL AMBULATORY INFUSION PUMP INSULIN 23 0 0.174 23.9 39.6 5 18 NA NA 2628 2628 Carrier G 2021 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A4230 INFUS SET EXT INSULIN PUMP NONNDLE CANNULA TYPE 5 0 0.2 6.4 69.2 1 4 NA NA 2629 2629 Carrier G 2021 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A4232 SYRINGE W/NDLE EXTERNAL INSULIN PUMP STERILE 3CC 4 0 0.25 6.4 62.1 1 3 NA NA 2630 2630 Carrier G 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L1970 AFO PLASTIC WITH ANKLE JOINT CUSTOM FABRICATED 9 0.89 53.2 9 NA NA 2631 2631 Carrier G 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0784 EXTERNAL AMBULATORY INFUSION PUMP INSULIN 23 0.83 23.9 39.6 5 18 NA NA 2632 2632 Carrier G 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT V2624 POLISHING/RESURFACING OF OCULAR PROSTHESIS 9 0.78 35 9 NA NA 2633 2633 Carrier G 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0486 ORL DEVC/APPL RDUC UP AIRWAY COLLAPSIBILITY CSTM 9 0.44 104.2 9 NA NA 2634 2634 Carrier G 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0667 SEG PNEUMAT APPLINC W/PNEUMAT COMPRS FULL LEG 8 0.38 85.7 8 NA NA 2635 2635 Carrier G 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT A6550 WND CARE SET NEG PRSS WND TX ELEC PUMP SPL 11 0.36 69.8 52.1 3 8 NA NA 2636 2636 Carrier G 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E2402 NEG PRESS WOUND THERAPY ELEC PUMP STATION/PRTBLE 11 0.36 69.8 52.1 3 8 NA NA 2637 2637 Carrier G 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT A7000 CANISTER DISPOSABLE USED WITH SUCTION PUMP EACH 11 0.36 69.8 52.1 3 8 NA NA 2638 2638 Carrier G 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0652 PNEUMAT COMPRS SEG HOM MDL W/CALBRTD GRADNT PRSS 12 0.33 78.5 12 NA NA 2639 2639 Carrier G 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L3000 FT INSRT MOLD PT MDL UCB TYPE BERKLY SHELL EA 13 0 28 1 12 NA NA 2640 2640 Carrier G 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A7048 VACUUM DRAINAGE COLLECTION UNIT AND TUBING KIT EA 2 1 17.4 2 NA NA 2641 2641 Carrier G 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72141 MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL 1 1 50.1 1 NA NA 2642 2642 Carrier G 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72148 MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL 1 1 50.1 1 NA NA 2643 2643 Carrier G 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A5514 DIAB ONLY MX DEN INSRT DIRECT CARV CUSTOM FAB EA 3 1 15.4 3 NA NA 2644 2644 Carrier G 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A0425 GROUND MILEAGE PER STATUTE MILE 1 1 91.3 1 NA NA 2645 2645 Carrier G 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A0428 AMBULANCE SERVICE BLS NONEMERGENCY TRANSPORT 1 1 91.3 1 NA NA 2646 2646 Carrier G 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A9270 NONCOVERED ITEM OR SERVICE 1 1 120 1 NA NA 2647 2647 Carrier G 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A9274 EXTERNAL AMB INSULIN DEL SYSTEM DISPOSABLE EA 1 1 140.3 1 NA NA 2648 2648 Carrier G 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0143 WALKER FOLDING WHEELED ADJUSTABLE/FIXED HEIGHT 1 1 28.1 1 NA NA 2649 2649 Carrier G 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0261 HOS BED SEMI-ELEC ANY TYPE SIDE RAIL W/O MATTRSS 1 1 213 1 NA NA 2650 2650 Carrier G 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0652 PNEUMAT COMPRS SEG HOM MDL W/CALBRTD GRADNT PRSS 12 0 0.25 78.5 12 NA NA 2651 2651 Carrier G 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0466 HOME VENTILATOR ANY TYPE USED W/NON-INVASV INTF 4 0 0.5 72.3 4 NA NA 2652 2652 Carrier G 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A4232 SYRINGE W/NDLE EXTERNAL INSULIN PUMP STERILE 3CC 4 0 0.25 6.4 62.1 1 3 NA NA 2653 2653 Carrier G 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0241 BATHTUB WALL RAIL EACH 2 0 0.5 4.4 2 NA NA 2654 2654 Carrier G 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0245 TUB STOOL OR BENCH 2 0 0.5 4.4 2 NA NA 2655 2655 Carrier G 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A0425 GROUND MILEAGE PER STATUTE MILE 1 0 1 91.3 1 NA NA 2656 2656 Carrier G 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A0428 AMBULANCE SERVICE BLS NONEMERGENCY TRANSPORT 1 0 1 91.3 1 NA NA 2657 2657 Carrier G 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0143 WALKER FOLDING WHEELED ADJUSTABLE/FIXED HEIGHT 1 0 1 28.1 1 NA NA 2658 2658 Carrier G 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E1815 DYN ADJ ANKLE EXT/FLEX DEVC INCL SOFT INTF MATL 1 0 1 126.8 1 NA NA 2659 2659 Carrier G 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0935 CONTINUOUS PASSIVE MOT EXERCISE DEVC KNEE ONLY 2 0 0.5 168.6 1 1 NA NA 2660 2660 Carrier G 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 38724 CERVICAL LYMPHADEC MODIFIED RADICAL NECK DSJ 12 1 9.8 57.1 5 7 NA NA 2661 2661 Carrier G 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44204 LAPAROSCOPY COLECTOMY PARTIAL W/ANASTOMOSIS 10 1 6.7 123.2 4 6 NA NA 2662 2662 Carrier G 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 120 Room & Board - Semiprivate - 2 Beds - General 25 0.96 78.1 0 22 3 NA NA 2663 2663 Carrier G 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 69990 MICROSURG TQS REQ USE OPERATING MICROSCOPE 18 0.94 15.6 82.8 8 10 NA NA 2664 2664 Carrier G 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44207 LAPS COLECTOMY PRTL W/COLOPXTSTMY LW ANAST 11 0.91 27 11 NA NA 2665 2665 Carrier G 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 61510 CRANIEC TREPHINE BONE FLP BRAIN TUMOR SUPRTENTOR 11 0.91 13 64.4 6 5 NA NA 2666 2666 Carrier G 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 61781 STRTCTC CPTR ASSTD PX CRANIAL INTRADURAL 16 0.88 5.3 69.6 7 9 NA NA 2667 2667 Carrier G 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 INSJ BIOMCHN DEV INTERVERTEBRAL DSC SPC W/ARTHRD 16 0.81 66.2 64.1 3 13 NA NA 2668 2668 Carrier G 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20936 AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION 14 0.79 26.3 68.3 3 11 NA NA 2669 2669 Carrier G 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20930 ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED 15 0.73 26.3 66.5 3 12 NA NA 2670 2670 Carrier G 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 200 Intensive Care - General 7 1 0 7 NA NA 2671 2671 Carrier G 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 110 Room & Board - Private - General 3 1 11 3 NA NA 2672 2672 Carrier G 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 113 Room & Board - Private - Pediatric 1 1 46.2 1 NA NA 2673 2673 Carrier G 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 122 Room & Board - Semiprivate - 2 Beds - OB 1 1 49.5 1 NA NA 2674 2674 Carrier G 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 127 Room & Board - Semiprivate - 2 Beds - Oncology 1 1 1 NA NA 2675 2675 Carrier G 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 11646 EXCISION MALIGNANT LESION F/E/E/N/L GT 4.0 CM 1 1 14.7 1 NA NA 2676 2676 Carrier G 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM OR LT 2 1 97.1 2 NA NA 2677 2677 Carrier G 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 11045 DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM 2 1 97.1 2 NA NA 2678 2678 Carrier G 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 206 Intensive Care - Intermediate (ICU) 5 1 0 167 4 1 NA NA 2679 2679 Carrier G 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 214 Coronary Care - Intermediate Coronary Care Unit (CCU) 4 1 17.9 0 3 1 NA NA 2680 2680 Carrier G 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 121 Room & Board - Semiprivate - 2 Beds - Medical/Surgical/GYN 5 0 0.8 189.61 5 NA NA 2681 2681 Carrier G 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 113 Room & Board - Private - Pediatric 1 0 1 46.2 1 NA NA 2682 2682 Carrier G 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 122 Room & Board - Semiprivate - 2 Beds - OB 1 0 1 49.5 1 NA NA 2683 2683 Carrier G 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT J7512 PREDNISONE IMMEDIATE RLSE/DELAYED RLSE ORAL 1 MG 1 0 1 4.8 1 NA NA 2684 2684 Carrier G 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT J9181 INJECTION ETOPOSIDE 10 MG 1 0 1 4.8 1 NA NA 2685 2685 Carrier G 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT J9312 INJECTION RITUXIMAB 10 MG 1 0 1 4.8 1 NA NA 2686 2686 Carrier G 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 15740 FLAP ISLAND PEDICLE ANATOMIC NAMED AXIAL ARTERY 4 0 0.5 127.8 4 NA NA 2687 2687 Carrier G 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 58571 LAPS TOTAL HYSTERECT 250 GM OR LT W/RMVL TUBE/OVARY 1 0 1 120 1 NA NA 2688 2688 Carrier G 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 61580 CRANIOFACIAL ANT CRANIAL FOSSA W/O ORBITAL EXNTJ 1 0 1 195.3 1 NA NA 2689 2689 Carrier G 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 61600 RESCJ/EXC LES BASE ANT CRANIAL FOSSA EXTRADURAL 1 0 1 195.3 1 NA NA 2690 2690 Carrier G 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 99231 SBSQ HOSPITAL CARE/DAY 15 MINUTES 1 1 24 1 NA NA 2691 2691 Carrier G 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 120 Room & Board - Semiprivate - 2 Beds - General 1 1 57.5 1 NA NA 2692 2692 Carrier G 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90792 PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES 1 1 24 1 NA NA 2693 2693 Carrier G 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 99238 HOSPITAL DISCHARGE DAY MANAGEMENT 30 MIN OR LT 1 1 24 1 NA NA 2694 2694 Carrier G 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 57335 VAGINOPLASTY INTERSEX STATE 2 1 169.3 2 NA NA 2695 2695 Carrier G 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 44204 LAPAROSCOPY COLECTOMY PARTIAL W/ANASTOMOSIS 2 1 169.3 2 NA NA 2696 2696 Carrier G 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 44955 APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX 1 1 95.7 1 NA NA 2697 2697 Carrier G 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 Room & Board - Semiprivate - 2 Beds - Psychiatric 3 1 24 0 2 1 NA NA 2698 2698 Carrier G 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 15570 FRMJ DIRECT/TUBED PEDICLE W/WO TRANSFER TRUNK 1 0 1 NA NA 2699 2699 Carrier G 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 15877 SUCTION ASSISTED LIPECTOMY TRUNK 1 0 1 NA NA 2700 2700 Carrier G 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 120 Room & Board - Semiprivate - 2 Beds - General 1 1 57.5 1 NA NA 2701 2701 Carrier G 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90792 PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES 1 1 24 1 NA NA 2702 2702 Carrier G 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99231 SBSQ HOSPITAL CARE/DAY 15 MINUTES 1 1 24 1 NA NA 2703 2703 Carrier G 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99238 HOSPITAL DISCHARGE DAY MANAGEMENT 30 MIN OR LT 1 1 24 1 NA NA 2704 2704 Carrier G 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44204 LAPAROSCOPY COLECTOMY PARTIAL W/ANASTOMOSIS 2 1 338.6 2 NA NA 2705 2705 Carrier G 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 57335 VAGINOPLASTY INTERSEX STATE 2 1 338.6 2 NA NA 2706 2706 Carrier G 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44955 APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX 1 1 95.7 1 NA NA 2707 2707 Carrier G 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 Room & Board - Semiprivate - 2 Beds - Psychiatric 3 1 48 0 2 1 NA NA 2708 2708 Carrier G 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15570 FRMJ DIRECT/TUBED PEDICLE W/WO TRANSFER TRUNK 1 0 1 NA NA 2709 2709 Carrier G 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15877 SUCTION ASSISTED LIPECTOMY TRUNK 1 0 1 NA NA 2710 2710 Carrier G 2021 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 120 Room & Board - Semiprivate - 2 Beds - General 1 0 1 57.5 1 NA NA 2711 2711 Carrier G 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 61782 STRTCTC CPTR ASSTD PX EXTRADURAL CRANIAL 2 0.5 18.4 2 NA NA 2712 2712 Carrier G 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 31299 UNLISTED PROCEDURE ACCESSORY SINUSES 2 0.5 18.4 2 NA NA 2713 2713 Carrier G 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43235 ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC 2 0.5 14.9 1 1 NA NA 2714 2714 Carrier G 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 49320 LAPS ABD PRTM and OMENTUM DX W/WO SPEC BR/WA SPX 2 0.5 14.9 1 1 NA NA 2715 2715 Carrier G 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63266 LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL THORACIC 1 0 43.6 1 NA NA 2716 2716 Carrier G 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 31622 BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX 2 0 2 NA NA 2717 2717 Carrier G 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 47120 HEPATECTOMY RESCJ PARTIAL LOBECTOMY 1 0 1 NA NA 2718 2718 Carrier G 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 39561 RESCJ DIAPHRAGM W/COMPLEX REPAIR 1 0 1 NA NA 2719 2719 Carrier G 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 69990 MICROSURG TQS REQ USE OPERATING MICROSCOPE 2 0 43.6 20.6 1 1 NA NA 2720 2720 Carrier G 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 33518 CORONARY ARTERY BYP W/VEIN and ARTERY GRAFT 2 VEIN 2 0 1 1 NA NA 2721 2721 Carrier G 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44186 LAPAROSCOPY SURGICAL JEJUNOSTOMY 1 1 14.9 1 NA NA 2722 2722 Carrier G 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99222 INITIAL HOSPITAL CARE/DAY 50 MINUTES 1 1 0 1 NA NA 2723 2723 Carrier G 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99223 INITIAL HOSPITAL CARE/DAY 70 MINUTES 1 1 0 1 NA NA 2724 2724 Carrier G 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 31040 PTERYGOMAXILLARY FOSSA SURGERY ANY APPROACH 1 1 37.8 1 NA NA 2725 2725 Carrier G 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 31241 NASAL/SINUS NDSC W/LIG SPHENOPALATINE ARTERY 1 1 37.8 1 NA NA 2726 2726 Carrier G 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 31255 NASAL/SINUS NDSC W/TOTAL ETHOIDECTOMY 1 1 37.8 1 NA NA 2727 2727 Carrier G 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 31256 NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY 1 1 37.8 1 NA NA 2728 2728 Carrier G 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 31257 NASAL/SINUS NDSC TOTAL WITH SPHENOIDOTOMY 1 1 37.8 1 NA NA 2729 2729 Carrier G 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 31259 NASAL/SINUS NDSC TOT W/SPHENDT W/SPHEN TISS RMVL 1 1 37.8 1 NA NA 2730 2730 Carrier G 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 31276 NASAL/SINUS NDSC W/RMVL TISS FROM FRONTAL SINUS 1 1 37.8 1 NA NA 2731 2731 Carrier G 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT H0011 ALCOHOL and / DRUG SERVICES; ACUTE DTOX RES PROG IP 15 1 10.4 15 NA NA 2732 2732 Carrier G 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97153 ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN 12 0.92 105.5 12 NA NA 2733 2733 Carrier G 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97155 ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN 12 0.92 105.5 12 NA NA 2734 2734 Carrier G 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT H0018 BHVAL HEALTH; SHORT-TERM RES W/O ROOM and BOARD-DIEM 13 0.92 17.7 22 11 2 NA NA 2735 2735 Carrier G 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 71271 COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C- 110 0.86 37.1 95.8 4 106 NA NA 2736 2736 Carrier G 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 REPET TMS TX SUBSEQ MOTR THRESHLD W/DELIV and MN 15 0.67 77 15 NA NA 2737 2737 Carrier G 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL and M 17 0.65 71.9 1 16 NA NA 2738 2738 Carrier G 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90833 PSYCHOTHERAPY W/PATIENT W/E and M SRVCS 30 MIN 11 0.64 53.4 11 NA NA 2739 2739 Carrier G 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 THERAP REPETITIVE TMS TX SUBSEQ DELIVERY AND MNG 19 0.63 71.9 1 18 NA NA 2740 2740 Carrier G 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION 17 0.47 47.3 69.1 3 14 NA NA 2741 2741 Carrier G 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 126 Room & Board - Semiprivate - 2 Beds - Detoxification 4 1 24.3 4 NA NA 2742 2742 Carrier G 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 912 Behavioral Health Treatments_Services - Partial hospitalizat 2 1 35.5 2 NA NA 2743 2743 Carrier G 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 905 Behavioral Health Treatments/Services -IOP Psychiatric 1 1 96 1 NA NA 2744 2744 Carrier G 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81381 HLA I TYPING HIGH RESOLUTION 1 ALLELE/ALLELE GRP 2 1 2 NA NA 2745 2745 Carrier G 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 906 Behavioral Health Treatments/Services - IOP Chemical Depende 1 1 55.2 1 NA NA 2746 2746 Carrier G 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70551 MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL 1 1 71.4 1 NA NA 2747 2747 Carrier G 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81380 HLA CLASS I TYPING HIGH RESOLUTION ONE LOCUS EA 1 1 1 NA NA 2748 2748 Carrier G 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 906 Behavioral Health Treatments_Services - Intensive outpatient 1 1 48 1 NA NA 2749 2749 Carrier G 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90846 FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS 1 1 0 1 NA NA 2750 2750 Carrier G 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 92521 EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER) 1 1 6.9 1 NA NA 2751 2751 Carrier G 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 126 Room & Board - Semiprivate - 2 Beds - Detoxification 4 0 0.25 24.3 4 NA NA 2752 2752 Carrier G 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 71271 COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C- 110 0 0.009 37.1 95.8 4 106 NA NA 2753 2753 Carrier G 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION 17 0 0.059 47.3 69.1 3 14 NA NA 2754 2754 Carrier G 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT G0283 E-STIM 1 OR GT AREAS OTH THAN WND CARE PART TX PLAN 1 0 1 74.6 1 NA NA 2755 2755 Carrier H 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year NA NA Test Strips 146 0.72 5.9 21.91 29 117 NA NA 2756 2756 Carrier H 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA Test Strips 146 0.72 5.9 21.91 29 117 NA NA 2757 2757 Carrier H 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0486 Oral Device/appliance Cusfab 329 0.99 3.71 0.15 0 329 NA NA 2758 2758 Carrier H 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2620 Positioning Wheelchair Back Cushion, Planar Back With Lateral Supports, Width 18 0.95 100.36 4.18 0 18 NA NA 2759 2759 Carrier H 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0005 Ultralightweight Wheelchair 25 0.92 75.84 3.16 0 25 NA NA 2760 2760 Carrier H 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC S1040 Cranial Remolding Orthosis, Rigid, With Soft Interface Material, Custom Fabricated, Includes Fitting And Adjustment(s) 47 0.88 69.23 2.88 0 47 NA NA 2761 2761 Carrier H 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0652 Pneumatic Compressor, Segmental Home Model With Calibrated Gradient Pr 20 0.85 56.35 2.35 0 20 NA NA 2762 2762 Carrier H 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0108 Wheelchair Component Or Accessory, Not Otherwise Specified 83 0.8 78 3.25 0 83 NA NA 2763 2763 Carrier H 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L1846 Ko, Double Upright, Thigh And Calf, With Adjustable Flexion And Extens 21 0.62 68.31 2.85 0 21 NA NA 2764 2764 Carrier H 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0748 Osteogenic Stimulator, Noninvasive, Spinal Applications 36 0.48 81.23 3.38 0 36 NA NA 2765 2765 Carrier H 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0747 Osteogenesis Stimulator (non-invasive) 38 0.43 79.35 3.31 0 38 NA NA 2766 2766 Carrier H 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0760 Osteogenesis Stimulator Low Intensity Ultrasound Noninvasive 33 0.04 85.03 3.54 0 33 NA NA 2767 2767 Carrier H 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8680 Implantable Neurostimulator Electrode Each 15 1 24 98.82 1 14 NA NA 2768 2768 Carrier H 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L2755 Addition To Lower Extremity Orthosis Carbon Graphite Lamination 12 1 60 0 12 NA NA 2769 2769 Carrier H 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1233 Wheelchair, Pediatric Size, Tilt-in-space, Rigid, Adj, Wo Seating 5 1 67.2 0 5 NA NA 2770 2770 Carrier H 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2617 Custom Fabricated Wheelchair Back Cushion, Any Size, Including Any Type 5 1 68 0 5 NA NA 2771 2771 Carrier H 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2609 Custom Fabricated Wheelchair Seat Cushion, Any Size 5 1 82.29 0 5 NA NA 2772 2772 Carrier H 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S1040 Cranial Remolding Orthosis, Rigid, With Soft Interface Material, Custom Fabricated, Includes Fitting And Adjustment(s) 5 1 84 0 5 NA NA 2773 2773 Carrier H 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1002 Wheelchair Accessory, Power Seating System, Tilt Only 4 1 110.4 0 4 NA NA 2774 2774 Carrier H 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2310 Power Wheelchair Accessory, Electronic Connection Between Wheelchair Controller A& One Power Seating System Motor, Incl All Related Electronics, Indicator Feature, Mechanical 3 1 56 0 3 NA NA 2775 2775 Carrier H 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1234 Wheelchair, Pediatric Size, Tilt-in-space, Folding, Adj, Wo Seating 3 1 88 0 3 NA NA 2776 2776 Carrier H 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8619 Cochlear Implant External Speech Processor And Controller, Integrated System, Replacement 2 1 84 0 2 NA NA 2777 2777 Carrier H 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC K0005 Ultralightweight Wheelchair 25 0 1 75.84 0 25 NA NA 2778 2778 Carrier H 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0652 Pneumatic Compressor, Segmental Home Model With Calibrated Gradient Pr 20 0 1 56.35 0 20 NA NA 2779 2779 Carrier H 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E2620 Positioning Wheelchair Back Cushion, Planar Back With Lateral Supports, Width 18 0 1 100.36 0 18 NA NA 2780 2780 Carrier H 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L8619 Cochlear Implant External Speech Processor And Controller, Integrated System, Replacement 9 0 1 80 0 9 NA NA 2781 2781 Carrier H 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0766 Electrical Stimulation Device Used For Cancer Treatment, Includes All Accessories, Any Type 8 0 0.5 9.6 57.6 2 6 NA NA 2782 2782 Carrier H 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0986 Manual Wheelchair Accessory, Push-rim Activated Power Assist, Each 5 0 1 76 0 5 NA NA 2783 2783 Carrier H 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L5856 Addition To Lower Extremity Prosthesis, Endoskeletal Knee-shin System, 5 0 1 24 100.8 1 4 NA NA 2784 2784 Carrier H 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0766 Electrical Stimulation Device Used For Cancer Treatment, Includes All Accessories, Any Type 1 0 1 72 0 1 NA NA 2785 2785 Carrier H 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0747 Osteogenesis Stimulator (non-invasive) 1 0 1 120 0 1 NA NA 2786 2786 Carrier H 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L1846 Ko, Double Upright, Thigh And Calf, With Adjustable Flexion And Extens 1 0 1 96 0 1 NA NA 2787 2787 Carrier H 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27130 Replacement Hip Total Simple 29 0.97 0 70.59 1 28 NA NA 2788 2788 Carrier H 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43775 Laps Gstrc Rstrictiv Px Longitudinal Gastrectomy 55 0.91 80.28 0 55 NA NA 2789 2789 Carrier H 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43644 Laparoscopy, Surg, Gastric Restrictive Procedure; W Gastric Bypass And Roux-en-y Gastroenterostomy (roux Limb <= 150 Cm) 44 0.91 98.77 0 44 NA NA 2790 2790 Carrier H 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22551 Arthrodesis, Anterior Interbody, Including Disc Space Preparation, Discectomy, Osteophytectomy And Decompression Of Spinal Cord And/or Nerve Roots; Cervical Below C2 35 0.89 33.6 87.27 2 33 NA NA 2791 2791 Carrier H 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63047 Laminectomy W Facetectomy-lumbar 29 0.87 0 79.76 1 28 NA NA 2792 2792 Carrier H 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 Arthrod,interbdy Tech;lumbar,allogf 53 0.82 24 78.48 2 51 NA NA 2793 2793 Carrier H 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27447 Replacement Knee Total 25 0.82 24 83 1 24 NA NA 2794 2794 Carrier H 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22633 Arthrodesis, Combined Posterior Or Posterolateral Technique Wi/ Posterior Interbody Technique Incl Laminectomy And/or Discectomy Sufficient To Prepare Interspace, Lumbar 43 0.77 40 73.67 2 41 NA NA 2795 2795 Carrier H 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22630 Arthrodesis Post Interbody-lumbar 10 0.7 93.82 0 10 NA NA 2796 2796 Carrier H 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22612 Arthrodesis, Posterior Or Posterolateral Technique, Single Interspace; Lumbar (with Lateral Transverse Technique, When Performed) 11 0.64 24 86.77 1 10 NA NA 2797 2797 Carrier H 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 75894 Transcatheter Therapy Embolize Any Meth 8 1 24 51.43 1 7 NA NA 2798 2798 Carrier H 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33361 Transcatheter Aortic Valve Replacement (tavr/tavi) With Prosthetic Valve; Percutaneous Femoral Artery Approach 7 1 24 75.43 1 6 NA NA 2799 2799 Carrier H 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63048 Laminectomy, Facetectomy & Foraminotomy (unilateral Or Bilateral W/ Decompression Of Spinal Cord, Cauda Equina And/or Nerve Root[s], Single Vertebral Segment; Each Addtl 6 1 133.71 0 6 NA NA 2800 2800 Carrier H 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63045 Laminectomy W Facetectomy-cervical 6 1 24 72 1 5 NA NA 2801 2801 Carrier H 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27134 Revis.tot.hip Arthropl;both Compnts 5 1 72 0 5 NA NA 2802 2802 Carrier H 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22802 Arthrod,post,spin.deform,gft;7+vert 4 1 54 0 4 NA NA 2803 2803 Carrier H 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22600 Arthrodesis, Posterior Or Posterolateral Technique, Single Interspace; Cervical Below C2 Segment 4 1 24 56 1 3 NA NA 2804 2804 Carrier H 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43235 Esophagogastroduodenoscopy Flexible, Transoral; Diagnostic, Including Collection Of Specimen(s) By Brushing Or Washing, When Performed (separate Procedure) 3 1 78 0 3 NA NA 2805 2805 Carrier H 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22552 Arthrodesis, Anterior Interbody, Incl Disc Space Prep, Discectomy, Osteophytectomy & Decompression Of Spinal Cord &/or Nerve Roots; Cervical Below C2 Each Additional Interspac 3 1 24 84 1 2 NA NA 2806 2806 Carrier H 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22585 Arthrodesis, Anterior/-lateral,ea Add.in 3 1 0 48 1 2 NA NA 2807 2807 Carrier H 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22558 Arthrod,interbdy Tech;lumbar,allogf 53 0 1 24 78 2 51 NA NA 2808 2808 Carrier H 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43644 Laparoscopy, Surg, Gastric Restrictive Procedure; W Gastric Bypass And Roux-en-y Gastroenterostomy (roux Limb <= 150 Cm) 44 0 1 0 98.77 0 44 NA NA 2809 2809 Carrier H 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22551 Arthrodesis, Anterior Interbody, Including Disc Space Preparation, Discectomy, Osteophytectomy And Decompression Of Spinal Cord And/or Nerve Roots; Cervical Below C2 35 0 1 34 87 2 33 NA NA 2810 2810 Carrier H 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27130 Replacement Hip Total Simple 29 0 1 0 70.59 1 28 NA NA 2811 2811 Carrier H 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63047 Laminectomy W Facetectomy-lumbar 29 0 1 0 80 1 28 NA NA 2812 2812 Carrier H 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27447 Replacement Knee Total 25 0 1 24 83 1 24 NA NA 2813 2813 Carrier H 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22630 Arthrodesis Post Interbody-lumbar 10 0 1 0 93.82 0 10 NA NA 2814 2814 Carrier H 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22533 Arthrodesis, Lateral Extracavitary Technique, Including Minimal Diskectomy To Prepare Interspace; Lumbar 9 0 1 24 87 1 8 NA NA 2815 2815 Carrier H 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 55970 Intersex Op Male To Female 7 0 1 0 76 0 7 NA NA 2816 2816 Carrier H 2021 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22614 Arthrodesis, Posterior Or Posterolateral Technique, Single Interspace; Each Additional Interspace (list Separately In Addition To Code For Primary Procedure) 5 0 1 24 192 1 4 NA NA 2817 2817 Carrier H 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 128 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Rehabilitation 13 0.46 27 17.09 6 7 NA NA 2818 2818 Carrier H 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Psychiatric 2 0 25 23.12 1 1 NA NA 2819 2819 Carrier H 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 128 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Rehabilitation 13 0.46 27 17.09 6 7 NA NA 2820 2820 Carrier H 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0399 Home Sleep Test W/type Iii Portable Monitor 3845 0.97 3 0 3845 NA NA 2821 2821 Carrier H 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 Echocardiography, Transthoracic, Real-time W/ Image Documentation (2d), Includes M-mode Recording, When Performed 7010 0.95 0 3.34 2 7008 NA NA 2822 2822 Carrier H 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 Mri Brain; W/o Contrast & W/contrast & A 3549 0.95 0 6 4 3545 NA NA 2823 2823 Carrier H 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74176 Ct Abd & Pelvis W/o Contrast 6673 0.94 0.18 5.09 22 6651 NA NA 2824 2824 Carrier H 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43235 Esophagogastroduodenoscopy Flexible, Transoral; Diagnostic, Including Collection Of Specimen(s) By Brushing Or Washing, When Performed (separate Procedure) 2927 0.9 0.69 49 154 2773 NA NA 2825 2825 Carrier H 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 Magnetic Resonance Imaging, Any Jnt-lowe 6052 0.89 0 7 4 6048 NA NA 2826 2826 Carrier H 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43239 Esophagogastroduodenoscopy Flexible, Transoral; With Biopsy, Single Or Multiple 3284 0.89 0.59 49 186 3098 NA NA 2827 2827 Carrier H 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72141 Mri,spin.canal,cerv;w/o Contrst Mat 2394 0.86 0 10.3 3 2391 NA NA 2828 2828 Carrier H 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72148 Mri,spin.canal,lumb;w/o Cntrst Matl 4276 0.85 1 9 6 4270 NA NA 2829 2829 Carrier H 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73221 Mri, Any Joint Of Upper Extremity 3078 0.85 0 8 2 3076 NA NA 2830 2830 Carrier H 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29888 Arthroscopically Aided Anter,cruciate Li 142 1 18 72.81 4 138 NA NA 2831 2831 Carrier H 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95806 Sleep Study, Unattended, Simultaneous Recording Of, Heart Rate, Oxygen Saturation, Respiratory Airflow, And Respiratory Effort (eg Thoracoabdominal Movement) 80 1 104.59 0 80 NA NA 2832 2832 Carrier H 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77371 Radiation Treatment Delivery, Sterotactic Radiosurgery (srs), Complete Course Of Treatment Of Cranial Lesion(s) Consisting Of 1 Session; Multi-source Cobalt 60 Based 63 1 20 0 63 NA NA 2833 2833 Carrier H 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29874 Arthroscop Knee W Remov Loose Body 58 1 8 73 3 55 NA NA 2834 2834 Carrier H 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29875 Arthroscopy,knee,surg;synovec,limited-se 50 1 10 74 5 45 NA NA 2835 2835 Carrier H 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 78472 Card Bld Pool Image; 1 Rest W/motn 34 1 0 0 34 NA NA 2836 2836 Carrier H 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95800 Slp Stdy Unatnd W/hrt Rate/o2 Sat/resp/slp Time 32 1 0 0 32 NA NA 2837 2837 Carrier H 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77386 Intensity Modulated Radiation Treatment Delivery (imrt), Includes Guidance And Tracking, When Performed; Complex 41 1 53 91 10 31 NA NA 2838 2838 Carrier H 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29876 Arthroscopy, Knee, Surgical; With Lateral Release 27 1 88 68 0 28 NA NA 2839 2839 Carrier H 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29879 Arthroscopy, Knee, Surgical; Abrasion Arthroplasty (includes Chondroplasty Where Necessary) Or Multiple Drilling Or Microfracture 28 1 24 95 1 27 NA NA 2840 2840 Carrier H 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 29881 Arthroscopy, Knee, With Meniscectomy Including Debridement/shaving Of Articular Cartilage, Same Or Separate Compartment(s), When Performed 501 0 1 17 74 23 478 NA NA 2841 2841 Carrier H 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 77402 Radiation Treatment Delivery, >= 1 Mev; Simple 329 0 1 4 0 329 NA NA 2842 2842 Carrier H 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 29880 Arthroscopy, Knee, With Meniscectomy Including Debridement/shaving Of Articular Cartilage, Same Or Separate Compartment(s), When Performed 137 0 1 0 73 1 136 NA NA 2843 2843 Carrier H 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 29877 Arthroscopy,knee,surg;debride/shave A.ca 119 0 1 21 77 8 111 NA NA 2844 2844 Carrier H 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 31255 Nasal/sinus Endoscopy,surgical; With Ethmoidectomy,total (anterior And Posterior) 99 0 1 16 63 3 96 NA NA 2845 2845 Carrier H 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 75572 Ct Heart Contrast Eval Cardiac Structure&morph 53 0 1 0 0 53 NA NA 2846 2846 Carrier H 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 29883 Arthroscop Knee W Tot Meniscus Rep 53 0 1 70 0 53 NA NA 2847 2847 Carrier H 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 72147 Mri,spinal Canal/contents,thorac;w/cntrs 51 0 1 0 0 51 NA NA 2848 2848 Carrier H 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63042 Laminotomy W Dec Nrv Rts;reex;lumb 49 0 1 19 77 5 44 NA NA 2849 2849 Carrier H 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27446 Arthropls,knee,cond/plat;medor Lat 34 0 1 83 0 34 NA NA 2850 2850 Carrier H 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC SIMULATION (TMS) TREATMENT; INCLUDING CORTICAL MAPPING, MOTOR THRESHOLD DETERMINATION, DELIVERY AND MGMT 196 0.82 24 64 1 153 NA NA 2851 2851 Carrier H 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; SUBSEQUENT MOTOR THRESHOLD RE-DETERMINATION WITH DELIVERY AND MANAGEMENT 150 0.79 24 65 1 149 NA NA 2852 2852 Carrier H 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC SIMULATION (TMS) TREATMENT; INITIAL, INCLUDING CORTICAL MAPPING, MOTOR THRESHOLD DETERMINATION, SUBSEQUENT DELIVERY AND MGMT. 251 0.69 24 68 1 171 NA NA 2853 2853 Carrier H 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90867 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC SIMULATION (TMS) TREATMENT; INCLUDING CORTICAL MAPPING, MOTOR THRESHOLD DETERMINATION, DELIVERY AND MGMT 196 0.82 24 64 1 153 NA NA 2854 2854 Carrier H 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90869 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; SUBSEQUENT MOTOR THRESHOLD RE-DETERMINATION WITH DELIVERY AND MANAGEMENT 150 0.79 24 65 1 149 NA NA 2855 2855 Carrier H 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90868 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC SIMULATION (TMS) TREATMENT; INITIAL, INCLUDING CORTICAL MAPPING, MOTOR THRESHOLD DETERMINATION, SUBSEQUENT DELIVERY AND MGMT. 251 0.69 24 68 1 171 NA NA 2856 2856 Carrier H 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90868 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC SIMULATION (TMS) TREATMENT; INITIAL, INCLUDING CORTICAL MAPPING, MOTOR THRESHOLD DETERMINATION, SUBSEQUENT DELIVERY AND MGMT. 251 0 0.05 24 68 1 171 NA NA 2857 2857 Carrier H 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90867 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC SIMULATION (TMS) TREATMENT; INCLUDING CORTICAL MAPPING, MOTOR THRESHOLD DETERMINATION, DELIVERY AND MGMT 196 0 0.09 24 64 1 153 NA NA 2858 2858 Carrier H 2021 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90869 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; SUBSEQUENT MOTOR THRESHOLD RE-DETERMINATION WITH DELIVERY AND MANAGEMENT 150 0 0.13 24 65 1 149 NA NA 2859 2859 Carrier I 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 11 0.91 70.35487886 11 NA NA 2860 2860 Carrier I 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4232 Syringe W/Needle Insulin 3cc 1 0 0.002192501 1 NA NA 2861 2861 Carrier I 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4230 Infus Insulin Pump Non Needl 1 0 0.002075832 1 NA NA 2862 2862 Carrier I 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4231 Infusion Insulin Pump Needle 1 0 0.00213611 1 NA NA 2863 2863 Carrier I 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 11 0.91 70.35487886 11 NA NA 2864 2864 Carrier I 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4232 Syringe W/Needle Insulin 3cc 1 0 0.002192501 1 NA NA 2865 2865 Carrier I 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4230 Infus Insulin Pump Non Needl 1 0 0.002075832 1 NA NA 2866 2866 Carrier I 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4231 Infusion Insulin Pump Needle 1 0 0.00213611 1 NA NA 2867 2867 Carrier I 2021 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0784 Ext Amb Infusn Pump Insulin 11 0 0.09 70.35487886 11 NA NA 2868 2868 Carrier I 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0562 Humidifier, heated, used with positive airway pressure device 1 1 51.8439325 1 NA NA 2869 2869 Carrier I 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 Continuous airway pressure (CPAP) device [may be used for either CPAP or APAP] 239 0.98 2.043918472 239 NA NA 2870 2870 Carrier I 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 13 0.85 4.681773504 13 NA NA 2871 2871 Carrier I 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 3 0.67 9.361759259 3 NA NA 2872 2872 Carrier I 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0760 Osteogen Ultrasound Stimltor 4 0.25 96.94006944 4 NA NA 2873 2873 Carrier I 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2624 Adj skin pro/pos cus<22in 1 0 0.086358331 1 NA NA 2874 2874 Carrier I 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0971 Wheelchair Anti-Tipping Devi 1 0 0.086472221 1 NA NA 2875 2875 Carrier I 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0973 Wheelchair Adjustabl Height 1 0 0.086313055 1 NA NA 2876 2876 Carrier I 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2620 WC planar back cush wd <22in 1 0 0.086410277 1 NA NA 2877 2877 Carrier I 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0961 Wheelchair Brake Extension 1 0 0.086274166 1 NA NA 2878 2878 Carrier I 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2300 Power wheelchair accessory, power seat elevation system 2 0 12.06875 2 NA NA 2879 2879 Carrier I 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0748 Elec Osteogen Stim Spinal 1 0 26.89350917 1 NA NA 2880 2880 Carrier I 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0486 Oral device/appliance cusfab 1 0 0.070833334 1 NA NA 2881 2881 Carrier I 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0562 Humidifier, heated, used with positive airway pressure device 1 1 51.8439325 1 NA NA 2882 2882 Carrier I 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0601 Continuous airway pressure (CPAP) device [may be used for either CPAP or APAP] 239 0.98 2.043918472 239 NA NA 2883 2883 Carrier I 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 13 0.85 4.681773504 13 NA NA 2884 2884 Carrier I 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 3 0.67 9.361759259 3 NA NA 2885 2885 Carrier I 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0760 Osteogen Ultrasound Stimltor 4 0.25 96.94006944 4 NA NA 2886 2886 Carrier I 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2624 Adj skin pro/pos cus<22in 1 0 0.086358331 1 NA NA 2887 2887 Carrier I 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0971 Wheelchair Anti-Tipping Devi 1 0 0.086472221 1 NA NA 2888 2888 Carrier I 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0973 Wheelchair Adjustabl Height 1 0 0.086313055 1 NA NA 2889 2889 Carrier I 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2620 WC planar back cush wd <22in 1 0 0.086410277 1 NA NA 2890 2890 Carrier I 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0961 Wheelchair Brake Extension 1 0 0.086274166 1 NA NA 2891 2891 Carrier I 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2300 Power wheelchair accessory, power seat elevation system 2 0 12.06875 2 NA NA 2892 2892 Carrier I 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0748 Elec Osteogen Stim Spinal 1 0 26.89350917 1 NA NA 2893 2893 Carrier I 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0486 Oral device/appliance cusfab 1 0 0.070833334 1 NA NA 2894 2894 Carrier I 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63012 Laminectomy with removal of abnormal facets and/or pars inter-articularis with decompression of cauda equina and nerve roots for spondylolisthesis, lumbar (Gill type procedure) 2 1 3.670543426 2 NA NA 2895 2895 Carrier I 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 3 0.67 7.384826028 3 NA NA 2896 2896 Carrier I 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 3 0.67 7.384826028 3 NA NA 2897 2897 Carrier I 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar 2 0.5 36.49746347 2 NA NA 2898 2898 Carrier I 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 69990 Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure) 3 0 1.091204352 3 NA NA 2899 2899 Carrier I 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 52005 Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; 3 0 0.058389166 3 NA NA 2900 2900 Carrier I 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 62141 Cranioplasty for skull defect; larger than 5 cm diameter 2 0 0.081991667 2 NA NA 2901 2901 Carrier I 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 52332 Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type) 2 0 0.046121806 2 NA NA 2902 2902 Carrier I 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); 2 0 0.002916667 2 NA NA 2903 2903 Carrier I 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 61512 Craniectomy, trephination, bone flap craniotomy; for excision of meningioma, supratentorial 2 0 1.593333334 2 NA NA 2904 2904 Carrier I 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44207 Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) 2 0 2.85989861 2 NA NA 2905 2905 Carrier I 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 61781 Stereotactic computer-assisted (navigational) procedure; cranial, intradural (List separately in addition to code for primary procedure) 3 0 0.086944445 1.593333334 1 2 NA NA 2906 2906 Carrier I 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 15750 Flap; neurovascular pedicle 2 0 0.087222221 0.005827778 1 1 NA NA 2907 2907 Carrier I 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15769 Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia) 1 1 24.15111111 1 NA NA 2908 2908 Carrier I 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63012 Laminectomy with removal of abnormal facets and/or pars inter-articularis with decompression of cauda equina and nerve roots for spondylolisthesis, lumbar (Gill type procedure) 2 1 3.670543426 2 NA NA 2909 2909 Carrier I 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22630 Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar 1 1 0.106666667 1 NA NA 2910 2910 Carrier I 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft 1 1 19.34411111 1 NA NA 2911 2911 Carrier I 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27446 Arthroplasty, knee, condyle and plateau; medial OR lateral compartment 1 1 11.44515194 1 NA NA 2912 2912 Carrier I 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27487 Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component 1 1 21.71432139 1 NA NA 2913 2913 Carrier I 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33361 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach 1 1 1.821111113 1 NA NA 2914 2914 Carrier I 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33362 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach 1 1 1.821111113 1 NA NA 2915 2915 Carrier I 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 47135 Liver allotransplantation, orthotopic, partial or whole, from cadaver or living donor, any age 1 1 17.83 1 NA NA 2916 2916 Carrier I 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 49560 Repair initial incisional or ventral hernia; reducible 1 1 240.5268472 1 NA NA 2917 2917 Carrier I 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15734 Muscle, myocutaneous, or fasciocutaneous flap; trunk 1 1 240.5268508 1 NA NA 2918 2918 Carrier I 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43644 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less) 1 1 2.738888887 1 NA NA 2919 2919 Carrier I 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1002 Residential treatment, Substance Use Disorder 14 1 43.07273148 14 NA NA 2920 2920 Carrier I 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 Room and board, Semi-Private, Psychiatric 2 1 21.58013889 2 NA NA 2921 2921 Carrier I 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1001 Residential treatment, Psychiatric 1 1 88.88666667 1 NA NA 2922 2922 Carrier I 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 126 Room and board, Semi Private Detoxification 1 1 0.2019675 1 NA NA 2923 2923 Carrier I 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1002 Residential treatment, Substance Use Disorder 14 1 43.07273148 14 NA NA 2924 2924 Carrier I 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 Room and board, Semi-Private, Psychiatric 2 1 21.58013889 2 NA NA 2925 2925 Carrier I 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1001 Residential treatment, Psychiatric 1 1 88.88666667 1 NA NA 2926 2926 Carrier I 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 126 Room and board, Semi Private Detoxification 1 1 0.2019675 1 NA NA 2927 2927 Carrier I 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 MRI of brain and further sequences 132 0.94 14.74452149 132 NA NA 2928 2928 Carrier I 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 ECHO, transthoracic w/doppler, complete 211 0.93 9.101342806 211 NA NA 2929 2929 Carrier I 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0399 Home sleep test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation 156 0.93 6.463750842 156 NA NA 2930 2930 Carrier I 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74176 CT abd & pelvis 223 0.89 16.77075072 223 NA NA 2931 2931 Carrier I 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72148 MRI of lumbar spine 140 0.85 0.280555558 7.621059028 672 1 139 1 NA NA 2932 2932 Carrier I 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 MRI, lower extremity any joint; wo contr 148 0.85 13.98278651 148 NA NA 2933 2933 Carrier I 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 270 0.74 30.39479178 270 NA NA 2934 2934 Carrier I 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97140 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes 256 0.72 33.19778745 256 NA NA 2935 2935 Carrier I 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 196 0.68 28.1757568 196 NA NA 2936 2936 Carrier I 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97112 Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities 139 0.62 38.76119208 139 NA NA 2937 2937 Carrier I 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93303 ECHO, transthoracic, complete cng 31 1 2.592382155 31 NA NA 2938 2938 Carrier I 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 71271 CT THORAX LW DOSE LNG CA SCR C- 27 1 0.000164609 27 NA NA 2939 2939 Carrier I 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27447 Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) 24 1 28.47179523 24 NA NA 2940 2940 Carrier I 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70491 Contrast CAT scan of neck tissue 19 1 7.380423977 19 NA NA 2941 2941 Carrier I 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 98943 Chiropractic manipulative treatment (CMT); extraspinal, 1 or more regions 17 1 0.124270915 17 NA NA 2942 2942 Carrier I 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70543 MRI orb/fc/nck w/o cntrst flwd cntr 14 1 24.03807407 14 NA NA 2943 2943 Carrier I 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72157 MRI of thoracic spine 11 1 2.040023148 11 NA NA 2944 2944 Carrier I 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93312 ECHO, transesophageal, heart, compl 9 1 0.000185185 9 NA NA 2945 2945 Carrier I 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93308 ECHO, transthoracic, heart, limited 8 1 3.355902778 8 NA NA 2946 2946 Carrier I 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64635 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint 7 1 25.14872683 7 NA NA 2947 2947 Carrier I 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC G0398 Home sleep study test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation 7 1 15.69222222 7 NA NA 2948 2948 Carrier I 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95805 Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness 7 1 0.000119048 7 NA NA 2949 2949 Carrier I 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70480 CT, orbit, sella or pos fos wo contrast 7 1 0.081825397 7 NA NA 2950 2950 Carrier I 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29888 Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction 7 1 13.32367756 7 NA NA 2951 2951 Carrier I 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 70460 Contrast CAT scan of head/brain 2 0.5 73.52277778 2 NA NA 2952 2952 Carrier I 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 62321 Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (ie, fluoroscopy or CT) 6 0.17 12.31216825 6 NA NA 2953 2953 Carrier I 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64405 Injection(s), anesthetic agent(s) and/or steroid; greater occipital nerve 13 0.15 38.698896 13 NA NA 2954 2954 Carrier I 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27096 Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed 16 0.06 23.89125918 16 NA NA 2955 2955 Carrier I 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 72148 MRI of lumbar spine 140 0.01 0.280555558 7.621059028 672 1 139 1 NA NA 2956 2956 Carrier I 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 70553 MRI of brain and further sequences 132 0.01 14.74452149 132 NA NA 2957 2957 Carrier I 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 7 1 19.33206349 7 NA NA 2958 2958 Carrier I 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 8 1 62.71416666 39.60111111 1 7 NA NA 2959 2959 Carrier I 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 7 1 62.71416666 46.20037037 1 6 NA NA 2960 2960 Carrier I 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H2036 Alcohol and/or other drug treatment program, per diem 5 1 35.11915778 5 NA NA 2961 2961 Carrier I 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 6 1 62.71416666 45.77027778 1 5 NA NA 2962 2962 Carrier I 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 Mental Health Partial Hospitalization, Treatment, Less Than 24 Hours 11 0.91 51.78626263 11 NA NA 2963 2963 Carrier I 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 71271 CT THORAX LW DOSE LNG CA SCR C- 6 0.83 10.37777778 6 NA NA 2964 2964 Carrier I 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual 17 0.82 34.68305429 17 NA NA 2965 2965 Carrier I 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 92526 Treatment of swallowing dysfunction and/or oral function for feeding 9 0.56 59.48722672 9 NA NA 2966 2966 Carrier I 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 19303 Mastectomy, simple, complete 4 0.5 80.90268519 4 NA NA 2967 2967 Carrier I 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 19350 Nipple/areola reconstruction 4 0.5 80.90268519 4 NA NA 2968 2968 Carrier I 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77386 Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex 1 1 0.003902779 1 NA NA 2969 2969 Carrier I 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 7 1 19.33206349 7 NA NA 2970 2970 Carrier I 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 8 1 62.71416666 39.60111111 1 7 NA NA 2971 2971 Carrier I 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 7 1 62.71416666 46.20037037 1 6 NA NA 2972 2972 Carrier I 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H2036 Alcohol and/or other drug treatment program, per diem 5 1 35.11915778 5 NA NA 2973 2973 Carrier I 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 6 1 62.71416666 45.77027778 1 5 NA NA 2974 2974 Carrier I 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70553 MRI of brain and further sequences 3 1 0.00037037 3 NA NA 2975 2975 Carrier I 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 17999 Unlisted procedure, skin, mucous membrane and subcutaneous tissue 3 1 63.60092593 3 NA NA 2976 2976 Carrier I 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 54520 Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach 2 1 21.31138889 2 NA NA 2977 2977 Carrier I 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 17380 Electrolysis epilation, each 30 minutes 1 1 45.00833334 1 NA NA 2978 2978 Carrier I 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19325 Breast augmentation with implant 1 1 3.03138889 1 NA NA 2979 2979 Carrier I 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 92523 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language) 1 1 0.075277778 1 NA NA 2980 2980 Carrier J 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 91 0.92 61.06683382 91 NA NA 2981 2981 Carrier J 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4230 Infus Insulin Pump Non Needl 8 0 18.08044733 8 NA NA 2982 2982 Carrier J 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9277 External transmitter, CGM 8 0 17.18122456 8 NA NA 2983 2983 Carrier J 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4232 Syringe W/Needle Insulin 3cc 8 0 18.08048913 8 NA NA 2984 2984 Carrier J 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9276 Disposable sensor, CGM sys 7 0 20.0444625 7 NA NA 2985 2985 Carrier J 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0553 "Supply allowance for therapeutic continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 Unit Of Service 2017-07-01 00:00:00.000 2199-12-31 23:59:59.000 ADD" 2 0 10.04166667 2 NA NA 2986 2986 Carrier J 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0554 Receiver (monitor), dedicated, for use with therapeutic glucose continueous monitor system 1 0 0.094166667 1 NA NA 2987 2987 Carrier J 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9274 Ext amb insuline delivery sys 1 0 0.004824166 1 NA NA 2988 2988 Carrier J 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 91 0.92 61.06683382 91 NA NA 2989 2989 Carrier J 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4230 Infus Insulin Pump Non Needl 8 0 18.08044733 8 NA NA 2990 2990 Carrier J 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9277 External transmitter, CGM 8 0 17.18122456 8 NA NA 2991 2991 Carrier J 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4232 Syringe W/Needle Insulin 3cc 8 0 18.08048913 8 NA NA 2992 2992 Carrier J 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9276 Disposable sensor, CGM sys 7 0 20.0444625 7 NA NA 2993 2993 Carrier J 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0553 "Supply allowance for therapeutic continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 Unit Of Service 2017-07-01 00:00:00.000 2199-12-31 23:59:59.000 ADD" 2 0 10.04166667 2 NA NA 2994 2994 Carrier J 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0554 Receiver (monitor), dedicated, for use with therapeutic glucose continueous monitor system 1 0 0.094166667 1 NA NA 2995 2995 Carrier J 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9274 Ext amb insuline delivery sys 1 0 0.004824166 1 NA NA 2996 2996 Carrier J 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 176 0.97 46.34777778 1.666598413 1 175 NA NA 2997 2997 Carrier J 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 Continuous airway pressure (CPAP) device [may be used for either CPAP or APAP] 3483 0.96 46.34777778 2.304491152 612 1 3482 2 NA NA 2998 2998 Carrier J 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 74 0.86 33.63027778 10.69826984 4 70 NA NA 2999 2999 Carrier J 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0748 Elec Osteogen Stim Spinal 8 0.38 136.7358895 8 NA NA 3000 3000 Carrier J 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0466 HOME VENT NON-INVASIVE INTER 7 0.29 33.63027778 111.8903704 4 3 NA NA 3001 3001 Carrier J 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1399 Durable Medical Equipment Mi 20 0.25 71.13215972 122.0365107 2 18 NA NA 3002 3002 Carrier J 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0760 Osteogen Ultrasound Stimltor 25 0.2 110.5392436 25 NA NA 3003 3003 Carrier J 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0747 Elec Osteogen Stim Not Spine 19 0.16 130.5461698 19 NA NA 3004 3004 Carrier J 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0971 Wheelchair Anti-Tipping Devi 7 0 40.98090317 7 NA NA 3005 3005 Carrier J 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0978 Wheelchair Belt W/Airplane B 6 0 47.79669463 6 NA NA 3006 3006 Carrier J 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0973 Wheelchair Adjustabl Height 6 0 30.69141032 6 NA NA 3007 3007 Carrier J 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0562 Humidifier, heated, used with positive airway pressure device 1 1 46.34777778 576 1 1 NA NA 3008 3008 Carrier J 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0561 Humidifier, non-heated, used with positive airway pressure device 1 1 46.34777778 1 NA NA 3009 3009 Carrier J 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2599 Accessory for speech generating device, not otherwise classified 4 1 140.6114583 4 NA NA 3010 3010 Carrier J 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 176 0.97 46.34777778 1.666598413 1 175 NA NA 3011 3011 Carrier J 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0601 Continuous airway pressure (CPAP) device [may be used for either CPAP or APAP] 3483 0.96 46.34777778 2.304491152 612 1 3482 2 NA NA 3012 3012 Carrier J 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 74 0.86 33.63027778 10.69826984 4 70 NA NA 3013 3013 Carrier J 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0748 Elec Osteogen Stim Spinal 8 0.38 136.7358895 8 NA NA 3014 3014 Carrier J 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0466 HOME VENT NON-INVASIVE INTER 7 0.29 33.63027778 111.8903704 4 3 NA NA 3015 3015 Carrier J 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1399 Durable Medical Equipment Mi 20 0.25 71.13215972 122.0365107 2 18 NA NA 3016 3016 Carrier J 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0760 Osteogen Ultrasound Stimltor 25 0.2 110.5392436 25 NA NA 3017 3017 Carrier J 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0601 Continuous airway pressure (CPAP) device [may be used for either CPAP or APAP] 3483 0 0 46.34777778 2.304491152 612 1 3482 2 NA NA 3018 3018 Carrier J 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 44 0.93 46.52218632 44 NA NA 3019 3019 Carrier J 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) 21 0.9 39.50508894 21 NA NA 3020 3020 Carrier J 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar 20 0.9 41.60779043 20 NA NA 3021 3021 Carrier J 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar 25 0.88 57.31271103 480 25 1 NA NA 3022 3022 Carrier J 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 32 0.88 47.11753477 32 NA NA 3023 3023 Carrier J 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); 33 0.21 1.428810834 32.52842918 4 29 NA NA 3024 3024 Carrier J 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44207 Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) 24 0.08 0.002777777 8.561956111 1 23 NA NA 3025 3025 Carrier J 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44204 Laparoscopy, surgical; colectomy, partial, with anastomosis 28 0.07 0.006783332 16.29482006 2 26 NA NA 3026 3026 Carrier J 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96416 Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump 20 0 0.005555556 6.504863889 1 19 NA NA 3027 3027 Carrier J 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 33405 Replacement, aortic valve, open, with cardiopulmonary bypass; with prosthetic valve other than homograft or stentless valve 21 0 16.85067514 22.84802685 6 15 NA NA 3028 3028 Carrier J 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 19 1 48.37969797 19 NA NA 3029 3029 Carrier J 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft 12 1 70.4370587 12 NA NA 3030 3030 Carrier J 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 23472 Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total shoulder)) 11 1 38.07345989 11 NA NA 3031 3031 Carrier J 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22830 Exploration of spinal fusion 7 1 55.4825526 7 NA NA 3032 3032 Carrier J 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22634 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; each additional interspace and segment (List separately in addition to code for primary procedure) 5 1 52.86069182 5 NA NA 3033 3033 Carrier J 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22843 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments (List separately in addition to code for primary procedure) 5 1 19.04977232 5 NA NA 3034 3034 Carrier J 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63042 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar 4 1 72.86497719 4 NA NA 3035 3035 Carrier J 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22216 Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; each additional vertebral segment (List separately in addition to primary procedure) 4 1 15.81222586 4 NA NA 3036 3036 Carrier J 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22585 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); each additional interspace (List separately in addition to code for primary procedure) 4 1 50.71772813 4 NA NA 3037 3037 Carrier J 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22214 Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; lumbar 3 1 24.99000422 3 NA NA 3038 3038 Carrier J 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22610 Arthrodesis, posterior or posterolateral technique, single level; thoracic (with lateral transverse technique, when performed) 3 1 17.87529292 3 NA NA 3039 3039 Carrier J 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43279 Laparoscopy, surgical, esophagomyotomy (Heller type), with fundoplasty, when performed 3 1 121.1876852 3 NA NA 3040 3040 Carrier J 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22846 Anterior instrumentation; 4 to 7 vertebral segments (List separately in addition to code for primary procedure) 3 1 54.81630383 3 NA NA 3041 3041 Carrier J 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 23470 Arthroplasty, glenohumeral joint; hemiarthroplasty 3 1 8.043526852 3 NA NA 3042 3042 Carrier J 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22802 Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to 12 vertebral segments 3 1 41.49119243 3 NA NA 3043 3043 Carrier J 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63045 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; cervical 3 1 5.107969833 0.384678611 2 1 NA NA 3044 3044 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue NA Room and board, Semi Private Detoxification 4 1 46.05034722 4 NA NA 3045 3045 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 56805 Clitoroplasty for intersex state 3 1 128.3168519 3 NA NA 3046 3046 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 54520 Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach 3 1 128.3168519 3 NA NA 3047 3047 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 54125 Amputation of penis; complete 2 1 26.24138889 2 NA NA 3048 3048 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 53430 Urethroplasty, reconstruction of female urethra 2 1 26.1616358 2 NA NA 3049 3049 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 57110 Vaginectomy, complete removal of vaginal wall; 1 1 71.76638889 1 NA NA 3050 3050 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 56800 Plastic repair of introitus 1 1 332.4677778 1 NA NA 3051 3051 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 57292 Construction of artificial vagina; with graft 1 1 332.4677778 1 NA NA 3052 3052 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 57291 Construction of artificial vagina; without graft 1 1 26.95916667 1 NA NA 3053 3053 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 53410 Urethroplasty, 1-stage reconstruction of male anterior urethra 1 1 71.76638889 1 NA NA 3054 3054 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC NA Alcohol and/or other drug treatment program, per diem 1 1 18.8475 1 NA NA 3055 3055 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 55180 Scrotoplasty; complicated 1 1 71.76638889 1 NA NA 3056 3056 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue NA Room and board, Semi-Private, Psychiatric 32 0.94 8.061203704 269.5459427 3 29 NA NA 3057 3057 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue NA Residential treatment, Substance Use Disorder 238 0.93 50.64727495 238 NA NA 3058 3058 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue NA Residential treatment, Psychiatric 47 0.72 28.53694444 241.0093836 3 44 NA NA 3059 3059 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 13121 Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm 2 0.5 70.93978211 2 NA NA 3060 3060 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC NA Crisis Intervention Mental H 1 0 0.005361943 1 NA NA 3061 3061 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 15002 Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; first 100 sq cm or 1% of body area of infants and children 1 0 48.62139917 1 NA NA 3062 3062 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 64859 Suture of each additional major peripheral nerve (List separately in addition to code for primary procedure) 1 0 48.62139917 1 NA NA 3063 3063 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 15240 Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less 1 0 48.62139917 1 NA NA 3064 3064 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC NA Alcohol And/Or Drug Services 1 0 0.003226944 1 NA NA 3065 3065 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 15273 Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children 1 0 48.62139917 1 NA NA 3066 3066 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 15274 Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure) 1 0 48.62139917 1 NA NA 3067 3067 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 15277 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children 1 0 48.62139917 1 NA NA 3068 3068 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 64910 Nerve repair; with synthetic conduit or vein allograft (eg, nerve tube), each nerve 1 0 48.62139917 1 NA NA 3069 3069 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 15574 Formation of direct or tubed pedicle, with or without transfer; forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands or feet 1 0 48.62139917 1 NA NA 3070 3070 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 15750 Flap; neurovascular pedicle 1 0 48.62139917 1 NA NA 3071 3071 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 15100 Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050) 1 0 48.62139917 1 NA NA 3072 3072 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 15757 Free skin flap with microvascular anastomosis 1 0 48.62139917 1 NA NA 3073 3073 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 14301 Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm 1 0 48.62139917 1 NA NA 3074 3074 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 29125 Application of short arm splint (forearm to hand); static 1 0 48.62139917 1 NA NA 3075 3075 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 31587 Laryngoplasty, cricoid split, without graft placement 1 0 246.25 1 NA NA 3076 3076 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 64856 Suture of major peripheral nerve, arm or leg, except sciatic; including transposition 1 0 48.62139917 1 NA NA 3077 3077 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 51102 Aspiration of bladder; with insertion of suprapubic catheter 1 0 48.62139917 1 NA NA 3078 3078 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 64874 Suture of nerve; requiring extensive mobilization, or transposition of nerve (List separately in addition to code for nerve suture) 1 0 48.62139917 1 NA NA 3079 3079 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97606 Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters 1 0 48.62139917 1 NA NA 3080 3080 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 13122 Repair, complex, scalp, arms, and/or legs; each additional 5 cm or less (List separately in addition to code for primary procedure) 1 0 48.62139917 1 NA NA 3081 3081 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 14040 Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less 1 0 48.62139917 1 NA NA 3082 3082 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 14302 Adjacent tissue transfer or rearrangement, any area; each additional 30.0 sq cm, or part thereof (List separately in addition to code for primary procedure) 1 0 48.62139917 1 NA NA 3083 3083 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 14041 Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10.1 sq cm to 30.0 sq cm 1 0 48.62139917 1 NA NA 3084 3084 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 15003 Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; each additional 100 sq cm, or part thereof, or each additional 1% of body area of infants and children (List separately in addition to code for primary procedure) 1 0 48.62139917 1 NA NA 3085 3085 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 15101 Split-thickness autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure) 1 0 48.62139917 1 NA NA 3086 3086 Carrier J 2021 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 55970 Intersex surgery; male to female 1 0 261.6 1 NA NA 3087 3087 Carrier J 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 126 Room and board, Semi Private Detoxification 4 1 46.05034722 4 NA NA 3088 3088 Carrier J 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 56805 Clitoroplasty for intersex state 3 1 128.3168519 3 NA NA 3089 3089 Carrier J 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 54520 Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach 3 1 128.3168519 3 NA NA 3090 3090 Carrier J 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 54125 Amputation of penis; complete 2 1 26.24138889 2 NA NA 3091 3091 Carrier J 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 53430 Urethroplasty, reconstruction of female urethra 2 1 26.1616358 2 NA NA 3092 3092 Carrier J 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 57110 Vaginectomy, complete removal of vaginal wall; 1 1 71.76638889 1 NA NA 3093 3093 Carrier J 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 56800 Plastic repair of introitus 1 1 332.4677778 1 NA NA 3094 3094 Carrier J 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 57292 Construction of artificial vagina; with graft 1 1 332.4677778 1 NA NA 3095 3095 Carrier J 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 57291 Construction of artificial vagina; without graft 1 1 26.95916667 1 NA NA 3096 3096 Carrier J 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 53410 Urethroplasty, 1-stage reconstruction of male anterior urethra 1 1 71.76638889 1 NA NA 3097 3097 Carrier J 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H2036 Alcohol and/or other drug treatment program, per diem 1 1 18.8475 1 NA NA 3098 3098 Carrier J 2021 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 55180 Scrotoplasty; complicated 1 1 71.76638889 1 NA NA 3099 3099 Carrier J 2021 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 1001 Residential treatment, Psychiatric 47 0 0.02 28.53694444 241.0093836 3 44 NA NA 3100 3100 Carrier J 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0399 Home sleep test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation 1717 0.96 4.55158774 1717 NA NA 3101 3101 Carrier J 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 MRI of brain and further sequences 1535 0.95 0.0875 9.113422664 3 1532 NA NA 3102 3102 Carrier J 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 ECHO, transthoracic w/doppler, complete 2782 0.94 0.087222221 6.260145469 660 1 2781 10 NA NA 3103 3103 Carrier J 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74176 CT abd & pelvis 3024 0.94 3.520114943 9.638329536 29 2995 NA NA 3104 3104 Carrier J 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 MRI, lower extremity any joint; wo contr 2511 0.88 0.239722222 11.00589676 648 1 2510 5 NA NA 3105 3105 Carrier J 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72148 MRI of lumbar spine 1845 0.86 1.048194444 8.480348817 672 2 1843 2 NA NA 3106 3106 Carrier J 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 5525 0.74 9.454080013 39.65143342 610.5 19 5506 16 NA NA 3107 3107 Carrier J 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97140 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes 5040 0.73 17.5520936 42.13966487 591 19 5021 8 NA NA 3108 3108 Carrier J 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 4657 0.73 24.91352116 39.53006852 810.6666667 12 4645 9 NA NA 3109 3109 Carrier J 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97112 Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities 3679 0.71 48.72115167 43.90158338 568 11 3668 3 NA NA 3110 3110 Carrier J 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63685 Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling 23 1 31.10083644 600 23 1 NA NA 3111 3111 Carrier J 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77435 Stereotactic body radiation therapy, treatment management, per treatment course, to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions 18 1 11.74046296 59.41540741 600 3 15 1 NA NA 3112 3112 Carrier J 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 23472 Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total shoulder)) 31 1 31.7586825 37.73359205 1 30 NA NA 3113 3113 Carrier J 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72147 Contrast MRI of thoracic spine 29 1 2.430747127 29 NA NA 3114 3114 Carrier J 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63042 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar 30 1 51.48078611 32.48858983 2 28 NA NA 3115 3115 Carrier J 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64492 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; third and any additional level(s) (List separately in addition to code for primary procedure) 25 1 3.868942683 25 NA NA 3116 3116 Carrier J 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 78472 Nuclear scan, cardiac blood pool 22 1 0.000113636 22 NA NA 3117 3117 Carrier J 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 22 1 60.95812965 22 NA NA 3118 3118 Carrier J 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77373 Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions 17 1 11.74046296 60.40331349 3 14 NA NA 3119 3119 Carrier J 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77432 Stereotactic radiation treatment management of cranial lesion(s) (complete course of treatment consisting of 1 session) 13 1 1.974444444 86.46290404 2 11 NA NA 3120 3120 Carrier J 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64405 Injection(s), anesthetic agent(s) and/or steroid; greater occipital nerve 93 0 0.04 0.221404167 54.87779854 648 2 91 1 NA NA 3121 3121 Carrier J 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64493 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level 309 0 0.03 23.44836431 15.21216818 2 307 NA NA 3122 3122 Carrier J 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64479 Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), cervical or thoracic, single level 153 0 0.02 14.66959782 153 NA NA 3123 3123 Carrier J 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22856 Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); single interspace, cervical 40 0 0.03 42.60520565 40 NA NA 3124 3124 Carrier J 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64520 Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic) 21 0 0.05 15.36934318 21 NA NA 3125 3125 Carrier J 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 78459 MYOCRD IMG PET METAB EVAL SINGLE STUDY 8 0 0.13 28.07048611 8 NA NA 3126 3126 Carrier J 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63020 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, cervical 7 0 0.14 46.31105176 7 NA NA 3127 3127 Carrier J 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63655 Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural 5 0 0.2 75.65615687 5 NA NA 3128 3128 Carrier J 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 23470 Arthroplasty, glenohumeral joint; hemiarthroplasty 5 0 0.2 80.84910755 5 NA NA 3129 3129 Carrier J 2021 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 62290 Injection procedure for discography, each level; lumbar 4 0 0.25 44.09172875 4 NA NA 3130 3130 Carrier J 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 187 1 7.529548055 32.13749977 9 178 NA NA 3131 3131 Carrier J 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H2036 Alcohol and/or other drug treatment program, per diem 99 0.97 43.77723558 99 NA NA 3132 3132 Carrier J 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 19303 Mastectomy, simple, complete 35 0.94 83.99884921 696 35 1 NA NA 3133 3133 Carrier J 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 19350 Nipple/areola reconstruction 34 0.94 243.6577778 85.11815657 1 33 NA NA 3134 3134 Carrier J 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 Mental Health Partial Hospitalization, Treatment, Less Than 24 Hours 115 0.91 54.67930556 62.02926565 2 113 NA NA 3135 3135 Carrier J 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 78 0.9 25.81089712 47.67570908 552 9 69 1 NA NA 3136 3136 Carrier J 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 71271 CT THORAX LW DOSE LNG CA SCR C- 198 0.9 3.088960078 198 NA NA 3137 3137 Carrier J 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 52 0.9 22.35729512 44.10535269 7 45 NA NA 3138 3138 Carrier J 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 82 0.89 25.81089663 44.54946906 9 73 NA NA 3139 3139 Carrier J 2021 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual 282 0.73 314.7020528 67.41074406 1 281 NA NA 3140 3140 Carrier J 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 187 1 7.529548055 32.13749977 9 178 NA NA 3141 3141 Carrier J 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70553 MRI of brain and further sequences 12 1 0.026828704 12 NA NA 3142 3142 Carrier J 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 17380 Electrolysis epilation, each 30 minutes 7 1 268.1345238 7 NA NA 3143 3143 Carrier J 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 17999 Unlisted procedure, skin, mucous membrane and subcutaneous tissue 5 1 103.4391667 5 NA NA 3144 3144 Carrier J 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81243 FMR1 (fragile X mental retardation 1) (eg, fragile X mental retardation) gene analysis; evaluation to detect abnormal (eg, expanded) alleles 4 1 26.46513889 4 NA NA 3145 3145 Carrier J 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81229 Cytogenomic constitutional (genome-wide) microarray analysis; interrogation of genomic regions for copy number and single nucleotide polymorphism (SNP) variants for chromosomal abnormalities 4 1 25.55006944 4 NA NA 3146 3146 Carrier J 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 98943 Chiropractic manipulative treatment (CMT); extraspinal, 1 or more regions 4 1 7.354965972 4 NA NA 3147 3147 Carrier J 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19325 Breast augmentation with implant 3 1 88.2137037 3 NA NA 3148 3148 Carrier J 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95810 Polysomnography; Age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist 4 1 0.289444445 0 1 3 NA NA 3149 3149 Carrier J 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77373 Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions 2 1 32.12763889 2 NA NA 3150 3150 Carrier J 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 56625 Vulvectomy simple; complete 2 1 81.96222222 2 NA NA 3151 3151 Carrier J 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 78608 Brain imaging, PET, metabolic eval 2 1 13.57888889 2 NA NA 3152 3152 Carrier J 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81415 Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis 2 1 17.92347222 2 NA NA 3153 3153 Carrier J 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81416 Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis, each comparator exome (eg, parents, siblings) (List separately in addition to code for primary procedure) 2 1 17.92347222 2 NA NA 3154 3154 Carrier J 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 54520 Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach 2 1 119.01875 2 NA NA 3155 3155 Carrier J 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 55175 Scrotoplasty; simple 2 1 119.01875 2 NA NA 3156 3156 Carrier J 2021 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC Q3014 Telehealth originating site facility fee 2 1 50.49276014 2 NA NA 3157 3157 Carrier K 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 External ambulatory infusion pump, insulin 6 1 7.03 0 6 0 NA NA 3158 3158 Carrier K 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9274 External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories 1 1 23.5 0 1 0 NA NA 3159 3159 Carrier K 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0607 Home blood glucose monitor 1 1 23.5 0 1 0 NA NA 3160 3160 Carrier K 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0553 Supply allowance for therapeutic continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 Unit of Service� 2 0.5 85.5 0 2 0 NA NA 3161 3161 Carrier K 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0554 Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system 2 0.5 85.5 0 2 0 NA NA 3162 3162 Carrier K 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 External ambulatory infusion pump, insulin 6 1 7.03 0 6 0 NA NA 3163 3163 Carrier K 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9274 External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories 1 1 23.5 0 1 0 NA NA 3164 3164 Carrier K 2021 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0607 Home blood glucose monitor 1 1 23.5 0 1 0 NA NA 3165 3165 Carrier K 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0748 Osteogenesis stimulator, electrical, noninvasive, spinal applications� 3 1 40.5 0 3 0 NA NA 3166 3166 Carrier K 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0739 Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes 2 1 84.9 0 2 0 NA NA 3167 3167 Carrier K 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5301 Below knee, molded socket, shin, sach foot, endoskeletal system 2 1 104.7 0 2 0 NA NA 3168 3168 Carrier K 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5620 Addition to lower extremity, test socket, below knee 2 1 104.7 0 2 0 NA NA 3169 3169 Carrier K 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5629 Addition to lower extremity, below knee, acrylic socket 2 1 104.7 0 2 0 NA NA 3170 3170 Carrier K 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5637 Addition to lower extremity, below knee, total contact 2 1 104.7 0 2 0 NA NA 3171 3171 Carrier K 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5645 Addition to lower extremity, below knee, flexible inner socket, external frame� 2 1 104.7 0 2 0 NA NA 3172 3172 Carrier K 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5671 Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert 2 1 104.7 0 2 0 NA NA 3173 3173 Carrier K 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5673 Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism 2 1 104.7 0 2 0 NA NA 3174 3174 Carrier K 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1399 Durable medical equipment, miscellaneous 3 0 140.8 0 3 0 NA NA 3175 3175 Carrier K 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0748 Osteogenesis stimulator, electrical, noninvasive, spinal applications� 3 1 40.5 0 3 0 NA NA 3176 3176 Carrier K 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5301 Below knee, molded socket, shin, sach foot, endoskeletal system 2 1 104.7 0 2 0 NA NA 3177 3177 Carrier K 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5620 Addition to lower extremity, test socket, below knee 2 1 104.7 0 2 0 NA NA 3178 3178 Carrier K 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5629 Addition to lower extremity, below knee, acrylic socket 2 1 104.7 0 2 0 NA NA 3179 3179 Carrier K 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5637 Addition to lower extremity, below knee, total contact 2 1 104.7 0 2 0 NA NA 3180 3180 Carrier K 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5645 Addition to lower extremity, below knee, flexible inner socket, external frame� 2 1 104.7 0 2 0 NA NA 3181 3181 Carrier K 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5671 Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert 2 1 104.7 0 2 0 NA NA 3182 3182 Carrier K 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5673 Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism 2 1 104.7 0 2 0 NA NA 3183 3183 Carrier K 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5910 Addition, endoskeletal system, below knee, alignable system 2 1 104.7 0 2 0 NA NA 3184 3184 Carrier K 2021 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5940 Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) 2 1 104.7 0 2 0 NA NA 3185 3185 Carrier K 2021 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E1399 Durable medical equipment, miscellaneous 1 0 1 325.44 0 1 0 NA NA 3186 3186 Carrier K 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 19364 Breast reconstruction; with free flap (eg, fTRAM, DIEP, SIEA, GAP flap) 3 1 37.3 0 3 0 NA NA 3187 3187 Carrier K 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 11970 Replacement of tissue expander with permanent implant 2 1 22 0 2 0 NA NA 3188 3188 Carrier K 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 11971 Removal of tissue expander without insertion of implant 2 1 56 0 2 0 NA NA 3189 3189 Carrier K 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 19380 Revision of reconstructed breast (eg, significant removal of tissue, re-advancement and/or re-inset of flaps in autologous reconstruction or significant capsular revision combined with soft tissue excision in implant-based reconstruction) 2 1 22 0 2 0 NA NA 3190 3190 Carrier K 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 49999 Unlisted procedure, abdomen, peritoneum and omentum� 2 1 115 0 2 0 NA NA 3191 3191 Carrier K 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 14302 Adjacent tissue transfer or rearrangement, any area; each additional 30.0 sq cm, or part thereof (List separately in addition to code for primary procedure) 2 0.5 108.8 0 2 0 NA NA 3192 3192 Carrier K 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 15240 Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less 2 0.5 108.8 0 2 0 NA NA 3193 3193 Carrier K 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 15241 Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) 2 0.5 108.8 0 2 0 NA NA 3194 3194 Carrier K 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 52332 Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type) 2 0.5 118.3 0 2 0 NA NA 3195 3195 Carrier K 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 53430 Urethroplasty, reconstruction of female urethra 2 0.5 108.5 0 2 0 NA NA 3196 3196 Carrier K 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19364 Breast reconstruction; with free flap (eg, fTRAM, DIEP, SIEA, GAP flap) 3 1 37.3 0 3 0 NA NA 3197 3197 Carrier K 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 11970 Replacement of tissue expander with permanent implant 2 1 22 0 2 0 NA NA 3198 3198 Carrier K 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 11971 Removal of tissue expander without insertion of implant 2 1 56 0 2 0 NA NA 3199 3199 Carrier K 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19380 Unlisted procedure, abdomen, peritoneum and omentum� 2 1 22 0 2 0 NA NA 3200 3200 Carrier K 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 49999 Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type) 2 1 115 0 2 0 NA NA 3201 3201 Carrier K 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple 55 1 9.7 3.66 4 51 0 NA NA 3202 3202 Carrier K 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 53 1 12.9 3.8 3 50 0 NA NA 3203 3203 Carrier K 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 81479 Unlisted molecular pathology procedure� 53 0.96 10.28 0 53 0 NA NA 3204 3204 Carrier K 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 81420 Fetal chromosomal aneuploidy (eg, trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18, and 21 35 0.94 9.8 0 35 0 NA NA 3205 3205 Carrier K 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)� 126 0.91 0.2 15.1 1 125 0 NA NA 3206 3206 Carrier K 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique� 85 0.91 0.2 15.11 1 84 0 NA NA 3207 3207 Carrier K 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45384 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps 65 0.91 0.2 16.4 1 64 0 NA NA 3208 3208 Carrier K 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 Colonoscopy, flexible; with biopsy, single or multiple 111 0.9 25.1 17.01 2 109 0 NA NA 3209 3209 Carrier K 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95811 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist 29 0.59 48.9 36.8 2 27 0 NA NA 3210 3210 Carrier K 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95810 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist 36 0.5 42.3 52.9 1 34 0 NA NA 3211 3211 Carrier K 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple 55 1 9.7 3.66 4 51 0 NA NA 3212 3212 Carrier K 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 53 1 12.9 3.8 3 50 0 NA NA 3213 3213 Carrier K 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43249 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter)� 20 1 1.3 0 20 0 NA NA 3214 3214 Carrier K 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43248 Esophagogastroduodenoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) through esophagus over guide wire 11 1 0.2 0 11 0 NA NA 3215 3215 Carrier K 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81374 HLA Class I typing, low resolution (eg, antigen equivalents); one antigen equivalent (eg, B*27), each� 10 1 0.17 0 10 0 NA NA 3216 3216 Carrier K 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81162 BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and full duplication/deletion analysis (ie, detection of large gene rearrangements)� 10 1 0.12 0 10 0 NA NA 3217 3217 Carrier K 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64490 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level� 9 1 5.7 0 9 0 NA NA 3218 3218 Carrier K 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 52356 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (eg, Gibbons or double-J type) 13 1 11.3 2.1 5 8 0 NA NA 3219 3219 Carrier K 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81241 F5 (coagulation factor V) (eg, hereditary hypercoagulability) gene analysis, Leiden variant 7 1 4.2 0 7 0 NA NA 3220 3220 Carrier K 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93656 Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation, including intracardiac electrophysiologic 3-dimensional mapping, intracardiac echocardiography including imaging supervision and interpretation, induction or attempted induction of an arrhythmia including left or right atrial pacing/recording, right ventricular pacing/recording, and His bundle recording, when performed� 7 1 25 45.6 1 6 0 NA NA 3221 3221 Carrier L 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1028 Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for joystick, other control interface or positioning accessory 4 1 117.2 0 4 0 NA NA 3222 3222 Carrier L 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2402 Negative pressure wound therapy electrical pump, stationary or portable 2 0.5 106.8 0 2 0 NA NA 3223 3223 Carrier L 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC S1040 Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s)� 2 0.5 46.4 0 2 0 NA NA 3224 3224 Carrier L 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1399 Durable medical equipment, miscellaneous 4 0 100 0 4 0 NA NA 3225 3225 Carrier L 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9999 Miscellaneous dme supply or accessory, not otherwise specified 3 0 139.4 0 3 0 NA NA 3226 3226 Carrier L 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0486 Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment 2 0 124.7 0 2 0 NA NA 3227 3227 Carrier L 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20930 SP BONE ALGRFT MORSEL ADD-ON 6 1 29 0 6 0 0 NA NA 3228 3228 Carrier L 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20936 SP BONE AGRFT LOCAL ADD-ON 6 1 29 0 6 0 0 NA NA 3229 3229 Carrier L 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22556 ARTHRD ANT NTRBD MIN DSC THC 6 1 29 0 6 0 0 NA NA 3230 3230 Carrier L 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22610 ARTHRD PST TQ 1NTRSPC THRC 6 1 29 0 6 0 0 NA NA 3231 3231 Carrier L 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22840 INSERT SPINE FIXATION DEVICE 6 1 29 0 6 0 0 NA NA 3232 3232 Carrier L 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 INSJ BIOMECHANICAL DEVICE 6 1 29 0 6 0 0 NA NA 3233 3233 Carrier L 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63064 DECOMPRESS SPINAL CORD THRC 6 1 29 0 6 0 0 NA NA 3234 3234 Carrier L 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s) 4 0.75 19.3 47.3 1 3 NA NA 3235 3235 Carrier L 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 15734 Muscle, myocutaneous, or fasciocutaneous flap; trunk 2 1 41.4 2 NA NA 3236 3236 Carrier L 2021 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 49560 Repair initial incisional or ventral hernia; reducible 2 1 41.4 2 NA NA 3237 3237 Carrier L 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 20930 SP BONE ALGRFT MORSEL ADD-ON 6 1 29 0 6 0 0 NA NA 3238 3238 Carrier L 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 20936 SP BONE AGRFT LOCAL ADD-ON 6 1 29 0 6 0 0 NA NA 3239 3239 Carrier L 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22556 ARTHRD ANT NTRBD MIN DSC THC 6 1 29 0 6 0 0 NA NA 3240 3240 Carrier L 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22610 ARTHRD PST TQ 1NTRSPC THRC 6 1 29 0 6 0 0 NA NA 3241 3241 Carrier L 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22840 INSERT SPINE FIXATION DEVICE 6 1 29 0 6 0 0 NA NA 3242 3242 Carrier L 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22853 INSJ BIOMECHANICAL DEVICE 6 1 29 0 6 0 0 NA NA 3243 3243 Carrier L 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63064 DECOMPRESS SPINAL CORD THRC 6 1 29 0 6 0 0 NA NA 3244 3244 Carrier L 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15734 Muscle, myocutaneous, or fasciocutaneous flap; trunk 2 1 41.4 2 NA NA 3245 3245 Carrier L 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 49560 Repair initial incisional or ventral hernia; reducible 2 1 41.4 2 NA NA 3246 3246 Carrier L 2021 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 49568 Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection 2 1 41.4 2 NA NA 3247 3247 Carrier L 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 192 0.84 0.2 16.1 6 186 0 NA NA 3248 3248 Carrier L 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 Colonoscopy, flexible; with biopsy, single or multiple 185 0.83 6.7 17.9 7 178 0 NA NA 3249 3249 Carrier L 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 138 0.804 11.6 19.6 4 134 0 NA NA 3250 3250 Carrier L 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45384 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps 86 0.81 19.2 0 86 0 NA NA 3251 3251 Carrier L 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 81479 Unlisted molecular pathology procedure 74 0.93 9.7 0 74 0 NA NA 3252 3252 Carrier L 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple 66 0.98 0.4 4.2 7 59 0 NA NA 3253 3253 Carrier L 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 64 0.98 0.2 4.4 6 58 0 NA NA 3254 3254 Carrier L 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95810 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist 62 0.61 22.8 43.2 1 61 0 NA NA 3255 3255 Carrier L 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95811 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist 49 0.63 48 47.4 1 48 0 NA NA 3256 3256 Carrier L 2021 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 81420 Fetal chromosomal aneuploidy (eg, trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18, and 21 27 0.96 7.7 0 27 0 NA NA 3257 3257 Carrier L 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 1 1 0 346.08 0 1 0 NA NA 3258 3258 Carrier L 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 45380 Colonoscopy, flexible; with biopsy, single or multiple 1 1 0 684.48 0 1 0 NA NA 3259 3259 Carrier L 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81479 Unlisted molecular pathology procedure 1 1 0 344.88 0 1 0 NA NA 3260 3260 Carrier L 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29827 SHO ARTHRS SRG RT8TR CUF RPR 0 NA NA 3261 3261 Carrier L 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29822 SHO ARTHRS SRG LMTD DBRDMT 0 NA NA 3262 3262 Carrier L 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 25390 SHORTEN RADIUS OR ULNA 0 NA NA 3263 3263 Carrier L 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27279 ARTHRODESIS SACROILIAC JOINT 0 NA NA 3264 3264 Carrier L 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27447 TOTAL KNEE ARTHROPLASTY 0 NA NA 3265 3265 Carrier L 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29828 SHO ARTHRS SRG BICP TENODSIS 0 NA NA 3266 3266 Carrier L 2021 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29846 WRIST ARTHROSCOPY/SURGERY 0 NA NA 3267 3267 Carrier L 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 External ambulatory infusion pump, insulin 9 1 13.7 16.4 1 8 0 NA NA 3268 3268 Carrier L 2021 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0553 Supply allowance for therapeutic continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 Unit of Service 1 1 0.1 0 1 0 NA NA 3269 3269 Carrier L 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1028 Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for joystick, other control interface or positioning accessory 4 1 117.2 0 4 0 NA NA 3270 3270 Carrier L 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1399 Durable medical equipment, miscellaneous 4 0 100 0 4 0 NA NA 3271 3271 Carrier L 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9999 Miscellaneous dme supply or accessory, not otherwise specified 3 0 139.4 0 3 0 NA NA 3272 3272 Carrier L 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0486 Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment 2 0 124.7 0 2 0 NA NA 3273 3273 Carrier L 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2402 Negative pressure wound therapy electrical pump, stationary or portable 2 0.5 106.8 0 2 0 NA NA 3274 3274 Carrier L 2021 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC S1040 Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s)� 2 0.5 46.4 0 2 0 NA NA 3275 3275 Carrier M 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20930 ALLOGRAFT, MORSELIZED, OR PLACEMENT OF OSTEOPROMOTIVE MATERIAL, FOR SPINE SURGERY ONLY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 12 0.5 167 0 12 NA NA 3276 3276 Carrier M 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44207 LAPS COLECTOMY PRTL W/COLOPXTSTMY LW ANAST 12 1 21.2 0 12 NA NA 3277 3277 Carrier M 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43644 LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM 11 0.5455 70.3 53.1 1 10 NA NA 3278 3278 Carrier M 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43775 LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; LONGITUDINAL GASTRECTOMY (IE, SLEEVE GASTRECTOMY) 10 0.8 57.4 0 10 NA NA 3279 3279 Carrier M 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 TOTAL HYSTERECTOMY (CORPUS AND CERVIX), WITH OR WITHOUT REMOVAL OF TUBE(S), WITH OR WITHOUT REMOVAL OF OVARY(S); 10 1 92.4 11.2 1 9 NA NA 3280 3280 Carrier M 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22842 POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG 10 0.8 63.4 88.5 1 9 NA NA 3281 3281 Carrier M 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95720 ELECTROENCEPHALOGRAM (EEG), CONTINUOUS RECORDING, PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL REVIEW OF RECORDED EVENTS, ANALYSIS OF SPIKE AND SEIZURE DETECTION, EACH INCREMENT OF GREATER THAN 12 HOURS, UP TO 26 HOURS OF EEG RECORDING, INTERPRE 10 0.6 44.2 0 10 NA NA 3282 3282 Carrier M 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44213 LAPS MOBLJ SPLENIC FLXR PFRMD W/PRTL COLECTOMY 8 1 17.1 0 8 NA NA 3283 3283 Carrier M 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT 8 0.625 45.5 0 8 NA NA 3284 3284 Carrier M 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20936 AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION 7 0.7143 149 0 7 NA NA 3285 3285 Carrier M 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44207 LAPS COLECTOMY PRTL W/COLOPXTSTMY LW ANAST 12 1 21.2 0 12 NA NA 3286 3286 Carrier M 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58150 TOTAL HYSTERECTOMY (CORPUS AND CERVIX), WITH OR WITHOUT REMOVAL OF TUBE(S), WITH OR WITHOUT REMOVAL OF OVARY(S); 10 1 92.4 11.2 1 9 NA NA 3287 3287 Carrier M 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44213 LAPS MOBLJ SPLENIC FLXR PFRMD W/PRTL COLECTOMY 8 1 17.1 0 8 NA NA 3288 3288 Carrier M 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44204 LAPAROSCOPY, SURGICAL;COLECTOMY, PARTIAL, WITH ANASTOMOSIS 7 1 6.2 0 7 NA NA 3289 3289 Carrier M 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J9208 INJECTION, IFOSFAMIDE, 1 GRAM 7 1 102.3 0 7 NA NA 3290 3290 Carrier M 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22614 ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE INTERSPACE; EACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 7 1 100.7 0 7 NA NA 3291 3291 Carrier M 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96416 CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP 6 1 50.8 0 6 NA NA 3292 3292 Carrier M 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 45330 SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE) 6 1 20.7 0 6 NA NA 3293 3293 Carrier M 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 55866 LAPS PROSTECT RETROPUBIC RAD W/NRV SPARING ROBOT 5 1 6.5 3.3 1 4 NA NA 3294 3294 Carrier M 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J9181 INJECTION, ETOPOSIDE, 10 MG 5 1 124.1 0 5 NA NA 3295 3295 Carrier M 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43644 LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM 11 0 0.55 70.3 53.1 1 10 NA NA 3296 3296 Carrier M 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22633 ARTHRODESIS, COMBINED POSTERIOR OR POSTEROLATERAL TECHNIQUE WITH POSTERIOR INTERBODY TECHNIQUE INCLUDING LAMINECTOMY AND/OR DISCECTOMY SUFFICIENT TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION), SINGLE INTERSPACE; LUMBAR 6 0 0.33 63.4 63.8 1 5 NA NA 3297 3297 Carrier M 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43775 LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; LONGITUDINAL GASTRECTOMY (IE, SLEEVE GASTRECTOMY) 10 0 0.8 57.4 0 10 NA NA 3298 3298 Carrier M 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22842 POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG 10 0 0.8 63.4 88.5 1 9 NA NA 3299 3299 Carrier M 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 20930 ALLOGRAFT, MORSELIZED, OR PLACEMENT OF OSTEOPROMOTIVE MATERIAL, FOR SPINE SURGERY ONLY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 12 0 0.5 167 0 12 NA NA 3300 3300 Carrier M 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63053 LAMINECTOMY, FACETECTOMY, OR FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT(S) (EG, SPINAL OR LATERAL RECESS STENOSIS)), DURING POSTERIOR INTERBODY ARTHRODESIS, LUMBAR; EACH ADDITIONAL SEGMENT (LIS 1 0 0 25.3 0 1 NA NA 3301 3301 Carrier M 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22840 POSTERIOR NON-SEGMENTAL INSTRUMENTATION (EG, HARRINGTON ROD TECHNIQUE, PEDICLE FIXATION ACROSS ONE INTERSPACE, ATLANTOAXIAL TRANSARTICULAR SCREW FIXATION, SUBLAMINAR WIRING AT C1, FACET SCREW FIXATION) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PRO 4 0 0.5 91.9 0 4 NA NA 3302 3302 Carrier M 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27279 ARTHRODESIS, SACROILIAC JOINT, PERCUTANEOUS OR MINIMALLY INVASIVE (INDIRECT VISUALIZATION), WITH IMAGE GUIDANCE, INCLUDES OBTAINING BONE GRAFT WHEN PERFORMED, AND PLACEMENT OF TRANSFIXING DEVICE 1 0 0 24 0 1 NA NA 3303 3303 Carrier M 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT 8 0 0.63 45.5 0 8 NA NA 3304 3304 Carrier M 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 20931 ALLOGRAFT, STRUCTURAL, FOR SPINE SURGERY ONLY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 2 0 0.5 273.7 0 2 NA NA 3305 3305 Carrier M 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC J0585 Botox 141 0.89 26 42 2 139 NA NA 3306 3306 Carrier M 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 66984 EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION); WITHOUT ENDOSCOPIC CYCLOPHOTOCOAGULATION 98 1 4 27.4 1 97 NA NA 3307 3307 Carrier M 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 89253 ASSTD EMBRYO HATCHING MICROTQS ANY METH 94 0.57 107.8 0 94 NA NA 3308 3308 Carrier M 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 89258 CRYOPRSRV EMBRYO 89 0.75 94.4 0 89 NA NA 3309 3309 Carrier M 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 89342 STORAGE, (PER YEAR); EMBRYO(S) 81 0.78 81.3 0 81 NA NA 3310 3310 Carrier M 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 19318 BREAST REDUCTION 81 0.7 69.5 0 81 NA NA 3311 3311 Carrier M 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT S4022 ASST OOCYTE FERT CASE RATE 73 0.42 91.5 0 73 NA NA 3312 3312 Carrier M 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT S4016 FROZEN IVF CASE RATE 66 0.89 55.8 0 66 NA NA 3313 3313 Carrier M 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY, 60 MINUTES WITH PATIENT 62 0.98 2414.3 0 62 NA NA 3314 3314 Carrier M 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT S4011 IVF PACKAGE 61 0.67 98 0 61 NA NA 3315 3315 Carrier M 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 66984 EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION); WITHOUT ENDOSCOPIC CYCLOPHOTOCOAGULATION 98 1 4 27.4 1 97 NA NA 3316 3316 Carrier M 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 36475 ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, RADIOFREQUENCY; FIRST VEIN TREATED 52 1 55.4 0 52 NA NA 3317 3317 Carrier M 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58558 HYSTEROSCOPY, SURGICAL; WITH SAMPLING (BIOPSY) OF ENDOMETRIUM AND/OR POLYPECTOMY, WITH OR WITHOUT D & C 33 1 19.1 78.8 1 32 NA NA 3318 3318 Carrier M 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 36478 ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS,LASER, FIRST VEIN TREATED 16 1 51.8 0 16 NA NA 3319 3319 Carrier M 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 66982 EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1-STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION), COMPLEX, REQUIRING DEVICES OR TECHNIQUES NOT GENERALLY USED IN ROUTIN 15 1 10.8 0 15 NA NA 3320 3320 Carrier M 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19380 REVJ RECONSTRUCTED BREAST 13 1 24.1 0 13 NA NA 3321 3321 Carrier M 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19357 TISSUE EXPANDER PLACEMENT IN BREAST RECONSTRUCTION, INCLUDING SUBSEQUENT EXPANSION(S) 13 1 7.8 0 13 NA NA 3322 3322 Carrier M 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15823 BLEPHAROPLASTY, UPPER EYELID; WITH EXCESSIVE SKIN WEIGHTING DOWN LID 12 1 24.9 0 12 NA NA 3323 3323 Carrier M 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 36471 NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG 11 1 54.4 0 11 NA NA 3324 3324 Carrier M 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99354 PROLNG SVC O/P 1ST HOUR 10 1 33.9 61.6 2 8 NA NA 3325 3325 Carrier M 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27447 ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS 61 0 0.67 38.1 0 61 NA NA 3326 3326 Carrier M 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 89258 CRYOPRSRV EMBRYO 89 0 0.75 94.4 0 89 NA NA 3327 3327 Carrier M 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT 54 0 0.76 39.3 0 54 NA NA 3328 3328 Carrier M 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT S4011 IVF PACKAGE 61 0 0.67 98 0 61 NA NA 3329 3329 Carrier M 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 89342 STORAGE, (PER YEAR); EMBRYO(S) 81 0 0.78 81.3 0 81 NA NA 3330 3330 Carrier M 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 31267 NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS 30 0 0.53 1.9 60.6 1 29 NA NA 3331 3331 Carrier M 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 19318 BREAST REDUCTION 81 0 0.7 69.5 0 81 NA NA 3332 3332 Carrier M 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 31276 NASAL/SINUS NDSC W/FRONTAL SINUS EXPLORATION 27 0 0.59 9.7 79.2 2 25 NA NA 3333 3333 Carrier M 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT S4015 COMPLETE IVF NOS CASE RATE 26 0 0.73 205.6 0 26 NA NA 3334 3334 Carrier M 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 89253 ASSTD EMBRYO HATCHING MICROTQS ANY METH 94 0 0.57 107.8 0 94 NA NA 3335 3335 Carrier M 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Internal NA MENTAL HEALTH RESIDENTIAL TREATMENT FACILITY 47 0.91 26.8 249.3 4 43 NA NA 3336 3336 Carrier M 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Internal NA CHEMICAL DEPENDENCY RESIDENTIAL TREATMENT FACILITY 7 1 11.4 24.4 4 3 NA NA 3337 3337 Carrier M 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Internal NA MENTAL HEALTH INPATIENT 2 1 96 0 2 NA NA 3338 3338 Carrier M 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Internal NA DETOXIFICATION 1 1 0.1 0 1 NA NA 3339 3339 Carrier M 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Internal NA CHEMICAL DEPENDENCY RESIDENTIAL TREATMENT FACILITY 7 1 11.4 24.4 4 3 NA NA 3340 3340 Carrier M 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Internal NA MENTAL HEALTH INPATIENT 2 1 96 0 2 NA NA 3341 3341 Carrier M 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Internal NA DETOXIFICATION 1 1 0.1 0 1 NA NA 3342 3342 Carrier M 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Internal NA MENTAL HEALTH RESIDENTIAL TREATMENT FACILITY 47 0.91 26.8 249.3 4 43 NA NA 3343 3343 Carrier M 2022 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Internal NA MENTAL HEALTH INPATIENT 2 0 1 96 0 2 NA NA 3344 3344 Carrier M 2022 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Internal NA CHEMICAL DEPENDENCY RESIDENTIAL TREATMENT FACILITY 7 0 1 11.4 24.4 4 3 NA NA 3345 3345 Carrier M 2022 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Internal NA DETOXIFICATION 1 0 1 0.1 0 1 NA NA 3346 3346 Carrier M 2022 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Internal NA MENTAL HEALTH RESIDENTIAL TREATMENT FACILITY 47 0 0.91 26.8 249.3 4 43 NA NA 3347 3347 Carrier M 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 MH PARTIAL HOSP TX UNDER 24H 93 0.98 9.8 328.8 2 91 NA NA 3348 3348 Carrier M 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 BEHAVIOR IDENTIFICATION ASSESSMENT, ADMINISTERED BY A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, EACH 15 MINUTES OF THE PHYSICIANS OR OTHER QUALI FIED HEALTH CARE PROFESSIONALS TIME FACE-TO-FACE WITH PATIENT AND/OR GUARDIAN( S)/CAREGIVER(S) A 75 0.99 491.7 0 75 NA NA 3349 3349 Carrier M 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97153 ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN 66 0.88 803.1 0 66 NA NA 3350 3350 Carrier M 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97155 ADAPTIVE BEHAVIOR TREATMENT WITH PROTOCOL MODIFICATION, ADMINISTERED BY PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, WHICH MAY INCLUDE SIMULTANEOUS DIRECTION OF TECHNICIAN, FACE-TO-FACE WITH ONE PATIENT, EACH 15 MINUTES 65 0.92 740.1 0 65 NA NA 3351 3351 Carrier M 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97156 FAMILY ADAPTIVE BEHAVIOR TREATMENT GUIDANCE, ADMINISTERED BY PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL (WITH OR WITHOUT THE PATIENT PRESENT),FACE- TO-FACE WITH GUARDIAN(S)/CAREGIVER(S), EACH 15 MINUTES 60 0.98 636.2 0 60 NA NA 3352 3352 Carrier M 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H2036 ALCOHOL AND/OR DRUG TREATMENT PROGRAM, PER DIEM 46 0.87 81.2 109.1 2 44 NA NA 3353 3353 Carrier M 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY, 60 MINUTES WITH PATIENT 42 0.93 730.4 0 42 NA NA 3354 3354 Carrier M 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; SUBSEQUENT DELIVERY AND MANAGEMENT, PER SESSION 38 0.61 239.9 0 38 NA NA 3355 3355 Carrier M 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; INITIAL, INCLUDING CORTICAL MAPPING, MOTOR THRESHOLD DETERMINATION, DELIVERY AND MANAGEMENT 35 0.57 204 0 35 NA NA 3356 3356 Carrier M 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; SUBSEQUENT MOTOR THRESHOLD RE-DETERMINATION WITH DELIVERY AND MANAGEMENT 18 0.56 285.2 0 18 NA NA 3357 3357 Carrier M 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90832 PSYCHOTHERAPY, 30 MINUTES WITH PATIENT 5 1 10.9 0 5 NA NA 3358 3358 Carrier M 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99215 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES A MEDICALLY APPROPRIATE HISTORY AND/OR EXAMINATION AND HIGH LEVEL OF MEDICAL DECISION MAKING. WHEN USING TIME FOR CODESELECTION, 40-54 MINUTES OF 2 1 127.4 0 2 NA NA 3359 3359 Carrier M 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96131 PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR 2 1 22.8 0 2 NA NA 3360 3360 Carrier M 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90847 FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 2 1 176.6 0 2 NA NA 3361 3361 Carrier M 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96137 PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN 2 1 22.8 0 2 NA NA 3362 3362 Carrier M 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96130 PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR 2 1 22.8 0 2 NA NA 3363 3363 Carrier M 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90846 FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 2 1 2.1 0 2 NA NA 3364 3364 Carrier M 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96136 PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN 2 1 22.8 0 2 NA NA 3365 3365 Carrier M 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90839 PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES 1 1 23.2 0 1 NA NA 3366 3366 Carrier M 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90853 GROUP MEDICAL PSYCHOTHERAPY (OTHER THAN OF A MULTIPLE-FAMILY GROUP) 1 1 24 0 1 NA NA 3367 3367 Carrier M 2022 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90868 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; SUBSEQUENT DELIVERY AND MANAGEMENT, PER SESSION 38 0 0.61 239.9 0 38 NA NA 3368 3368 Carrier M 2022 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90867 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; INITIAL, INCLUDING CORTICAL MAPPING, MOTOR THRESHOLD DETERMINATION, DELIVERY AND MANAGEMENT 35 0 0.57 204 0 35 NA NA 3369 3369 Carrier M 2022 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 99205 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES A MEDICALLY APPROPRIATE HISTORY AND/OR EXAMINATION AND HIGH LEVEL OF MEDICAL DECISION MAKING. WHEN USING TIME FOR CODE SELECTION, 60-74 MINUTES OF TOTAL T 1 0 0 115.6 0 1 NA NA 3370 3370 Carrier M 2022 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90836 PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 45 MIN 2 0 0.5 58.6 0 2 NA NA 3371 3371 Carrier M 2022 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90832 PSYCHOTHERAPY, 30 MINUTES WITH PATIENT 5 0 1 10.9 0 5 NA NA 3372 3372 Carrier M 2022 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97154 GROUP ADAPTIVE BHV TX BY PROTOCOL TECH EA 15 MIN 3 0 0.67 1527.7 0 3 NA NA 3373 3373 Carrier M 2022 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION 14 0 0.86 124.3 0 14 NA NA 3374 3374 Carrier M 2022 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97151 BEHAVIOR IDENTIFICATION ASSESSMENT, ADMINISTERED BY A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, EACH 15 MINUTES OF THE PHYSICIANS OR OTHER QUALI FIED HEALTH CARE PROFESSIONALS TIME FACE-TO-FACE WITH PATIENT AND/OR GUARDIAN( S)/CAREGIVER(S) A 75 0 0.99 491.7 0 75 NA NA 3375 3375 Carrier M 2022 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 96130 PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR 2 0 1 22.8 0 2 NA NA 3376 3376 Carrier M 2022 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97158 GRP ADAPT BHV PRTCL MODIFCAJ PHYS/QHP EA 15 MIN 3 0 0.33 1527.7 0 3 NA NA 3377 3377 Carrier M 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0486 ORAL DEVICE/APPLIANCE USED TO REDUCE UPPER AIRWAY COLLAPSIBILITY, ADJUSTABLE OR NON-ADJUSTABLE, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT 2 0 59.7 0 2 NA NA 3378 3378 Carrier M 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5652 SUCTION SUSP AK/KNEE DISART 1 1 28.3 0 1 NA NA 3379 3379 Carrier M 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5649 ISCH CONTAINMT/NARROW M-L SO 1 1 28.2 0 1 NA NA 3380 3380 Carrier M 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5845 KNEE-SHIN SYS STANCE FLEXION 1 1 28.3 0 1 NA NA 3381 3381 Carrier M 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L8480 PROS SOCK SINGLE PLY AK 1 1 28.2 0 1 NA NA 3382 3382 Carrier M 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5981 FLEX-WALK SYS LOW EXT PROSTH 1 1 22 0 1 NA NA 3383 3383 Carrier M 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L8460 SHRINKER ABOVE KNEE 1 1 28.2 0 1 NA NA 3384 3384 Carrier M 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5950 ENDO AK ULTRA-LIGHT MATERIAL 1 1 28.2 0 1 NA NA 3385 3385 Carrier M 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5650 TOT CONTACT AK/KNEE DISART S 1 1 28.2 0 1 NA NA 3386 3386 Carrier M 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5920 ENDO AK/HIP ALIGNABLE SYSTEM 1 1 28.2 0 1 NA NA 3387 3387 Carrier M 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5652 SUCTION SUSP AK/KNEE DISART 1 1 28.3 0 1 NA NA 3388 3388 Carrier M 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8480 PROS SOCK SINGLE PLY AK 1 1 28.2 0 1 NA NA 3389 3389 Carrier M 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5649 ISCH CONTAINMT/NARROW M-L SO 1 1 28.2 0 1 NA NA 3390 3390 Carrier M 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5845 KNEE-SHIN SYS STANCE FLEXION 1 1 28.3 0 1 NA NA 3391 3391 Carrier M 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5968 MULTIAXIAL ANKLE W DORSIFLEX 1 1 21.9 0 1 NA NA 3392 3392 Carrier M 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5981 FLEX-WALK SYS LOW EXT PROSTH 1 1 22 0 1 NA NA 3393 3393 Carrier M 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8460 SHRINKER ABOVE KNEE 1 1 28.2 0 1 NA NA 3394 3394 Carrier M 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5950 ENDO AK ULTRA-LIGHT MATERIAL 1 1 28.2 0 1 NA NA 3395 3395 Carrier M 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5650 TOT CONTACT AK/KNEE DISART S 1 1 28.2 0 1 NA NA 3396 3396 Carrier M 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5920 ENDO AK/HIP ALIGNABLE SYSTEM 1 1 28.2 0 1 NA NA 3397 3397 Carrier M 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L5652 SUCTION SUSP AK/KNEE DISART 1 0 1 28.3 0 1 NA NA 3398 3398 Carrier M 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L5649 ISCH CONTAINMT/NARROW M-L SO 1 0 1 28.2 0 1 NA NA 3399 3399 Carrier M 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L5845 KNEE-SHIN SYS STANCE FLEXION 1 0 1 28.3 0 1 NA NA 3400 3400 Carrier M 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L8480 PROS SOCK SINGLE PLY AK 1 0 1 28.2 0 1 NA NA 3401 3401 Carrier M 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L5981 FLEX-WALK SYS LOW EXT PROSTH 1 0 1 22 0 1 NA NA 3402 3402 Carrier M 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L8460 SHRINKER ABOVE KNEE 1 0 1 28.2 0 1 NA NA 3403 3403 Carrier M 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L5950 ENDO AK ULTRA-LIGHT MATERIAL 1 0 1 28.2 0 1 NA NA 3404 3404 Carrier M 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L5650 TOT CONTACT AK/KNEE DISART S 1 0 1 28.2 0 1 NA NA 3405 3405 Carrier M 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L5920 ENDO AK/HIP ALIGNABLE SYSTEM 1 0 1 28.2 0 1 NA NA 3406 3406 Carrier M 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 373 0.563 4.74 12.95 92 281 OZEMPIC/RYBELSUS NA 3407 3407 Carrier M 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 242 0.756 4.13 9.56 65 177 DEPO-TESTOSTERONE/TESTOSTERONE NA 3408 3408 Carrier M 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 197 0.898 10.16 9.46 30 167 FIRST-OMEPRAZOLE/OMEPRAZOLE/PRILOSEC NA 3409 3409 Carrier M 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 147 0.748 2.89 15.68 45 102 ADDERALL/AMPHETAMINE-DEXTROAMPHET/AMPHETAMINE-DEXTROAMPHETAMINE/AMPHETAMINE/DEXTROAMPHETAMINE/MYDAYIS NA 3410 3410 Carrier M 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 147 0.714 3.12 10.5 19 128 PROTOPIC/TACROLIMUS NA 3411 3411 Carrier M 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 146 0.87 3.78 12.45 52 94 HYDROCODONE/HYDROCODONE-ACETAMINOPHEN/HYDROCODONE-APAP/HYDROCODONE/ACETAMINOPHEN NA 3412 3412 Carrier M 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 132 0.932 0.53 6.9 26 106 PANTOPRAZOLE NA 3413 3413 Carrier M 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 121 0.777 7.89 16.15 27 94 DULAGLUTIDE/TRULICITY NA 3414 3414 Carrier M 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 121 0.876 7.95 40.74 25 96 HUMIRA NA 3415 3415 Carrier M 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 115 0.817 0.29 7.44 25 90 ABSORICA/ACCUTANE/AMNESTEEM/CLARAVIS/ISOTRETINOIN/MYORISAN/ZENATANE NA 3416 3416 Carrier M 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 25 1 7.74 18.09 9 16 SKYRIZI NA 3417 3417 Carrier M 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 22 1 1.77 18.81 6 16 GABAPENTIN NA 3418 3418 Carrier M 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 20 1 8.38 15.88 6 14 OMEPRAZOLE/PANTOPRAZOLE/RABEPRAZOLE NA 3419 3419 Carrier M 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 14 1 5.34 2.62 4 10 JANUMET NA 3420 3420 Carrier M 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 14 1 0 16.31 1 13 AKLIEF NA 3421 3421 Carrier M 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 9 1 16.86 0 9 HIZENTRA NA 3422 3422 Carrier M 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 9 1 2.66 0.04 8 1 CAPECITABINE NA 3423 3423 Carrier M 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 0 0 2 5 ZALEPLON NA 3424 3424 Carrier M 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 0 0.01 4 3 RAMELTEON NA 3425 3425 Carrier M 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 6 1 0.92 19.02 1 5 PROLIA NA 3426 3426 Carrier M 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 5 0 1 41.37 0 5 STELARA NA 3427 3427 Carrier M 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 0 1 60.18 0 3 ANDROGEL/TESTOSTERONE NA 3428 3428 Carrier M 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 0 1 0.71 42.43 1 2 HUMIRA NA 3429 3429 Carrier M 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 0 1 2.2 3 0 ELIQUIS NA 3430 3430 Carrier M 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 0 1 52.62 2.72 1 1 TESTOSTERONE NA 3431 3431 Carrier M 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 0 1 13.85 2 0 WEGOVY NA 3432 3432 Carrier M 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 0 1 0.54 2 0 ARMODAFINIL NA 3433 3433 Carrier M 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 0 1 5.08 5.18 1 1 GRALISE NA 3434 3434 Carrier M 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 0 1 35.61 0 2 SIMPONI NA 3435 3435 Carrier M 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 0 1 0.26 19.75 1 1 COSENTYX NA 3436 3436 Carrier F 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 121 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Medical/Surgical/GYN 140 0.7 19 53 31 109 NA NA 3437 3437 Carrier F 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 17 0.9412 26 70 2 15 NA NA 3438 3438 Carrier F 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20936 Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure) 14 0.9286 16 71 2 12 NA NA 3439 3439 Carrier F 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure) 11 1 26 65 2 9 NA NA 3440 3440 Carrier F 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 11 0.9091 29 69 1 10 NA NA 3441 3441 Carrier F 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); 9 1 17 57 3 6 NA NA 3442 3442 Carrier F 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63048 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; each additional vertebral segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure) 9 0.7778 19 73 3 6 NA NA 3443 3443 Carrier F 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 760 Ancillary Services - Specialty Services-General Classification 7 0.8571 1 26 1 6 NA NA 3444 3444 Carrier F 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22612 Arthrodesis, posterior or posterolateral technique, single interspace; lumbar (with lateral transverse technique, when performed) 6 0.8333 67 0 6 NA NA 3445 3445 Carrier F 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22614 Arthrodesis, posterior or posterolateral technique, single interspace; each additional interspace (List separately in addition to code for primary procedure) 6 1 17 52 2 4 NA NA 3446 3446 Carrier F 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure) 11 1 26 65 2 9 NA NA 3447 3447 Carrier F 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); 9 1 17 57 3 6 NA NA 3448 3448 Carrier F 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22614 Arthrodesis, posterior or posterolateral technique, single interspace; each additional interspace (List separately in addition to code for primary procedure) 6 1 17 52 2 4 NA NA 3449 3449 Carrier F 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44207 Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) 6 1 32 0 6 NA NA 3450 3450 Carrier F 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 55866 Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed 6 1 14 31 1 5 NA NA 3451 3451 Carrier F 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19364 Breast reconstruction; with free flap (eg, fTRAM, DIEP, SIEA, GAP flap) 5 1 80 0 5 NA NA 3452 3452 Carrier F 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 5 1 57 0 5 NA NA 3453 3453 Carrier F 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 69990 Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure) 5 1 13 41 2 3 NA NA 3454 3454 Carrier F 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22600 Arthrodesis, posterior or posterolateral technique, single interspace; cervical below C2 segment 4 1 17 45 2 2 NA NA 3455 3455 Carrier F 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 38770 Pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes (separate procedure) 4 1 14 49 1 3 NA NA 3456 3456 Carrier F 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 121 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Medical/Surgical/GYN 140 0 0.0071 19 53 31 109 NA NA 3457 3457 Carrier F 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple 505 0.9267 14 48 72 433 NA NA 3458 3458 Carrier F 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 431 0.9188 16 49 69 362 NA NA 3459 3459 Carrier F 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation 132 0.9394 21 61 11 121 NA NA 3460 3460 Carrier F 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64483 Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, single level 131 0.9389 16 46 14 117 NA NA 3461 3461 Carrier F 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 116 0.6638 13 40 8 108 NA NA 3462 3462 Carrier F 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 Colonoscopy, flexible; with biopsy, single or multiple 104 0.6923 17 36 7 97 NA NA 3463 3463 Carrier F 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter. 102 0.3627 29 76 31 71 NA NA 3464 3464 Carrier F 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 92250 Fundus photography with interpretation and report 91 0.967 10 70 20 71 NA NA 3465 3465 Carrier F 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft 91 0.8791 32 73 7 84 NA NA 3466 3466 Carrier F 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27447 Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) 83 0.9157 22 67 3 80 NA NA 3467 3467 Carrier F 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27096 Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed 50 1 18 37 5 45 NA NA 3468 3468 Carrier F 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29877 Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty) 14 1 14 80 2 12 NA NA 3469 3469 Carrier F 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 31276 Nasal/sinus endoscopy, surgical, with frontal sinus exploration, including removal of tissue from frontal sinus, when performed 13 1 15 65 3 10 NA NA 3470 3470 Carrier F 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77067 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed 12 1 81 0 12 NA NA 3471 3471 Carrier F 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC G0260 Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography 10 1 89 0 10 NA NA 3472 3472 Carrier F 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29824 Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure) 9 1 59 0 9 NA NA 3473 3473 Carrier F 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure) 8 1 24 98 1 7 NA NA 3474 3474 Carrier F 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 31287 Nasal/sinus endoscopy, surgical, with sphenoidotomy; 7 1 59 0 7 NA NA 3475 3475 Carrier F 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43242 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis) 7 1 25 75 2 5 NA NA 3476 3476 Carrier F 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63650 Percutaneous implantation of neurostimulator electrode array, epidural 7 1 83 0 7 NA NA 3477 3477 Carrier F 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27784 Open treatment of proximal fibula or shaft fracture, includes internal fixation, when performed 1 0 1 43 1 0 NA NA 3478 3478 Carrier F 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27759 Treatment of tibial shaft fracture (with or without fibular fracture) by intramedullary implant, with or without interlocking screws and/or cerclage 1 0 1 43 1 0 NA NA 3479 3479 Carrier F 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43254 Esophagogastroduodenoscopy, flexible, transoral; with endoscopic mucosal resection 1 0 1 52 0 1 NA NA 3480 3480 Carrier F 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64910 Nerve repair; with synthetic conduit or vein allograft (eg, nerve tube), each nerve 2 0 0.5 74 0 2 NA NA 3481 3481 Carrier F 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 67036 Vitrectomy, mechanical, pars plana approach; 2 0 0.5 24 119 1 1 NA NA 3482 3482 Carrier F 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 15877 Suction assisted lipectomy; trunk 4 0 0.25 97 0 4 NA NA 3483 3483 Carrier F 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 99245 Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded. 9 0 0.2222 20 100 7 2 NA NA 3484 3484 Carrier F 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 58563 Hysteroscopy, surgical; with endometrial ablation (eg, endometrial resection, electrosurgical ablation, thermoablation) 7 0 0.1429 85 0 7 NA NA 3485 3485 Carrier F 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 19350 Nipple/areola reconstruction 14 0 0.0714 101 0 14 NA NA 3486 3486 Carrier F 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 10-19 minutes of total time is spent on the date of the encounter. 22 0 0.0455 29 85 9 13 NA NA 3487 3487 Carrier F 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 128 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Rehabilitation 10 0.7 29 68 3 7 NA NA 3488 3488 Carrier F 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0017 Behavioral health; residential (hospital residential treatment program), without room and board, per diem 4 0.75 14 83 2 2 NA NA 3489 3489 Carrier F 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Psychiatric 2 0.5 69 112 1 1 NA NA 3490 3490 Carrier F 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0046 Mental health services, not otherwise specified 1 1 69 1 0 NA NA 3491 3491 Carrier F 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0018 Behavioral health; short-term residential (nonhospital residential treatment program), without room and board, per diem 1 1 24 0 1 NA NA 3492 3492 Carrier F 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0011 Alcohol and/or drug services; acute detoxification (residential addiction program inpatient) 1 1 26 0 1 NA NA 3493 3493 Carrier F 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0011 Alcohol and/or drug services; acute detoxification (residential addiction program inpatient) 1 1 26 0 1 NA NA 3494 3494 Carrier F 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0046 Mental health services, not otherwise specified 1 1 69 1 0 NA NA 3495 3495 Carrier F 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0018 Behavioral health; short-term residential (nonhospital residential treatment program), without room and board, per diem 1 1 24 0 1 NA NA 3496 3496 Carrier F 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0017 Behavioral health; residential (hospital residential treatment program), without room and board, per diem 4 0.75 14 83 2 2 NA NA 3497 3497 Carrier F 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 128 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Rehabilitation 10 0.7 29 68 3 7 NA NA 3498 3498 Carrier F 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Psychiatric 2 0.5 69 112 1 1 NA NA 3499 3499 Carrier F 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 Mental health partial hospitalization, treatment, less than 24 hours 143 0.8741 27 51 16 127 NA NA 3500 3500 Carrier F 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0015 Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education 56 0.6964 23 60 3 53 NA NA 3501 3501 Carrier F 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC S9480 Intensive outpatient psychiatric services, per diem 41 0.8293 18 51 6 35 NA NA 3502 3502 Carrier F 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan 32 0.8125 23 79 2 30 NA NA 3503 3503 Carrier F 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 30 0.7 18 65 7 23 NA NA 3504 3504 Carrier F 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97156 Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes 30 0.8333 23 76 2 28 NA NA 3505 3505 Carrier F 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 27 0.6296 15 59 5 22 NA NA 3506 3506 Carrier F 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC S0201 Partial hospitalization services, less than 24 hours, per diem 25 0.76 26 49 6 19 NA NA 3507 3507 Carrier F 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H2019 Therapeutic behavioral services, per 15 minutes 24 0.75 0 73 1 23 NA NA 3508 3508 Carrier F 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97153 Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes 23 0.8696 76 0 23 NA NA 3509 3509 Carrier F 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96132 Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour 4 1 46 0 4 NA NA 3510 3510 Carrier F 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96133 Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; each additional hour (List separately in addition to code for primary procedure) 3 1 43 0 3 NA NA 3511 3511 Carrier F 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 0373T Adaptive behavior treatment with protocol modification, each 15 minutes of technicians' time face-to-face with a patient, requiring the following components: administration by the physician or other qualified health care professional who is on site; with the assistance of two or more technicians; for a patient who exhibits destructive behavior; completion in an environment that is customized to the patient's behavior. 2 1 103 0 2 NA NA 3512 3512 Carrier F 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96137 Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; each additional 30 minutes (List separately in addition to code for primary procedure) 2 1 54 0 2 NA NA 3513 3513 Carrier F 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97154 Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with two or more patients, each 15 minutes 2 1 51 0 2 NA NA 3514 3514 Carrier F 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H2012 Behavioral health day treatment, per hour 2 1 22 0 2 NA NA 3515 3515 Carrier F 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90833 Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) 1 1 19 0 1 NA NA 3516 3516 Carrier F 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96116 Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; first hour 1 1 74 0 1 NA NA 3517 3517 Carrier F 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96138 Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes 1 1 74 0 1 NA NA 3518 3518 Carrier F 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96139 Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; each additional 30 minutes (List separately in addition to code for primary procedure) 1 1 74 0 1 NA NA 3519 3519 Carrier F 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with nondurable medical equipment interstitial continuous glucose monitoring system (CGM), one unit = 1 day supply 39 0.6667 93 0 39 NA NA 3520 3520 Carrier F 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9277 Transmitter; external, for use with nondurable medical equipment interstitial continuous glucose monitoring system (CGM) 29 0.7931 91 0 29 NA NA 3521 3521 Carrier F 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 Continuous positive airway pressure (CPAP) device 22 0.4091 74 0 22 NA NA 3522 3522 Carrier F 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A7000 Canister, disposable, used with suction pump, each 15 0.8667 13 102 2 13 NA NA 3523 3523 Carrier F 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2402 Negative pressure wound therapy electrical pump, stationary or portable 15 0.9333 13 102 2 13 NA NA 3524 3524 Carrier F 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A6550 Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories 14 0.9286 13 100 2 12 NA NA 3525 3525 Carrier F 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0108 Wheelchair component or accessory, not otherwise specified 9 0.5556 54 0 9 NA NA 3526 3526 Carrier F 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 External ambulatory infusion pump, insulin 9 0.8889 48 0 9 NA NA 3527 3527 Carrier F 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A7035 Headgear used with positive airway pressure device 8 0.125 71 0 8 NA NA 3528 3528 Carrier F 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L1852 Knee orthosis (KO), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf 8 0.875 21 50 1 7 NA NA 3529 3529 Carrier F 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S9342 Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem 7 1 1 93 1 6 NA NA 3530 3530 Carrier F 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L2820 Addition to lower extremity orthosis, soft interface for molded plastic, below knee section 6 1 90 0 6 NA NA 3531 3531 Carrier F 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC G0249 Provision of test materials and equipment for home INR monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include four tests 5 1 98 0 5 NA NA 3532 3532 Carrier F 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L0464 Thoracic-lumbar-sacral orthosis (TLSO), triplanar control, modular segmented spinal system, four rigid plastic shells, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment 5 1 4.3 52 1 4 NA NA 3533 3533 Carrier F 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L1833 Knee orthosis (KO), adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf 5 1 90 0 5 NA NA 3534 3534 Carrier F 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC V2624 Polishing/resurfacing of ocular prosthesis 5 1 87 0 5 NA NA 3535 3535 Carrier F 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1392 Portable oxygen concentrator, rental 4 1 13 70 2 2 NA NA 3536 3536 Carrier F 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L2330 Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only 4 1 82 0 4 NA NA 3537 3537 Carrier F 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC B4153 Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit 3 1 82 0 3 NA NA 3538 3538 Carrier F 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0748 Osteogenesis stimulator, electrical, noninvasive, spinal applications 3 1 97 0 3 NA NA 3539 3539 Carrier F 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L3913 Hand-finger orthosis (HFO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment 2 0 0.5 142 0 2 NA NA 3540 3540 Carrier F 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0240 Bath/shower chair, with or without wheels, any size 2 0 0.5 73 0 2 NA NA 3541 3541 Carrier F 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC B4153 Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit 3 0 0.3333 82 0 3 NA NA 3542 3542 Carrier F 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0667 Segmental pneumatic appliance for use with pneumatic compressor, full leg 4 0 0.25 0 112 2 2 NA NA 3543 3543 Carrier F 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0652 Pneumatic compressor, segmental home model with calibrated gradient pressure 4 0 0.25 0 112 2 2 NA NA 3544 3544 Carrier F 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC S9342 Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem 7 0 0.1429 1 93 1 6 NA NA 3545 3545 Carrier F 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year NA NA Test Strips 23 0.6086 9.2 24 3 20 NA NA 3546 3546 Carrier F 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA Test Strips 23 0.6086 9.2 24 3 20 NA NA 3547 3547 Carrier H 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 121 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Medical/Surgical/GYN 109 0.67 16.4 48.7 18 91 NA NA 3548 3548 Carrier H 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43644 Laparoscopy, Surg, Gastric Restrictive Procedure; W Gastric Bypass And Roux-En-Y Gastroent 61 0.75 24 40.1 1 60 NA NA 3549 3549 Carrier H 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 Total Abdominal Hysterectomy (Corpus And Cervix), With Or Without Removal Of Tube(S), With 49 0.69 28.8 45.2 7 42 NA NA 3550 3550 Carrier H 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43775 Laps Gstrc Rstrictiv Px Longitudinal Gastrectomy 47 0.94 47.5 0 47 NA NA 3551 3551 Carrier H 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22614 Arthrodesis, Posterior Or Posterolateral Technique, Single Interspace; Each Additional Int 42 0.86 12 66.2 2 40 NA NA 3552 3552 Carrier H 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22552 Arthrodesis, Anterior Interbody, Incl Disc Space Prep, Discectomy, Osteophytectomy & Decom 21 0.86 50.5 0 21 NA NA 3553 3553 Carrier H 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22634 Arthrodesis, Combined Posterior Or Posterolateral Technique With Posterior Interbody Techn 14 1 24 54.5 1 13 NA NA 3554 3554 Carrier H 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 19328 Removal Of Intact Breast Implant 14 0.07 24 0 14 NA NA 3555 3555 Carrier H 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22585 Arthrodesis, Anterior/-Lateral,Ea Add.In 14 0.64 64.8 0 14 NA NA 3556 3556 Carrier H 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43235 Esophagogastroduodenoscopy Flexible, Transoral; Diagnostic, Including Collection Of Specim 14 0.43 0 68 1 13 NA NA 3557 3557 Carrier H 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22634 Arthrodesis, Combined Posterior Or Posterolateral Technique With Posterior Interbody Techn 14 1 24 54.5 1 13 NA NA 3558 3558 Carrier H 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27130 Replacement Hip Total Simple 13 1 0 40 1 12 NA NA 3559 3559 Carrier H 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 75894 Transcatheter Therapy Embolize Any Meth 7 1 0 48 4 3 NA NA 3560 3560 Carrier H 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33340 Percutaneous Transcatheter Closure Of The Left Atrial Appendage With Endocardial Implant, 6 1 40 0 6 NA NA 3561 3561 Carrier H 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33361 Transcatheter Aortic Valve Replacement (Tavr/Tavi) With Prosthetic Valve; Percutaneous Fem 5 1 28.8 0 5 NA NA 3562 3562 Carrier H 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22633 Arthrodesis, Combined Posterior Or Posterolateral Technique Wi/ Posterior Interbody Techni 5 1 24 0 1 4 NA NA 3563 3563 Carrier H 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 42950 Pharyngoplasty 4 1 54 0 4 NA NA 3564 3564 Carrier H 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22632 Arthrodesis, Each Additional Interspace 4 1 54 0 4 NA NA 3565 3565 Carrier H 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 50365 Renal Homotxplnt,Implnt Gft;W/Recipnt Ne 3 1 8 0 3 NA NA 3566 3566 Carrier H 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43644 Laparoscopy, Surg, Gastric Restrictive Procedure; W Gastric Bypass And Roux-En-Y Gastroent 61 0 1 24 40.1 1 60 NA NA 3567 3567 Carrier H 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43775 Laps Gstrc Rstrictiv Px Longitudinal Gastrectomy 47 0 1 47.5 0 47 NA NA 3568 3568 Carrier H 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22634 Arthrodesis, Combined Posterior Or Posterolateral Technique With Posterior Interbody Techn 14 0 1 24 54.5 1 13 NA NA 3569 3569 Carrier H 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43235 Esophagogastroduodenoscopy Flexible, Transoral; Diagnostic, Including Collection Of Specim 14 0 1 0 68 1 13 NA NA 3570 3570 Carrier H 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43659 Unlisted Laparoscopy Procedure, Stomach 11 0 1 0 37.7 2 9 NA NA 3571 3571 Carrier H 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27447 Replacement Knee Total 10 0 1 45.3 0 10 NA NA 3572 3572 Carrier H 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43845 Gastric Restrictive Proc W/ Partial Gastrectomy, Pylorus-Preserving Duodenoileostomy & Ile 5 0 1 33.6 0 5 NA NA 3573 3573 Carrier H 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22632 Arthrodesis, Each Additional Interspace 4 0 1 54 0 4 NA NA 3574 3574 Carrier H 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 61736 Laser Interstitial Thermal Tx (Litt) Of Lesion, Intracranial, Incl Burr Hole(S), W/ Magnet 2 0 1 36 0 2 NA NA 3575 3575 Carrier H 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 Echo, Transthoracic W/Doppler, Complete 32093 0.97 2.4 3.8 20 32073 NA NA 3576 3576 Carrier H 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 Continuous Airway Pressure (Cpap) Device [May Be Used For Either Cpap Or Apap] 27168 0.97 1.7 0 27168 NA NA 3577 3577 Carrier H 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 Mri, Lower Extremity Any Joint; Wo Contr 25161 0.93 1.9 4.9 63 25098 NA NA 3578 3578 Carrier H 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74176 Ct Abd & Pelvis 24003 0.96 2.1 4.5 174 23829 NA NA 3579 3579 Carrier H 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT MSMPT Physical Therapy 21069 0.69 4 11 NA NA 3580 3580 Carrier H 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72148 Mri Of Lumbar Spine 18239 0.93 6.3 5.6 23 18216 NA NA 3581 3581 Carrier H 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 Mri Of Brain And Further Sequences 15547 0.97 1.7 3.6 28 15519 NA NA 3582 3582 Carrier H 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73221 Mri, Any Joint Of Upper Extremity; Wo Co 12303 0.92 4 5.8 18 12285 NA NA 3583 3583 Carrier H 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72141 Mri Of Cervical Spine 10691 0.93 2.4 5.9 10 10681 NA NA 3584 3584 Carrier H 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70551 Mri Of Brain 9509 0.96 2.5 5 19 9490 NA NA 3585 3585 Carrier H 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 74712 Mri Fetal Sngl/1St Gestation 107 1 0.7 0 107 NA NA 3586 3586 Carrier H 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70545 Mra, Head, W/Contrast 101 1 12 3.2 2 99 NA NA 3587 3587 Carrier H 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC J0585 Injection, Onabotulinumtoxin A, 1 Unit 49 1 0 0 49 NA NA 3588 3588 Carrier H 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 74261 Ct Colonography, Diag, W/O Dye 41 1 1.8 0 41 NA NA 3589 3589 Carrier H 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64615 Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial, Trigeminal, Cervical Spinal 34 1 0 0 34 NA NA 3590 3590 Carrier H 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 73206 Cta Upr Extrm W/Wo Contrast 31 1 3.9 0 31 NA NA 3591 3591 Carrier H 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72191 Cta, Pelvis W/O Cntrst Flwd Cntrst 27 1 0 0 27 NA NA 3592 3592 Carrier H 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81340 Trb@ Gene Rearrange Amplify 24 1 3 0 24 NA NA 3593 3593 Carrier H 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27447 Replacement Knee Total 229 0 1 4.8 34.9 5 224 NA NA 3594 3594 Carrier H 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27130 Replacement Hip Total Simple 191 0 1 0 32.5 6 185 NA NA 3595 3595 Carrier H 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 15771 Grafting Of Autologous Fat Harvested By Liposuction Technique To Trunk, Breasts, Scalp, Ar 71 0 1 35 0 71 NA NA 3596 3596 Carrier H 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 58570 Tlh, Uterus 250 G Or Less 69 0 1 24 43 3 66 NA NA 3597 3597 Carrier H 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 15772 Grafting Of Autologous Fat Harvested By Liposuction Technique To Trunk, Breasts, Scalp, Ar 42 0 1 31.8 0 42 NA NA 3598 3598 Carrier H 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 36465 Injection Of Non-Compounded Foam Sclerosant W/ Ultrasound Compression Maneuvers To Guide D 41 0 1 38 0 41 NA NA 3599 3599 Carrier H 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22551 Arthrodesis, Anterior Interbody, Including Disc Space Preparation, Discectomy, Osteophytec 38 0 1 0 72 2 36 NA NA 3600 3600 Carrier H 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43644 Laparoscopy, Surg, Gastric Restrictive Procedure; W Gastric Bypass And Roux-En-Y Gastroent 33 0 1 32 0 33 NA NA 3601 3601 Carrier H 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 37243 Vascular Embolzatn Or Occlusion Incl Of All Rad Sup & Int Intraprocedural Roadmapping & Im 32 0 1 3.4 39.3 7 25 NA NA 3602 3602 Carrier H 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 128 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Rehabilitation 11 0.18 20.7 63.4 5 6 NA NA 3603 3603 Carrier H 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0017 Behavioral health; residential (hospital residential treatment program), without room and board, per diem 2 0.5 24.2 0 2 NA NA 3604 3604 Carrier H 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0015 Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education 1 0 65.4 0 1 NA NA 3605 3605 Carrier H 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Psychiatric 1 0 41.7 1 0 NA NA 3606 3606 Carrier H 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 126 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Detoxification 1 0 65.4 0 1 NA NA 3607 3607 Carrier H 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0010 Alcohol And/Or Drug Services; Subacute Detoxification (Residential Addiction Program Inpat 1 0 0 0 1 NA NA 3608 3608 Carrier H 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0008 Alcohol And/Or Drug Services; Subacute Detoxification (Hospital Inpatient) 1 0 0 0 1 NA NA 3609 3609 Carrier H 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0011 Alcohol And/Or Drug Services; Acute Detoxification (Residential Addiction Program Inpatien 1 0 0 0 1 NA NA 3610 3610 Carrier H 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0017 Behavioral health; residential (hospital residential treatment program), without room and board, per diem 2 0.5 24.2 0 2 NA NA 3611 3611 Carrier H 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 128 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Rehabilitation 11 0.18 20.7 63.4 5 6 NA NA 3612 3612 Carrier H 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Psychiatric 1 0 41.7 1 0 NA NA 3613 3613 Carrier H 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 126 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Detoxification 1 0 65.4 0 1 NA NA 3614 3614 Carrier H 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0015 Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education 1 0 65.4 0 1 NA NA 3615 3615 Carrier H 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0010 Alcohol And/Or Drug Services; Subacute Detoxification (Residential Addiction Program Inpat 1 0 0 0 1 NA NA 3616 3616 Carrier H 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0008 Alcohol And/Or Drug Services; Subacute Detoxification (Hospital Inpatient) 1 0 0 0 1 NA NA 3617 3617 Carrier H 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0011 Alcohol And/Or Drug Services; Acute Detoxification (Residential Addiction Program Inpatien 1 0 0 0 1 NA NA 3618 3618 Carrier H 2022 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC H0017 Behavioral health; residential (hospital residential treatment program), without room and board, per diem 2 0 0.5 24.2 0 2 NA NA 3619 3619 Carrier H 2022 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 128 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Rehabilitation 11 0 0.18 20.7 63.4 5 6 NA NA 3620 3620 Carrier H 2022 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 124 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Psychiatric 1 0 0 41.7 1 0 NA NA 3621 3621 Carrier H 2022 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 126 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Detoxification 1 0 0 65.4 0 1 NA NA 3622 3622 Carrier H 2022 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC H0015 Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education 1 0 0 65.4 0 1 NA NA 3623 3623 Carrier H 2022 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC H0010 Alcohol And/Or Drug Services; Subacute Detoxification (Residential Addiction Program Inpat 1 0 0 0 0 1 NA NA 3624 3624 Carrier H 2022 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC H0008 Alcohol And/Or Drug Services; Subacute Detoxification (Hospital Inpatient) 1 0 0 0 0 1 NA NA 3625 3625 Carrier H 2022 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC H0011 Alcohol And/Or Drug Services; Acute Detoxification (Residential Addiction Program Inpatien 1 0 0 0 0 1 NA NA 3626 3626 Carrier H 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Therapeutic Repetitive Transcranial Magnetic Simulation (Tms) Treatment; Initial, Includin 258 0.87 6.9 54.5 10 248 NA NA 3627 3627 Carrier H 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 Therapeutic Repetitive Transcranial Magnetic Simulation (Tms) Treatment; Including Cortica 202 0.86 78 52.4 4 198 NA NA 3628 3628 Carrier H 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 Mental health partial hospitalization, treatment, less than 24 hours 176 0.8 33.5 43.9 11 165 NA NA 3629 3629 Carrier H 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 Therapeutic Repetitive Transcranial Magnetic Stimulation (Tms) Treatment; Subsequent Motor 174 0.83 56 59.8 8 166 NA NA 3630 3630 Carrier H 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan 93 0.7 32.4 58.3 14 79 NA NA 3631 3631 Carrier H 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97156 Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes 93 0.74 31.6 50.8 18 75 NA NA 3632 3632 Carrier H 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 92 0.73 16.5 53.8 11 81 NA NA 3633 3633 Carrier H 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97155 Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes 90 0.72 32.2 53.3 21 69 NA NA 3634 3634 Carrier H 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC S9480 Intensive outpatient psychiatric services, per diem 86 0.72 17.1 45.3 7 79 NA NA 3635 3635 Carrier H 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97153 Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes 79 0.72 32.4 51.2 18 61 NA NA 3636 3636 Carrier H 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97156 Family Adptve Bhvr Trtmnt Guidance, Admnstrd By Phys Or Other Qualified Hlth Care Profess 9 1 24 9 1 8 NA NA 3637 3637 Carrier H 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97153 Adaptive Behavior Treatment By Protocol, Admnstrd By Tech Under The Direction Of A Phys Or 9 1 24 9 1 8 NA NA 3638 3638 Carrier H 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97151 Behavior Identification Assessment, Administered By A Physician Or Other Qualified Health 8 1 12 0 8 NA NA 3639 3639 Carrier H 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97155 Adptve Bhvr Trtmnt W/ Protocol Modifictn, Admnstrd By Phys Or Other Qualified Hlth Care Pr 8 1 24 10.3 1 7 NA NA 3640 3640 Carrier H 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S9480 Intensive Outpatient Psychiatric Services Per Diem 7 1 0 33 1 6 NA NA 3641 3641 Carrier H 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0035 Mental Health Partial Hospitalization, Treatment, Less Than 24 Hours 6 1 28 0 6 NA NA 3642 3642 Carrier H 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90870 Electroconvulsive Therapy;1 Seizure 2 1 0 0 2 NA NA 3643 3643 Carrier H 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H2014 Skills Training And Development Per 15 Minutes 1 1 24 0 1 NA NA 3644 3644 Carrier H 2022 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90868 Therapeutic Repetitive Transcranial Magnetic Simulation (Tms) Treatment; Initial, Includin 258 0 1 6.9 54.5 10 248 NA NA 3645 3645 Carrier H 2022 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90867 Therapeutic Repetitive Transcranial Magnetic Simulation (Tms) Treatment; Including Cortica 202 0 1 78 52.4 4 198 NA NA 3646 3646 Carrier H 2022 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90869 Therapeutic Repetitive Transcranial Magnetic Stimulation (Tms) Treatment; Subsequent Motor 174 0 1 56 59.8 8 166 NA NA 3647 3647 Carrier H 2022 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC G2083 Office Or Other Outpatient Visit For The Evaluation And Management Of An Established Patie 44 0 1 74.4 45 11 33 NA NA 3648 3648 Carrier H 2022 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC G2082 Office Or Other Outpatient Visit For The Evaluation And Management Of An Established Patie 31 0 1 82.7 45.2 10 21 NA NA 3649 3649 Carrier H 2022 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC J3490 Unclassified drugs 3 0 0.33 26.4 121.9 2 1 NA NA 3650 3650 Carrier H 2022 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97151 Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan 93 0 0.02 32.4 58.3 14 79 NA NA 3651 3651 Carrier H 2022 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97153 Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes 79 0 0.01 32.4 51.2 18 61 NA NA 3652 3652 Carrier H 2022 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97155 Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes 90 0 0.01 32.2 53.3 21 69 NA NA 3653 3653 Carrier H 2022 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97156 Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes 93 0 0.01 31.6 50.8 18 75 NA NA 3654 3654 Carrier H 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0486 Adjustable, Custom Fabricated, Includes Fitting And Adjustment 208 0.95 7.7 0 1329 NA NA 3655 3655 Carrier H 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0108 Wheelchair Component Or Accessory, Not Otherwise Specified 99 0.8 43 0 99 NA NA 3656 3656 Carrier H 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC S1040 Cranial Remolding Orthosis, Rigid, With Soft Interface Material, Custom Fabricated, Includ 71 0.94 0 56.9 2 69 NA NA 3657 3657 Carrier H 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L8680 Implantable Neurostimulator Electrode Each 48 0.92 24 105.4 1 47 NA NA 3658 3658 Carrier H 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0652 Pneumatic Compressor, Segmental Home Model With Calibrated Gradient Pr 41 0.8 0 62.4 1 40 NA NA 3659 3659 Carrier H 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0748 Osteogenic Stimulator, Noninvasive, Spinal Applications 36 0.36 24 87.2 1 35 NA NA 3660 3660 Carrier H 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0747 Osteogenesis Stimulator (Non-Invasive) 32 0.25 48 88.6 3 29 NA NA 3661 3661 Carrier H 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L2755 Addition To Lower Extremity Orthosis Carbon Graphite Lamination 27 0.89 24 36 1 26 NA NA 3662 3662 Carrier H 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0606 Aed Garment With Electrocardiogram Analysis 26 0.58 21.8 72 24 2 NA NA 3663 3663 Carrier H 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L8688 Implt Nrostm Pls Gen Dua Non 23 0.87 109.4 0 23 NA NA 3664 3664 Carrier H 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8691 Auditory Osseointegrated Device, External Sound Processor, Excludes Transducer/Actuator, R 9 1 97.7 0 9 NA NA 3665 3665 Carrier H 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8694 Auditory Osseointegrated Device, Transducer/Actuator, Replacement Only, Each 8 1 61.7 0 8 NA NA 3666 3666 Carrier H 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0955 Wheelchair Accessory, Headrest, Cushioned, Prefabricated, Including Fixed Mounting Hardwar 6 1 67.2 0 6 NA NA 3667 3667 Carrier H 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A6549 Gradient compression stocking/sleeve, not otherwise specified 5 1 60.4 0 5 NA NA 3668 3668 Carrier H 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with nondurable medical equipment interstitial continuous glucose monitoring system (CGM), one unit = 1 day supply 4 1 32.8 169.5 3 1 NA NA 3669 3669 Carrier H 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0277 Alternating Pressure Mattress 4 1 0 48 1 3 NA NA 3670 3670 Carrier H 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1233 Wheelchair, Pediatric Size, Tilt-In-Space, Rigid, Adj, Wo Seating 3 1 24 0 3 NA NA 3671 3671 Carrier H 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0265 Hospital Bed, Total Electric (Head, Foot And Height Adjustments), With Any Type Side Rails 3 1 56 0 3 NA NA 3672 3672 Carrier H 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8687 Implt Nrostm Pls Gen Dua Rec 3 1 108 0 3 NA NA 3673 3673 Carrier H 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8681 Pt Prgrm For Implt Neurostim 3 1 156 0 3 NA NA 3674 3674 Carrier H 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0486 Adjustable, Custom Fabricated, Includes Fitting And Adjustment 208 0 1 7.7 0 1329 NA NA 3675 3675 Carrier H 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L8680 Implantable Neurostimulator Electrode Each 48 0 1 24 105.4 1 47 NA NA 3676 3676 Carrier H 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0748 Osteogenic Stimulator, Noninvasive, Spinal Applications 36 0 1 24 87.2 1 35 NA NA 3677 3677 Carrier H 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC K0005 Ultralightweight Wheelchair 22 0 1 58.7 0 22 NA NA 3678 3678 Carrier H 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L8614 Cochlear Device/System 14 0 1 112 0 14 NA NA 3679 3679 Carrier H 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L8691 Auditory Osseointegrated Device, External Sound Processor, Excludes Transducer/Actuator, R 9 0 1 97.7 0 9 NA NA 3680 3680 Carrier H 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L8694 Auditory Osseointegrated Device, Transducer/Actuator, Replacement Only, Each 8 0 1 61.7 0 8 NA NA 3681 3681 Carrier H 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0986 Manual Wheelchair Accessory, Push-Rim Activated Power Assist, Each 4 0 1 72 0 4 NA NA 3682 3682 Carrier H 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0277 Alternating Pressure Mattress 4 0 1 0 48 1 3 NA NA 3683 3683 Carrier H 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L1844 Ko, Single Upright, Thigh And Calf, With Adjustable Flexion And Extens 3 0 1 80 0 3 NA NA 3684 3684 Carrier H 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year NA NA Test Strips 107 0.62 9 31.2 29 78 NA NA 3685 3685 Carrier H 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA Test Strips 107 0.62 9 31.2 29 78 NA NA 3686 3686 Carrier N 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 47379 UNLISTED LAPS PX LIVER 2 0.5 0 60 0 0 2 0 NA NA 3687 3687 Carrier N 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44204 LAPARO PARTIAL COLECTOMY 2 1 0 0 0 0 2 0 NA NA 3688 3688 Carrier N 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 33405 REPLACEMENT AORTIC VALVE OPN 2 1 72 24 0 1 1 0 NA NA 3689 3689 Carrier N 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 TOTAL HYSTERECTOMY 1 1 0 0 0 0 1 0 NA NA 3690 3690 Carrier N 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 21705 REVISION OF NECK MUSCLE/RIB 1 0 0 120 0 0 1 0 NA NA 3691 3691 Carrier N 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 33464 VALVULOPLASTY TRICUSPID 1 1 0 0 0 0 1 0 NA NA 3692 3692 Carrier N 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 21175 RECONSTRUCT ORBIT/FOREHEAD 1 1 0 0 0 0 1 0 NA NA 3693 3693 Carrier N 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 32662 THORACOSCOPY W/MEDIAST EXC 1 1 0 0 0 0 1 0 NA NA 3694 3694 Carrier N 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44205 LAP COLECTOMY PART W/ILEUM 1 1 0 0 0 0 1 0 NA NA 3695 3695 Carrier N 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22633 ARTHRD CMBN 1NTRSPC LUMBAR 1 0 0 312 0 0 1 0 NA NA 3696 3696 Carrier N 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44204 LAPARO PARTIAL COLECTOMY 2 1 0 0 0 0 2 0 NA NA 3697 3697 Carrier N 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33405 REPLACEMENT AORTIC VALVE OPN 2 1 72 24 0 1 1 0 NA NA 3698 3698 Carrier N 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58150 TOTAL HYSTERECTOMY 1 1 0 0 0 0 1 0 NA NA 3699 3699 Carrier N 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33464 VALVULOPLASTY TRICUSPID 1 1 0 0 0 0 1 0 NA NA 3700 3700 Carrier N 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 21175 RECONSTRUCT ORBIT/FOREHEAD 1 1 0 0 0 0 1 0 NA NA 3701 3701 Carrier N 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 32662 THORACOSCOPY W/MEDIAST EXC 1 1 0 0 0 0 1 0 NA NA 3702 3702 Carrier N 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44205 LAP COLECTOMY PART W/ILEUM 1 1 0 0 0 0 1 0 NA NA 3703 3703 Carrier N 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 38240 TRANSPLT ALLO HCT/DONOR 1 1 0 0 0 1 0 0 NA NA 3704 3704 Carrier N 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 37215 TRANSCATH STENT CCA W/EPS 1 1 0 24 0 0 1 0 NA NA 3705 3705 Carrier N 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43659 UNLISTED LAPS PX STOMACH 1 1 0 24 0 0 1 0 NA NA 3706 3706 Carrier N 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 92507 SPEECH/HEARING THERAPY 33 1 0 133.1 0 0 33 0 NA NA 3707 3707 Carrier N 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95810 POLYSOM 6/> YRS 4/> PARAM 31 0.839 0 151 0 0 31 0 NA NA 3708 3708 Carrier N 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT J0585 INJECTION,ONABOTULINUMTOXINA 28 0.821 72 419.5 0 3 25 0 NA NA 3709 3709 Carrier N 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64615 CHEMODENERV MUSC MIGRAINE 16 0.938 96 56.6 0 2 14 0 NA NA 3710 3710 Carrier N 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95811 POLYSOM 6/>YRS CPAP 4/> PARM 14 0.786 0 222.9 0 0 14 0 NA NA 3711 3711 Carrier N 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 36471 NJX SCLRSNT MLT INCMPTNT VN 14 0.857 0 330.9 0 0 14 0 NA NA 3712 3712 Carrier N 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 OFFICE O/P EST MOD 30-39 MIN 13 0.615 0 127.4 0 0 13 0 NA NA 3713 3713 Carrier N 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT Q5103 INJECTION, INFLECTRA 12 0.833 12 57.6 0 2 10 0 NA NA 3714 3714 Carrier N 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 36475 ENDOVENOUS RF 1ST VEIN 12 0.917 0 666 0 0 12 0 NA NA 3715 3715 Carrier N 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT J0178 AFLIBERCEPT INJECTION 10 0.9 0 31.2 0 0 10 0 NA NA 3716 3716 Carrier N 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 92507 SPEECH/HEARING THERAPY 33 1 0 133.1 0 0 33 0 NA NA 3717 3717 Carrier N 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95810 POLYSOM 6/> YRS 4/> PARAM 26 0.839 0 98.8 0 0 26 0 NA NA 3718 3718 Carrier N 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J0585 INJECTION,ONABOTULINUMTOXINA 23 0.821 96 468.6 0 2 21 0 NA NA 3719 3719 Carrier N 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64615 CHEMODENERV MUSC MIGRAINE 15 0.938 96 60.9 0 2 13 0 NA NA 3720 3720 Carrier N 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 36471 NJX SCLRSNT MLT INCMPTNT VN 12 0.857 0 368 0 0 12 0 NA NA 3721 3721 Carrier N 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 36475 ENDOVENOUS RF 1ST VEIN 11 0.917 0 717.8 0 0 11 0 NA NA 3722 3722 Carrier N 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95811 POLYSOM 6/>YRS CPAP 4/> PARM 11 0.786 0 117.8 0 0 11 0 NA NA 3723 3723 Carrier N 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J9299 INJECTION, NIVOLUMAB 10 1 0 962.7 0 1 9 0 NA NA 3724 3724 Carrier N 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81162 BRCA1&2 GEN FULL SEQ DUP/DEL 10 1 0 60 0 0 10 0 NA NA 3725 3725 Carrier N 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT Q5103 INJECTION, INFLECTRA 10 0.833 12 39 0 2 8 0 NA NA 3726 3726 Carrier N 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 89356 Reproductive Medicine 1 0 1 0 480 0 0 1 0 NA NA 3727 3727 Carrier N 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21139 Head, Repair, Revision, and/or Reconstruction 1 0 1 0 384 0 0 1 0 NA NA 3728 3728 Carrier N 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43239 Surgery Digestive System 1 0 1 0 912 0 0 1 0 NA NA 3729 3729 Carrier N 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22842 Posterior segmental instrumentation 1 0 1 24 0 0 1 0 0 NA NA 3730 3730 Carrier N 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27096 Injection procedure for sacroiliac joint 1 0 1 48 0 0 1 0 0 NA NA 3731 3731 Carrier N 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year NA NA Substance Use Residential 2 1 12 2 NA NA 3732 3732 Carrier N 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year NA NA Detox 1 1 12 1 NA NA 3733 3733 Carrier N 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA Substance Use Residential 2 1 12 2 NA NA 3734 3734 Carrier N 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA Detox 1 1 12 1 NA NA 3735 3735 Carrier N 2022 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NA NA MH IP 1 0 1 24 0 0 1 0 0 NA NA 3736 3736 Carrier N 2022 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NA NA MH RES 1 0 1 72 0 0 1 0 0 NA NA 3737 3737 Carrier N 2022 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NA NA CD RES 1 0 1 48 0 0 1 0 0 NA NA 3738 3738 Carrier N 2022 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NA NA SA RES 1 0 1 24 0 0 1 0 0 NA NA 3739 3739 Carrier N 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 TCRANIAL MAGN STIM TX DELI 5 0.6 64.12 5 NA NA 3740 3740 Carrier N 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97155 ADAPT BEHAVIOR TX PHYS/QHP 2 0.5 36.23 2 NA NA 3741 3741 Carrier N 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYTX W PT 60 MINUTES 1 1 12 1 NA NA 3742 3742 Carrier N 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT H0015 ALCOHOL AND/OR DRUG SERVICES 1 1 135.9 1 NA NA 3743 3743 Carrier N 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 BHV ID ASSMT BY PHYS/QHP 1 1 126.15 1 NA NA 3744 3744 Carrier N 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT S0201 PARTIAL HOSPITALIZATION SERV 1 1 12 1 NA NA 3745 3745 Carrier N 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT H0035 MH PARTIAL HOSP TX UNDER 24H 1 1 98.28 1 NA NA 3746 3746 Carrier N 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90868 TCRANIAL MAGN STIM TX DELI 3 0.6 36.16 3 NA NA 3747 3747 Carrier N 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90837 PSYTX W PT 60 MINUTES 1 1 12 1 NA NA 3748 3748 Carrier N 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97155 ADAPT BEHAVIOR TX PHYS/QHP 1 0.5 72.15 1 NA NA 3749 3749 Carrier N 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT H0015 ALCOHOL AND/OR DRUG SERVICES 1 1 135.9 1 NA NA 3750 3750 Carrier N 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97151 BHV ID ASSMT BY PHYS/QHP 1 1 126.15 1 NA NA 3751 3751 Carrier N 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT S0201 PARTIAL HOSPITALIZATION SERV 1 1 12 1 NA NA 3752 3752 Carrier N 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT H0035 MH PARTIAL HOSP TX UNDER 24H 1 1 98.28 1 NA NA 3753 3753 Carrier N 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97151 ABA 1 0 1 0 192 0 0 1 0 NA NA 3754 3754 Carrier N 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97155 MH OIF 1 0 1 0 144 0 0 1 0 NA NA 3755 3755 Carrier N 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0784 EXT AMB INFUSN PUMP INSULIN 5 1 0 5 0 0 0 0 NA NA 3756 3756 Carrier N 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0466 HOME VENT NON-INVASIVE INTER 3 1 0 3 0 0 0 0 NA NA 3757 3757 Carrier N 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0760 OSTEOGEN ULTRASOUND STIMLTOR 2 0.667 0 2 0 0 0 0 NA NA 3758 3758 Carrier N 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L8688 IMPLT NROSTM PLS GEN DUA NON 1 1 0 1 0 0 0 0 NA NA 3759 3759 Carrier N 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E2599 SGD ACCESSORY NOC 1 1 0 1 0 0 0 0 NA NA 3760 3760 Carrier N 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E2510 SGD W MULTI METHODS MSG/ACCS 1 1 0 1 0 0 0 0 NA NA 3761 3761 Carrier N 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0766 ELEC STIM CANCER TREATMENT 1 1 0 1 0 0 0 0 NA NA 3762 3762 Carrier N 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L8680 IMPLT NEUROSTIM ELCTR EACH 1 1 0 1 0 0 0 0 NA NA 3763 3763 Carrier N 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0784 EXT AMB INFUSN PUMP INSULIN 5 1 0 5 0 0 0 0 NA NA 3764 3764 Carrier N 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0466 HOME VENT NON-INVASIVE INTER 3 1 0 3 0 0 0 0 NA NA 3765 3765 Carrier N 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0760 OSTEOGEN ULTRASOUND STIMLTOR 2 0.667 0 2 0 0 0 0 NA NA 3766 3766 Carrier N 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L8688 IMPLT NROSTM PLS GEN DUA NON 1 1 0 1 0 0 0 0 NA NA 3767 3767 Carrier N 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E2599 SGD ACCESSORY NOC 1 1 0 1 0 0 0 0 NA NA 3768 3768 Carrier N 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E2510 SGD W MULTI METHODS MSG/ACCS 1 1 0 1 0 0 0 0 NA NA 3769 3769 Carrier N 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0766 ELEC STIM CANCER TREATMENT 1 1 0 1 0 0 0 0 NA NA 3770 3770 Carrier N 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L8680 IMPLT NEUROSTIM ELCTR EACH 1 1 0 1 0 0 0 0 NA NA 3771 3771 Carrier N 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 92 0.6 17.31 56.4 0 16 76 0 OZEMPIC 0.25 OR .5 PEN INJCTR NA 3772 3772 Carrier N 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 55 0.89 0.09 90.64 0 10 45 0 OZEMPIC 1/0.75 (3) PEN INJCTR NA 3773 3773 Carrier N 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 42 0.81 31.57 59.6 0 14 28 0 NURTEC ODT 75 MG TAB RAPDIS NA 3774 3774 Carrier N 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 35 1 0.21 0.13 0 19 16 0 ELIQUIS 5 MG TABLET NA 3775 3775 Carrier N 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 33 0.85 3.07 155.83 0 9 24 0 DEXCOM G6 EACH/DEXCOM G6 SENSOR EACH NA 3776 3776 Carrier N 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 33 0.82 0.02 29.31 0 10 23 0 TRULICITY 0.75MG/0.5 PEN INJCTR NA 3777 3777 Carrier N 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 29 0.86 3.94 138.34 0 13 16 0 STELARA 90 MG/ML SYRINGE NA 3778 3778 Carrier N 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 27 0.3 45.99 122.41 0 8 19 0 DESCOVY 200MG-25MG TABLET NA 3779 3779 Carrier N 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 26 1 0.54 11.37 0 5 21 0 HUMIRA(CF) PEN 40MG/0.4ML PEN IJ KIT NA 3780 3780 Carrier N 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 24 0.79 2.8 151.7 0 4 20 0 DEXCOM G6 EACH/DEXCOM G6 TRANSMITTER EACH NA 3781 3781 Carrier N 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 26 1 0.54 11.37 0 5 21 0 HUMIRA(CF) PEN 40MG/0.4ML PEN IJ KIT NA 3782 3782 Carrier N 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 21 1 0.01 1.29 0 4 17 0 TRULICITY 1.5 MG/0.5 PEN INJCTR NA 3783 3783 Carrier N 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 18 1 16.37 19.69 0 4 14 0 DEXTROAMPHETAMINE-AMPHET ER 20 MG CAP.SR 24H NA 3784 3784 Carrier N 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 16 1 0.02 42.93 0 3 13 0 ENBREL SURECLICK 50MG/ML(1) PEN INJCTR NA 3785 3785 Carrier N 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 14 1 1.28 43.49 0 2 12 0 STELARA 45MG/0.5ML SYRINGE NA 3786 3786 Carrier N 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 14 1 0.01 12.06 0 2 12 0 TRULICITY 3 MG/0.5ML PEN INJCTR NA 3787 3787 Carrier N 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 13 1 0.01 0.01 0 4 9 0 DEXTROAMPHETAMINE-AMPHETAMINE 10 MG TABLET NA 3788 3788 Carrier N 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 12 1 3.06 25.09 0 9 3 0 MENOPUR 75 UNIT VIAL NA 3789 3789 Carrier N 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 11 1 0.1 33.04 0 1 10 0 SKYRIZI PEN 150 MG/ML PEN INJCTR NA 3790 3790 Carrier N 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 10 1 0 47.31 0 0 10 0 OTEZLA 30 MG TABLET NA 3791 3791 Carrier E 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99223 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES 4 1 23.7 18.7 1 3 NA NA 3792 3792 Carrier E 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 367 OPERATING ROOM SERVICES, KIDNEY TRANSPLANT 4 1 46.6 4 NA NA 3793 3793 Carrier E 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99221 1ST HOSPITAL IP/OBS CARE SF/LOW MDM 40 MINUTES 2 1 45.4 2 NA NA 3794 3794 Carrier E 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 71046 RADIOLOGIC EXAM CHEST 2 VIEWS 2 1 66 2 NA NA 3795 3795 Carrier E 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 23586 REFERRAL REHAB, ACUTE 2 1 0 2 NA NA 3796 3796 Carrier E 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 333 RADIOLOGY, THERAPEUTIC AND/OR CHEMO ADMIN - RADIATION THERAPY 2 1 70.2 2 NA NA 3797 3797 Carrier E 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 150 ROOM & BOARD, WARD - GENERAL 2 1 2.9 50.6 1 1 NA NA 3798 3798 Carrier E 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC S4042 MANAGEMENT OF OVULATION INDUCTION PER CYCLE 1 1 97.8 1 NA NA 3799 3799 Carrier E 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC D0501 HISTOPATHOLOGIC EXAMINATIONS 1 1 0 1 NA NA 3800 3800 Carrier E 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC C1901 C1901GUILLIAN BARRE WITH MOTOR >35.95.,COMORBIDITY IN TIER 2 1 1 0 1 NA NA 3801 3801 Carrier E 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99223 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES 4 1 23.7 18.7 1 3 NA NA 3802 3802 Carrier E 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 367 OPERATING ROOM SERVICES, KIDNEY TRANSPLANT 4 1 46.6 4 NA NA 3803 3803 Carrier E 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99221 1ST HOSPITAL IP/OBS CARE SF/LOW MDM 40 MINUTES 2 1 45.4 2 NA NA 3804 3804 Carrier E 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 71046 RADIOLOGIC EXAM CHEST 2 VIEWS 2 1 66 2 NA NA 3805 3805 Carrier E 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 23586 REFERRAL REHAB, ACUTE 2 1 0 2 NA NA 3806 3806 Carrier E 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 333 RADIOLOGY, THERAPEUTIC AND/OR CHEMO ADMIN - RADIATION THERAPY 2 1 70.2 2 NA NA 3807 3807 Carrier E 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 150 ROOM & BOARD, WARD - GENERAL 2 1 2.9 50.6 1 1 NA NA 3808 3808 Carrier E 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC D0501 HISTOPATHOLOGIC EXAMINATIONS 1 1 0 1 NA NA 3809 3809 Carrier E 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC C1901 C1901GUILLIAN BARRE WITH MOTOR >35.95.,COMORBIDITY IN TIER 2 1 1 0 1 NA NA 3810 3810 Carrier E 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC C0305 C0305NON-TRAUMATIC BRAIN INJURY M <42.50 AND A <78.50.COMORBIDITY IN TIER 2 1 1 0.1 1 NA NA 3811 3811 Carrier E 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99203 OFFICE/OUTPATIENT NEW LOW MDM 30-44 MINUTES 408 0.9951 4.3 35.7 26 382 NA NA 3812 3812 Carrier E 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97161 PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS 273 0.9634 7.5 36.4 13 260 NA NA 3813 3813 Carrier E 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96040 MEDICAL GENETICS COUNSELING EACH 30 MINUTES 166 1 0.5 21.1 115.8 3 162 1 NA NA 3814 3814 Carrier E 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ 114 1 30.7 114 NA NA 3815 3815 Carrier E 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72148 MRI LUMBAR SPINE NO CONTRAST 107 1 10.7 30.6 39 68 NA NA 3816 3816 Carrier E 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99204 OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES 93 1 8.3 45.1 2 91 NA NA 3817 3817 Carrier E 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99213 OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN 81 0.9753 26.7 38.2 3 78 NA NA 3818 3818 Carrier E 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0151 SERVICE PHYS THERAP HOME HLTH/HOSPICE EA 15 MIN 76 1 3 76 NA NA 3819 3819 Carrier E 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 MRI BRAIN WO/W CONTRAST 74 1 7.9 24.3 22 52 NA NA 3820 3820 Carrier E 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97810 ACUPUNCTURE 1/> NDLES W/O ELEC STIMJ INIT 15 MIN 72 0.8194 57.6 72 NA NA 3821 3821 Carrier E 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96040 MEDICAL GENETICS COUNSELING EACH 30 MINUTES 166 1 0.5 21.1 115.8 3 162 1 NA NA 3822 3822 Carrier E 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ 114 1 30.7 114 NA NA 3823 3823 Carrier E 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72148 MRI LUMBAR SPINE NO CONTRAST 107 1 10.7 30.6 39 68 NA NA 3824 3824 Carrier E 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99204 OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES 93 1 8.3 45.1 2 91 NA NA 3825 3825 Carrier E 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC G0151 SERVICE PHYS THERAP HOME HLTH/HOSPICE EA 15 MIN 76 1 3 76 NA NA 3826 3826 Carrier E 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70553 MRI BRAIN WO/W CONTRAST 74 1 7.9 24.3 22 52 NA NA 3827 3827 Carrier E 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 73721 MRI RIGHT KNEE NO CONTRAST 72 1 6 22.3 41 31 NA NA 3828 3828 Carrier E 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 45378 COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD 66 1 3.8 36.6 1 65 NA NA 3829 3829 Carrier E 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 73721 MRI LEFT KNEE NO CONTRAST 64 1 11.1 19.7 41 23 NA NA 3830 3830 Carrier E 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97162 PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS 55 1 10 42.6 2 53 NA NA 3831 3831 Carrier E 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97810 ACUPUNCTURE 1/> NDLES W/O ELEC STIMJ INIT 15 MIN 72 0 0.0139 57.6 72 NA NA 3832 3832 Carrier E 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 93306 ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D 16 0 0.0625 25 59.5 1 15 NA NA 3833 3833 Carrier E 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 72148 MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL 9 0 0.1111 1.1 61.9 1 8 NA NA 3834 3834 Carrier E 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC Q5103 INJECTION, INFLIXIMAB-DYYB, BIOSIMILAR, (INFLECTRA), 10 MG 6 0 0.1667 45.6 49.7 1 5 NA NA 3835 3835 Carrier E 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 23683 EXT REFERRAL OBGYN 5 0 0.2 69 5 NA NA 3836 3836 Carrier E 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 ROOM & BOARD, SEMIPRIVATE TWO-BED - PSYCHIATRIC 41 1 15.7 26 39 2 NA NA 3837 3837 Carrier E 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1002 BEHAVIORAL HEALTH ACCOMMODATIONS, RESIDENTIAL TREATMENT, CHEM DEP 32 1 42.5 12.8 30 2 NA NA 3838 3838 Carrier E 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 126 ROOM & BOARD, SEMIPRIVATE TWO-BED - DETOXIFICATION 20 1 23.6 38 3.4 1 18 1 NA NA 3839 3839 Carrier E 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 194 SUBACUTE CARE, LEVEL IV 12 1 46.4 12 NA NA 3840 3840 Carrier E 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1001 BEHAVIORAL HEALTH ACCOMMODATIONS, RESIDENTIAL TREATMENT, PSYCHIATRIC 10 1 32.6 10 NA NA 3841 3841 Carrier E 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 154 ROOM & BOARD, WARD - PSYCHIATRIC 2 1 24.2 2 NA NA 3842 3842 Carrier E 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 99223 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES 1 1 0.5 1 NA NA 3843 3843 Carrier E 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 99220 INITIAL OBSERVATION CARE/DAY 70 MINUTES 1 1 95.9 1 NA NA 3844 3844 Carrier E 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 912 BEHAVIORAL HEALTH TREATMENTS/SVCS, PARTIAL HOSPITAL - LESS INTENSIVE 1 1 0.2 1 NA NA 3845 3845 Carrier E 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 128 ROOM & BOARD, SEMIPRIVATE TWO-BED - REHABILITATION 1 1 50.1 1 NA NA 3846 3846 Carrier E 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 ROOM & BOARD, SEMIPRIVATE TWO-BED - PSYCHIATRIC 41 1 15.7 26 39 2 NA NA 3847 3847 Carrier E 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1002 BEHAVIORAL HEALTH ACCOMMODATIONS, RESIDENTIAL TREATMENT, CHEM DEP 32 1 42.5 12.8 30 2 NA NA 3848 3848 Carrier E 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 126 ROOM & BOARD, SEMIPRIVATE TWO-BED - DETOXIFICATION 20 1 23.6 38 3.4 1 18 1 NA NA 3849 3849 Carrier E 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 194 SUBACUTE CARE, LEVEL IV 12 1 46.4 12 NA NA 3850 3850 Carrier E 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1001 BEHAVIORAL HEALTH ACCOMMODATIONS, RESIDENTIAL TREATMENT, PSYCHIATRIC 10 1 32.6 10 NA NA 3851 3851 Carrier E 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 154 ROOM & BOARD, WARD - PSYCHIATRIC 2 1 24.2 2 NA NA 3852 3852 Carrier E 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99223 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES 1 1 0.5 1 NA NA 3853 3853 Carrier E 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99220 INITIAL OBSERVATION CARE/DAY 70 MINUTES 1 1 95.9 1 NA NA 3854 3854 Carrier E 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 912 BEHAVIORAL HEALTH TREATMENTS/SVCS, PARTIAL HOSPITAL - LESS INTENSIVE 1 1 0.2 1 NA NA 3855 3855 Carrier E 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 128 ROOM & BOARD, SEMIPRIVATE TWO-BED - REHABILITATION 1 1 50.1 1 NA NA 3856 3856 Carrier E 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION 522 0.9904 41 522 NA NA 3857 3857 Carrier E 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES 106 1 44.9 106 NA NA 3858 3858 Carrier E 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97153 ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN 56 1 50.2 56 NA NA 3859 3859 Carrier E 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90899 UNLISTED PSYCHIATRIC SERVICE/PROCEDURE 23 1 15.7 83.9 20 3 NA NA 3860 3860 Carrier E 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0020 ALCOHOL AND/OR DRUG SERVICES METHADONE ADMINISTRATION 18 1 27.5 20.1 17 1 NA NA 3861 3861 Carrier E 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0001 ALCOHOL AND/OR DRUG ASSESS 17 1 48.5 38.7 16 1 NA NA 3862 3862 Carrier E 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN 15 1 14.2 15 NA NA 3863 3863 Carrier E 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90834 PSYCHOTHERAPY W/PATIENT 45 MINUTES 13 1 51.2 13 NA NA 3864 3864 Carrier E 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 905 BEHAVIORAL HEALTH TREATMENTS/SVCS, INTENSIVE OP, PSYCHIATRIC 13 1 26.4 13 NA NA 3865 3865 Carrier E 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97152 BEHAVIOR ID SUPPORT ASSMT BY 1 TECH EA 15 MIN 11 1 37.5 11 NA NA 3866 3866 Carrier E 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES 106 1 44.9 106 NA NA 3867 3867 Carrier E 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97153 ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN 56 1 50.2 56 NA NA 3868 3868 Carrier E 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90899 UNLISTED PSYCHIATRIC SERVICE/PROCEDURE 23 1 15.7 83.9 20 3 NA NA 3869 3869 Carrier E 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0020 ALCOHOL AND/OR DRUG SERVICES METHADONE ADMINISTRATION 18 1 27.5 20.1 17 1 NA NA 3870 3870 Carrier E 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0001 ALCOHOL AND/OR DRUG ASSESS 17 1 48.5 38.7 16 1 NA NA 3871 3871 Carrier E 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97151 BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN 15 1 14.2 15 NA NA 3872 3872 Carrier E 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90834 PSYCHOTHERAPY W/PATIENT 45 MINUTES 13 1 51.2 13 NA NA 3873 3873 Carrier E 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 905 BEHAVIORAL HEALTH TREATMENTS/SVCS, INTENSIVE OP, PSYCHIATRIC 13 1 26.4 13 NA NA 3874 3874 Carrier E 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97152 BEHAVIOR ID SUPPORT ASSMT BY 1 TECH EA 15 MIN 11 1 37.5 11 NA NA 3875 3875 Carrier E 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97156 FAMILY ADAPT BHV TX GDN PHYS/QHP EA 15 MIN 10 1 30.4 10 NA NA 3876 3876 Carrier E 2022 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION 521 0 0.0019 41 521 NA NA 3877 3877 Carrier E 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0143 WALKER FOLDING WHEELED W/O S 160 1 12.3 17.5 5 155 NA NA 3878 3878 Carrier E 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0604 BREAST PUMP HEAVY DUTY HOSP GRADE PISTON OP 133 0.985 4.9 17.1 15 118 NA NA 3879 3879 Carrier E 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0570 NEBULIZER WITH COMPRESSOR 121 0.9917 9.5 10.7 8 113 NA NA 3880 3880 Carrier E 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1390 OXYGEN CONCENTRATOR 86 0.9884 7.9 26 10 76 NA NA 3881 3881 Carrier E 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0730 TENS DEVICE 4/MORE LEADS MULTI NERVE STIMULATION 81 1 27.9 81 NA NA 3882 3882 Carrier E 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A5500 DIAB ONLY FIT CSTM PREP&SPL SHOE MX DNSITY INSRT PER SHOE 71 1 50.9 71 NA NA 3883 3883 Carrier E 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0001 STANDARD WHEELCHAIR 28 1 0.3 15.3 1 27 NA NA 3884 3884 Carrier E 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0693 UV LT TX SYS PANL W/BULBS/LAMPS TIMER 6 FT PANEL 23 1 23.9 23 NA NA 3885 3885 Carrier E 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L1846 KNEE ORTHOSIS DOUBLE UPRIGHT THIGH & CALF CUSTOM 22 1 77.9 22 NA NA 3886 3886 Carrier E 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2402 NEG PRESS WOUND THERAPY PUMP 22 1 5.7 13.6 4 18 NA NA 3887 3887 Carrier E 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0143 WALKER FOLDING WHEELED W/O S 160 1 12.3 17.5 5 155 NA NA 3888 3888 Carrier E 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0730 TENS DEVICE 4/MORE LEADS MULTI NERVE STIMULATION 81 1 27.9 81 NA NA 3889 3889 Carrier E 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A5500 DIAB ONLY FIT CSTM PREP&SPL SHOE MX DNSITY INSRT PER SHOE 71 1 50.9 71 NA NA 3890 3890 Carrier E 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0001 STANDARD WHEELCHAIR 28 1 0.3 15.3 1 27 NA NA 3891 3891 Carrier E 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0693 UV LT TX SYS PANL W/BULBS/LAMPS TIMER 6 FT PANEL 23 1 23.9 23 NA NA 3892 3892 Carrier E 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L1846 KNEE ORTHOSIS DOUBLE UPRIGHT THIGH & CALF CUSTOM 22 1 77.9 22 NA NA 3893 3893 Carrier E 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2402 NEG PRESS WOUND THERAPY PUMP 22 1 5.7 13.6 4 18 NA NA 3894 3894 Carrier E 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0691 UV LIGHT TX SYS BULB/LAMP TIMER; TX 2 SQ FT/LESS 22 1 43.2 22 NA NA 3895 3895 Carrier E 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A7005 NONDISPOSABLE NEBULIZER SET 20 1 5.2 20 NA NA 3896 3896 Carrier E 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L1900 AFO SPRNG WIR DRSFLX CALF BD 19 1 107.6 19 NA NA 3897 3897 Carrier E 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0651 PNEUM COMPRESSOR SEGMENTAL 3 0 0.3333 60.2 3 NA NA 3898 3898 Carrier E 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT 95250 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneou 67 0.3881 29.2 67 NA NA 3899 3899 Carrier E 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0553 SUPPLY ALLOW FOR TX CGM1 MO SPL = 1 U OF SERVICE 43 1 90.4 43 NA NA 3900 3900 Carrier E 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4230 INFUS INSULIN PUMP NON NEEDL 28 1 94.7 28 NA NA 3901 3901 Carrier E 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4211 SUPP FOR SELF-ADM INJECTIONS 23 1 22.8 10.3 1 22 NA NA 3902 3902 Carrier E 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4232 SYRINGE W/NEEDLE INSULIN 3CC 21 1 35.6 21 NA NA 3903 3903 Carrier E 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 EXT AMB INFUSN PUMP INSULIN 15 1 129.8 15 NA NA 3904 3904 Carrier E 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A6257 TRANSPARENT FILM STERL 16 SQ IN OR LESS EA DRESS 3 1 408.4 3 NA NA 3905 3905 Carrier E 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4456 ADHESIVE REMOVER WIPES ANY TYPE EACH 2 1 331 2 NA NA 3906 3906 Carrier E 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0554 RECEIVER DEDICATED FOR USE W/THERAPEUTIC GCM SYS 1 1 29.8 1 NA NA 3907 3907 Carrier E 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9276 SNSR;INVSV DISP USE NONDME INTRSTL CGM 1U=1D SPL 1 1 0.1 1 NA NA 3908 3908 Carrier E 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0553 SUPPLY ALLOW FOR TX CGM1 MO SPL = 1 U OF SERVICE 43 1 90.4 43 NA NA 3909 3909 Carrier E 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4230 INFUS INSULIN PUMP NON NEEDL 28 1 94.7 28 NA NA 3910 3910 Carrier E 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4211 SUPP FOR SELF-ADM INJECTIONS 23 1 22.8 10.3 1 22 NA NA 3911 3911 Carrier E 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4232 SYRINGE W/NEEDLE INSULIN 3CC 21 1 35.6 21 NA NA 3912 3912 Carrier E 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 EXT AMB INFUSN PUMP INSULIN 15 1 129.8 15 NA NA 3913 3913 Carrier E 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A6257 TRANSPARENT FILM STERL 16 SQ IN OR LESS EA DRESS 3 1 408.4 3 NA NA 3914 3914 Carrier E 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4456 ADHESIVE REMOVER WIPES ANY TYPE EACH 2 1 331 2 NA NA 3915 3915 Carrier E 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0554 RECEIVER DEDICATED FOR USE W/THERAPEUTIC GCM SYS 1 1 29.8 1 NA NA 3916 3916 Carrier E 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9276 SNSR;INVSV DISP USE NONDME INTRSTL CGM 1U=1D SPL 1 1 0.1 1 NA NA 3917 3917 Carrier E 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95250 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneou 67 0.3881 29.2 67 NA NA 3918 3918 Carrier E 2022 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 95250 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneou 67 0 0.0149 29.2 67 NA NA 3919 3919 Carrier E 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 122 0.8197 23.91155738 0 122 0 EMPAGLIFLOZIN NA 3920 3920 Carrier E 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 66 0.4697 30.93660354 0 66 0 VARENICLINE TARTRATE NA 3921 3921 Carrier E 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 57 0.9649 18.10929337 0 57 0 UBROGEPANT NA 3922 3922 Carrier E 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 51 0.6471 17.95818627 0 51 0 INSULIN GLARGINE NA 3923 3923 Carrier E 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 49 1 29.88755102 0 49 0 RIVAROXABAN NA 3924 3924 Carrier E 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 45 0.4889 25.21466667 0 45 0 SEMAGLUTIDE NA 3925 3925 Carrier E 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 40 0.975 13.00740972 0 40 0 SECUKINUMAB NA 3926 3926 Carrier E 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 39 0.9744 17.96470085 0 39 0 FREMANEZUMAB-VFRM NA 3927 3927 Carrier E 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 35 0.6286 27.68711111 0 35 0 LISDEXAMFETAMINE DIMESYLATE NA 3928 3928 Carrier E 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 35 1 14.15750794 0 35 0 ADALIMUMAB NA 3929 3929 Carrier E 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 49 1 29.88755102 0 49 0 RIVAROXABAN NA 3930 3930 Carrier E 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 35 1 14.15750794 0 35 0 ADALIMUMAB NA 3931 3931 Carrier E 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 28 1 76.1397619 0 28 0 TICAGRELOR NA 3932 3932 Carrier E 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 11 1 21.82257576 0 11 0 GALCANEZUMAB-GNLM NA 3933 3933 Carrier E 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 10 1 10.72491667 0 10 0 GUSELKUMAB NA 3934 3934 Carrier E 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 5 1 12.0475 0 5 0 VORTIOXETINE HBR NA 3935 3935 Carrier E 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 5 1 28.54044444 0 5 0 BREXPIPRAZOLE NA 3936 3936 Carrier E 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 4 1 17.31354167 0 4 0 ABATACEPT NA 3937 3937 Carrier E 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 4 1 37.44520833 0 4 0 EMTRICITABINE-TENOFOVIR ALAFENAMIDE FUMARATE NA 3938 3938 Carrier E 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 3 1 8.633796296 0 3 0 LACOSAMIDE NA 3939 3939 Carrier E 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 51 0 0.0196 17.95818627 0 51 0 INSULIN GLARGINE NA 3940 3940 Carrier C 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 120 ROOM AND BOARD 11080 0.9922 18 24 11060 20 NA NA 3941 3941 Carrier C 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 128 ROOM AND BOARD 77 0.9737 15 3 76 1 NA NA 3942 3942 Carrier C 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 59510 FULL ROUT OBSTE CARE,CESAREAN DELIV 40 0.95 2 24 1 39 NA NA 3943 3943 Carrier C 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 59400 FULL ROUT OBSTE CARE,VAGINAL DELIV 25 1 6 0 25 NA NA 3944 3944 Carrier C 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44204 COLECTOMY LAP PARTIAL W/ ANAST 19 0.8947 9 16 3 16 NA NA 3945 3945 Carrier C 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 33533 CABG USING ART GRFTS 1 ART GRFT 15 0.8 2 10 5 10 NA NA 3946 3946 Carrier C 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 ARTHRODESIS ANT INTERBODY W/ DISKECTOMY LU 15 0.8 25 95 4 11 NA NA 3947 3947 Carrier C 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 TOTAL ABDOM HYSTERECTOMY 13 0.9231 1.5 11 2 11 NA NA 3948 3948 Carrier C 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 35301 THROMBOENDARTECTMY NECK,NECK INCIS 11 0.8182 14 0 11 NA NA 3949 3949 Carrier C 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 33405 REPLACE PROSTH AORTIC VALVE, OPEN, W/BYPASS NON-HOMO 9 0.7778 9 31 3 6 NA NA 3950 3950 Carrier C 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 59400 FULL ROUT OBSTE CARE,VAGINAL DELIV 25 1 6 0 25 NA NA 3951 3951 Carrier C 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22551 ARTHRODESIS ANT INTERBODY CERVICAL BELOW C2 7 1 18 35 1 6 NA NA 3952 3952 Carrier C 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 32663 THORACOSCOPY SURG W/ LOBECTOMY TOTAL/SEGMEN 7 1 39 0 7 NA NA 3953 3953 Carrier C 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 762 MISC SERVICES 6 1 93 6 0 NA NA 3954 3954 Carrier C 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 32650 THORACOSCOPY SURG W/ PLEURODESIS (MECHANICA 6 1 0 1.5 2 4 NA NA 3955 3955 Carrier C 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 59410 VAG DELIVERY ONLY W/ POSTPARTUM CARE 4 1 0 0 4 NA NA 3956 3956 Carrier C 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 59514 CESAREAN DELIVERY ONLY 4 1 0 7 1 3 NA NA 3957 3957 Carrier C 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27447 TOTAL KNEE ARTHROPLASTY 3 1 44 0 3 NA NA 3958 3958 Carrier C 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43239 UPPER GI ENDO W/ BX SINGLE/MULT 3 1 84 0 3 NA NA 3959 3959 Carrier C 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43280 LAP,ESOPHAGOGAST FUNDOPLASTY 3 1 24 0 3 NA NA 3960 3960 Carrier C 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 120 ROOM AND BOARD 11080 0 0.0001 18 24 11060 20 NA NA 3961 3961 Carrier C 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 OFFICE VISIT E&M EST PT, MODERATE MDM, 30-39 MINS 92371 0.9677 4.7 13.6 9679 82692 NA NA 3962 3962 Carrier C 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97110 THERA PROC 1+ AREAS EA 15 MIN THERA EXERCISES 11294 0.9368 6.3 17.6 391 10903 NA NA 3963 3963 Carrier C 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97124 THERA PROC 1+ AREAS EA 15 MIN MASSAGE 10397 0.9876 1 7 183 10214 NA NA 3964 3964 Carrier C 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 COLONOSCOPY W/ BX SINGLE/MULT 7042 0.9746 1 4.5 342 6700 NA NA 3965 3965 Carrier C 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 762 MISC SERVICES 4748 0.9928 17 4 4747 1 NA NA 3966 3966 Carrier C 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 TTE (ECHO) WITH SPECTRAL & COLOR FLOW DOPPLER 2382 0.9736 2.7 14 263 2119 NA NA 3967 3967 Carrier C 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43235 UPPER GI ENDO DX (SEP PROC) 1945 0.9635 1 5.5 179 1766 NA NA 3968 3968 Carrier C 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99202 OFFICE VISIT E&M NEW PT STRAIGHTFORWARD MDM, 15-29 MINS 1942 0.9197 7 29 334 1608 NA NA 3969 3969 Carrier C 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97530 THERA ACTVI DIRECT PAT CONTACT EA 15 MIN 1747 0.9525 8.5 22.3 88 1659 NA NA 3970 3970 Carrier C 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97802 MED NUTRIT THRPY INIT ASSESS 15 MIN 1629 0.9638 5.3 16.3 77 1552 NA NA 3971 3971 Carrier C 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58300 INSERT INTRAUTERINE DEVICE 136 1 2 4.7 31 105 NA NA 3972 3972 Carrier C 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J3301 TRIAMCINOLONE ACETONIDE INJ PER 10 MG 126 1 1 20 5 121 NA NA 3973 3973 Carrier C 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 92523 EVALUATION OF SPEECH SOUND PRODUCTION W/EVAL LANG COMP/EXPRESSION 114 1 0 8.7 1 113 NA NA 3974 3974 Carrier C 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 17260 DESTRUCT MALIG LES TRUNK/ARM/LEG < 0.5 CM 112 1 0.6 2.5 8 104 NA NA 3975 3975 Carrier C 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 51798 MEASUREMENT PVR URIN&/BLADD CAPACTY US NON-IMAG 92 1 4 8 2 90 NA NA 3976 3976 Carrier C 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 92526 TX SWALLOWING DYSFUNCTION &/OR ORAL FUNCTION FEED 68 1 4 35.4 7 61 NA NA 3977 3977 Carrier C 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95115 PROFES SVC IMMUNOTHER NON-PROV EXTRACT SINGLE INJ 65 1 0.3 11.3 3 62 NA NA 3978 3978 Carrier C 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77001 FLUORO GUIDE FOR CENT VENOUS ACCESS DEVICE 62 1 5.4 7 11 51 NA NA 3979 3979 Carrier C 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 559 OTHER THERAPY SERV 59 1 158.5 0 59 NA NA 3980 3980 Carrier C 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 92960 CARDIOVERSION ELECTIVE EXT 57 1 0.5 9 10 47 NA NA 3981 3981 Carrier C 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 50688 CHANGE URETEROSTOMY TUBE 1 0 1 19 0 1 NA NA 3982 3982 Carrier C 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 62380 ENDO DECOMPRESS NEURAL ELEMNTS/EXCIS HERNIATD DISK, 1 INTERSPACE, LUMBAR 2 0 0.5 168 0 2 NA NA 3983 3983 Carrier C 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 70545 MAGNETIC RESONANCE ANGIO, HEAD W/DYE 2 0 0.5 125 0 2 NA NA 3984 3984 Carrier C 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 76390 MRI SPECTROSCOPY 2 0 0.5 65 0 2 NA NA 3985 3985 Carrier C 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27822 TRIMALLEOLAR FX W/WO FIX W/O FIX POST LIP OP TX 4 0 0.25 2 4 2 2 NA NA 3986 3986 Carrier C 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22513 PERCUTANEOUS VERTBRAL AUGMENT, UNILATRL OR BILAT CANNULATION; THORACIC 5 0 0.2 24.3 39 3 2 NA NA 3987 3987 Carrier C 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 61885 INSRT/REDO NEUROSTIM 1 ARRAY 5 0 0.2 16 124.3 2 3 NA NA 3988 3988 Carrier C 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 66991 XCAPSL CTRC RMVL INSJ IO LENS PROSTH INSJ 1+ 10 0 0.2 0.5 64.8 2 8 NA NA 3989 3989 Carrier C 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 81455 TGSAP SO/HEMATOLYMPHOID NEO/DO 51/=3HRS DA/3DAWK 1 1 0 0 0 0 NA NA 4290 4290 Carrier B 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96101 PSYCHOLOGICAL TESTING PER HOUR FACE TO FACE TIME WITH PATIENT 10 1 0 110.73 0.1 0 10 1 NA NA 4291 4291 Carrier B 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE 282 0.9539 19.74 90.26 0 2 277 0 NA NA 4292 4292 Carrier B 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1390 PORTABLE OXYGEN CONCENTRATOR 71 0.9296 56.9 51.87 0 6 63 0 NA NA 4293 4293 Carrier B 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0781 AMBULATORY INFUSION PUMP 1 OR MULTIPLE CHANNELS PATIENT WEARS 38 0.9211 87.78 0 0 38 0 NA NA 4294 4294 Carrier B 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0470 BI-PAP RESPIRATORY ASSIST DEVICE WITH OUT BACKUP 24 0.9583 2.39 139.98 0 1 22 0 NA NA 4295 4295 Carrier B 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2402 NEGATIVE PRESSURE WOUND PUMP 18 0.9444 67.25 102.29 0 1 17 0 NA NA 4296 4296 Carrier B 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0935 PASSIVE MOTION EXERCISE DEVICE 8 1 97.1 0 0 7 0 NA NA 4297 4297 Carrier B 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0471 BI-PAP RESPIRATORY ASSIST DEVICE WITH BACKUP 7 1 89.58 0 0 6 0 NA NA 4298 4298 Carrier B 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0001 STANDARD WHEELCHAIR 7 0.7143 14.69 67.13 0 3 4 0 NA NA 4299 4299 Carrier B 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC B9002 ENTERAL NUTRITION INFUSION PUMP WITH ALARM 6 1 99.24 0 0 6 0 NA NA 4300 4300 Carrier B 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0604 HOSP GRADE ELECTRIC BREAST PUMP 3 0.6667 102.69 0 0 3 0 NA NA 4301 4301 Carrier B 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0005 ULTRALIGHTWEIGHT WHEELCHAIR 1 1 71.3 0 0 1 0 NA NA 4302 4302 Carrier B 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2202 MANUAL WHEELCHAIR NON-STANDARD SEAT FRAME WIDTH, 24-27 INCHES 1 1 223.02 0 1 0 0 NA NA 4303 4303 Carrier B 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S9342 HOME THERAPY 1 1 22.17 0 1 0 0 NA NA 4304 4304 Carrier B 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9279 MONITOR FEATURE/DEVICE, STAND-ALONE OR INTEGRATED, ANY TYPE, NOT OTHERWISE CLASSIFIED 1 1 286.14 0 0 1 0 NA NA 4305 4305 Carrier B 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2611 GENERAL WHEELCHAIR BACK CUSSION WIDTH < 22 INCHES, ANY HEIGHT MOUNT HARDWARE 1 1 71.29 0 0 1 0 NA NA 4306 4306 Carrier B 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC B9002 ENTERAL NUTRITION INFUSION PUMP WITH ALARM 6 1 99.24 0 0 6 0 NA NA 4307 4307 Carrier B 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0835 POWER WHEEL CHAIR, GROUP 2 STANDARD, SINGLE POWER OPTION, SLING/SOLID SEAT/BACK, 1 1 124.03 0 0 1 0 NA NA 4308 4308 Carrier B 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0260 HOSPITAL BED SEMI-ELEC WITH ANY RAILS WITH MATTRESS 2 1 21.73 90.12 0 1 1 0 NA NA 4309 4309 Carrier B 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0637 COMBINATION SIT TO STAND SYSTEM 1 1 285.97 0 0 1 0 NA NA 4310 4310 Carrier B 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0471 BI-PAP RESPIRATORY ASSIST DEVICE WITH BACKUP 7 1 89.58 0 0 6 0 NA NA 4311 4311 Carrier B 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0781 AMBULATORY INFUSION PUMP 1 OR MULTIPLE CHANNELS PATIENT WEARS 38 0 0.0263 87.78 0 0 38 0 NA NA 4312 4312 Carrier B 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9277 EXTERNAL TRANSMITTER CONTINOUS GLUCOSE MONITOR DAILY 78 0.9744 40.17 93.72 0 1 77 0 NA NA 4313 4313 Carrier B 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9276 DISPOSABLE SENSOR FOR CONTINOUS GLUCOSE MONITORING SYSTEM DAILY 13 0.8462 137.58 0 0 13 0 NA NA 4314 4314 Carrier B 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9278 EXTERNAL RECEIVER FOR CONTINOUS GLUCOSE MONITORING 11 0.9091 124.62 0 0 11 0 NA NA 4315 4315 Carrier B 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9274 EXTERNAL AMBULATORY INSULIN DELIVERY SYSTEM 8 1 88.3 0 0 8 0 NA NA 4316 4316 Carrier B 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0553 CONTINOUS GLUCOSE MONITORING SYSTEM SUPPLIES MONTH AT A TIME 4 0 122.19 0 0 4 0 NA NA 4317 4317 Carrier B 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 EXTERNAL AMBULATORY INFUSION PUMP, INSULIN 4 1 74.1 0 0 4 0 NA NA 4318 4318 Carrier B 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0554 THERAPEUTIC CONTINOUS GLUCOSE MONITORING RECEIVER/MONITOR MONTHLY 3 0 124.78 0 0 3 0 NA NA 4319 4319 Carrier B 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 EXTERNAL AMBULATORY INFUSION PUMP, INSULIN 4 1 74.1 0 0 4 0 NA NA 4320 4320 Carrier B 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9274 EXTERNAL AMBULATORY INSULIN DELIVERY SYSTEM 8 1 88.3 0 0 8 0 NA NA 4321 4321 Carrier B 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9277 EXTERNAL TRANSMITTER CONTINOUS GLUCOSE MONITOR DAILY 78 0.9744 40.17 93.72 0 1 77 0 NA NA 4322 4322 Carrier B 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9278 EXTERNAL RECEIVER FOR CONTINOUS GLUCOSE MONITORING 11 0.9091 124.62 0 0 11 0 NA NA 4323 4323 Carrier B 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9276 DISPOSABLE SENSOR FOR CONTINOUS GLUCOSE MONITORING SYSTEM DAILY 13 0.8462 137.58 0 0 13 0 NA NA 4324 4324 Carrier B 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0554 THERAPEUTIC CONTINOUS GLUCOSE MONITORING RECEIVER/MONITOR MONTHLY 3 0 124.78 0 0 3 0 NA NA 4325 4325 Carrier B 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0553 CONTINOUS GLUCOSE MONITORING SYSTEM SUPPLIES MONTH AT A TIME 4 0 122.19 0 0 4 0 NA NA 4326 4326 Carrier G 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22842 POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG 16 0.6875 4.7 75.5 1 15 NA NA 4327 4327 Carrier G 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22614 ARTHRODESIS PST/PSTLAT TQ 1NTRSPC EA ADDL NTRSPC 13 0.6154 3.8 67.7 2 11 NA NA 4328 4328 Carrier G 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96416 CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP 12 0.9167 11 57.8 4 8 NA NA 4329 4329 Carrier G 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63048 LAM FACETECTOMY and FORAMOT 1 VRT SGM EA ADDL SGM 10 0.7 3.8 99.8 2 8 NA NA 4330 4330 Carrier G 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 69990 MICROSURG TQS REQ USE OPERATING MICROSCOPE 9 0.7778 22.1 17.2 1 8 NA NA 4331 4331 Carrier G 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22600 ARTHRD PST/PSTLAT TQ 1NTRSPC CRV BELW C2 SEGMENT 9 0.7778 3.8 87.4 2 7 NA NA 4332 4332 Carrier G 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44207 LAPS COLECTOMY PRTL W/COLOPXTSTMY LW ANAST 9 0.7778 23.9 19.9 2 7 NA NA 4333 4333 Carrier G 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 38724 CERVICAL LYMPHADEC MODIFIED RADICAL NECK DSJ 9 0.6667 24.9 40 2 7 NA NA 4334 4334 Carrier G 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT J9100 INJECTION CYTARABINE 100 MG 8 0.75 15.2 57.4 4 4 NA NA 4335 4335 Carrier G 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY 8 0.875 18.1 21.4 4 4 NA NA 4336 4336 Carrier G 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22840 POSTERIOR NON-SEGMENTAL INSTRUMENTATION 13 1 62.5 13 NA NA 4337 4337 Carrier G 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22558 ARTHRD ANT INTERBODY MIN DSC LUMBAR 7 1 75.2 7 NA NA 4338 4338 Carrier G 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 49000 EXPLORATORY LAPAROTOMY CELIOTOMY W/WO BIOPSY SPX 6 1 11.3 14 4 2 NA NA 4339 4339 Carrier G 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95961 FUNCJAL CORT and SUBCORT MAPG PHYS/QHP ATTND INIT HR 6 1 20.6 45.9 3 3 NA NA 4340 4340 Carrier G 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44620 CLOSURE ENTEROSTOMY LG/SMALL INTESTINE 4 1 33.1 98.1 2 2 NA NA 4341 4341 Carrier G 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 13101 REPAIR COMPLEX TRUNK 2.6-7.5 CM 3 1 26.1 58.5 1 2 NA NA 4342 4342 Carrier G 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 13102 REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM OR LT 3 1 26.1 58.5 1 2 NA NA 4343 4343 Carrier G 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15002 PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT 3 1 26.1 58.5 1 2 NA NA 4344 4344 Carrier G 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15003 PREP SITE TRUNK/ARM/LEG ADDL 100 SQ CM/1PCT 3 1 26.1 58.5 1 2 NA NA 4345 4345 Carrier G 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22585 ARTHRD ANT NTRBD MIN DSC EA ADDL INTERSPACE 3 1 72.6 3 NA NA 4346 4346 Carrier G 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 23440 RESECTION/TRANSPLANTATION LONG TENDON BICEPS 1 0 1 96.2 1 NA NA 4347 4347 Carrier G 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 50949 UNLISTED LAPAROSCOPY PROCEDURE URETER 1 0 1 18.2 1 NA NA 4348 4348 Carrier G 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 58146 MYOMECTOMY 5 OR GT MYOMAS and OR GT 250 GM ABDOMINA 1 0 1 42.6 1 NA NA 4349 4349 Carrier G 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 61458 CRNEC SOPL EXPL/DCMPRN CRNL NRV 1 0 1 51.1 1 NA NA 4350 4350 Carrier G 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 44626 CLSR NTRSTM LG/SM RESCJ and COLORECTAL ANASTOMOSIS 2 0 0.5 48 25.6 1 1 NA NA 4351 4351 Carrier G 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 52351 CYSTO W/URTROSCOPY and /PYELOSCOPY DX 2 0 0.5 18.2 73.6 1 1 NA NA 4352 4352 Carrier G 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 92652 AEP THRESHOLD ESTIMATION MLT FREQUENCIES I and R 3 0 0.3333 21.2 37.5 1 2 NA NA 4353 4353 Carrier G 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 47135 LVR ALTRNSPLJ ORTHOTOPIC PRTL/WHL DON ANY AGE 3 0 0.3333 19.2 150.1 1 2 NA NA 4354 4354 Carrier G 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 58140 MYOMECTOMY 1-4 MYOMAS W/250 GM OR LT ABDOMINAL APPR 3 0 0.3333 46.3 3 NA NA 4355 4355 Carrier G 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 44620 CLOSURE ENTEROSTOMY LG/SMALL INTESTINE 4 0 0.25 33.1 98.1 2 2 NA NA 4356 4356 Carrier G 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC and COLR D 1415 0.9004 9.3 45.4 28 1387 NA NA 4357 4357 Carrier G 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 78452 MYOCARDIAL SPECT MULTIPLE STUDIES 261 0.9004 58.8 3 258 NA NA 4358 4358 Carrier G 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93015 CV STRS TST XERS and /OR RX CONT ECG W/SI and R 232 0.8707 1 48.9 2 230 NA NA 4359 4359 Carrier G 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93971 DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY 197 0.9137 14.5 22.1 23 174 NA NA 4360 4360 Carrier G 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 77334 TX DEVICES DESIGN AND CONSTRUCTION COMPLEX 171 0.924 13.2 18.7 65 106 NA NA 4361 4361 Carrier G 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93350 ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST and ST 169 0.8994 29 40.3 3 166 NA NA 4362 4362 Carrier G 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74177 CT ABDOMEN and PELVIS W/CONTRAST MATERIAL 150 0.8909 27.3 36.6 45 105 NA NA 4363 4363 Carrier G 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT J0585 BOTULINUM TOXIN TYPE A PER UNIT 157 0.8025 7.4 63.1 10 147 NA NA 4364 4364 Carrier G 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 71271 COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C- 148 0.9085 0 43.7 1 147 NA NA 4365 4365 Carrier G 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93248 EXTERNAL ECG REC GT 7D LT 15D REVIEW and INTERPRETATION 146 0.9178 60.5 146 NA NA 4366 4366 Carrier G 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93271 XTRNL PT ACTIVATED ECG REC DWNLD 30 DAYS 32 1 0 32 NA NA 4367 4367 Carrier G 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93975 DUP-SCAN ARTL FLO ABDL/PEL/SCROT and /RPR ORGN COM 28 1 48.1 2 26 NA NA 4368 4368 Carrier G 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93229 XTRNL MOBILE CV TELEMETRY W/TECHNICAL SUPPORT 24 1 24 NA NA 4369 4369 Carrier G 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93280 PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER 24 1 0 24 NA NA 4370 4370 Carrier G 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93460 R AND L HRT CATH WINJX HRT ART AND L VENTR IMG 19 1 0 19 NA NA 4371 4371 Carrier G 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A9502 TECHNETIUM TC-99M TETROFOSMIN DX PER STUDY DOSE 18 1 26.8 18 NA NA 4372 4372 Carrier G 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93295 INTERROGATION EVAL REMOTE LT 90 D 1/2/MLT LD DFB 17 1 0 17 NA NA 4373 4373 Carrier G 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77470 SPECIAL TREATMENT PROCEDURE 13 1 22.1 2 11 NA NA 4374 4374 Carrier G 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93451 RIGHT HEART CATH O2 SATURATION AND CARDIAC OUTPUT 13 1 40.9 1 12 NA NA 4375 4375 Carrier G 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93990 DUPLEX SCAN HEMODIALYSIS ACCESS 13 1 1 12 NA NA 4376 4376 Carrier G 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 17999 UNLISTED PX SKIN MUC MEMBRANE AND SUBQ TISSUE 1 0 1 161 1 NA NA 4377 4377 Carrier G 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 20930 ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED 1 0 1 225 1 NA NA 4378 4378 Carrier G 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 20936 AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION 1 0 1 225 1 NA NA 4379 4379 Carrier G 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21705 DIVISION SCALENUS ANTICUS RESECTION CERVICAL RIB 1 0 1 33 1 NA NA 4380 4380 Carrier G 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 23405 TENOTOMY SHOULDER AREA 1 TENDON 1 0 1 33 1 NA NA 4381 4381 Carrier G 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 40819 EXC FRENUM LABIAL/BUCCAL 1 0 1 98 1 NA NA 4382 4382 Carrier G 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 41115 EXCISION LINGUAL FRENUM FRENECTOMY 1 0 1 98 1 NA NA 4383 4383 Carrier G 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 52601 TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE 1 0 1 46 1 NA NA 4384 4384 Carrier G 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 61783 STEREOTACTIC COMPUTER ASSISTED PX SPINAL 1 0 1 225 1 NA NA 4385 4385 Carrier G 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64713 NEURP MAJOR PRPH NRV OPN ARM/LEG BRACH PLEXUS 1 0 1 33 1 NA NA 4386 4386 Carrier G 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 Room & Board - Semiprivate - 2 Beds - Psychiatric 1 1 0 1 NA NA 4387 4387 Carrier G 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 Room & Board - Semiprivate - 2 Beds - Psychiatric 1 1 0 1 NA NA 4388 4388 Carrier G 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 THERAP REPETITIVE TMS TX SUBSEQ DELIVERY AND MNG 34 0.5294 99.3 34 NA NA 4389 4389 Carrier G 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL and M 33 0.5455 99.8 33 NA NA 4390 4390 Carrier G 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 REPET TMS TX SUBSEQ MOTR THRESHLD W/DELIV and MN 24 0.5417 102.2 24 NA NA 4391 4391 Carrier G 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION 12 0.6667 98 42.3 1 11 NA NA 4392 4392 Carrier G 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES 11 0.4545 72.5 43 3 8 NA NA 4393 4393 Carrier G 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 80307 DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE 8 0.375 40 92.7 1 7 NA NA 4394 4394 Carrier G 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90833 PSYCHOTHERAPY W/PATIENT W/E and M SRVCS 30 MIN 6 0.8333 122 6 NA NA 4395 4395 Carrier G 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96131 PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR 6 0.8333 68 6 NA NA 4396 4396 Carrier G 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT S9480 INTENSIVE OP PSYCHIATRIC SERVICES PER DIEM 6 0.8333 32.3 60.7 3 3 NA NA 4397 4397 Carrier G 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96130 PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR 5 0.8 82.8 5 NA NA 4398 4398 Carrier G 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96116 NEUROBEHAVIORAL STATUS XM PHYS/QHP 1ST HOUR 2 1 185.5 2 NA NA 4399 4399 Carrier G 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96121 NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR 2 1 188.5 2 NA NA 4400 4400 Carrier G 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96132 NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR 2 1 185.5 2 NA NA 4401 4401 Carrier G 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96133 NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR 2 1 185.5 2 NA NA 4402 4402 Carrier G 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT H0018 BHVAL HEALTH; SHORT-TERM RES W/O ROOM and BOARD-DIEM 2 1 72.5 2 NA NA 4403 4403 Carrier G 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 80305 DRUG TEST PRSMV READ DIRECT OPTICAL OBS PR DATE 1 1 40 1 1 NA NA 4404 4404 Carrier G 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90838 PSYCHOTHERAPY W/PATIENT W/E and M SRVCS 60 MIN 1 1 350 1 NA NA 4405 4405 Carrier G 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90899 UNLISTED PSYCHIATRIC SERVICE/PROCEDURE 1 1 1 NA NA 4406 4406 Carrier G 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT H0015 ALCOHL and /RX SRVC;INTENSV OP;CRISIS INTRVN and ACTV TX 1 1 49 1 NA NA 4407 4407 Carrier G 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT H2012 BEHAVIORAL HEALTH DAY TREATMENT PER HOUR 1 1 35 1 NA NA 4408 4408 Carrier G 2022 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES 11 0 0.09 72.6 56.1 3 8 NA NA 4409 4409 Carrier G 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT E0784 EXTERNAL AMBULATORY INFUSION PUMP INSULIN 16 1 73 45.9 1 15 NA NA 4410 4410 Carrier G 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT K0553 SUPPLY ALLOW FOR TX CGM1 MO SPL Equal to 1 U OF SERVICE 1 1 0 1 NA NA 4411 4411 Carrier G 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A9277 TRANSMITTER; EXT USE WITH NONDME INTRSTL CGM 1 0 1 NA NA 4412 4412 Carrier G 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0784 EXTERNAL AMBULATORY INFUSION PUMP INSULIN 16 1 73 45.9 1 15 NA NA 4413 4413 Carrier G 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT K0553 SUPPLY ALLOW FOR TX CGM1 MO SPL Equal to 1 U OF SERVICE 1 1 0 1 NA NA 4414 4414 Carrier G 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E1390 O2 CONC 1 DEL PORT 85 PCT OR GT 02 CONC AT PRSC FLW RATE 78 0.6282 25.8 114.5 8 70 NA NA 4415 4415 Carrier G 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L0650 LSO SAGITTAL-CORONAL CONTRL RIGD ANT POST PANELS 12 0.25 68.2 12 NA NA 4416 4416 Carrier G 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0652 PNEUMAT COMPRS SEG HOM MDL W/CALBRTD GRADNT PRSS 10 0 155.6 10 NA NA 4417 4417 Carrier G 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L1960 AFO POSTERIOR SOLID ANK PLASTIC CUSTOM FAB 9 0.6667 43 9 NA NA 4418 4418 Carrier G 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0601 CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE 8 0.125 38.3 8 NA NA 4419 4419 Carrier G 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0466 HOME VENTILATOR ANY TYPE USED W/NON-INVASV INTF 8 0.5 19.8 80.3 4 4 NA NA 4420 4420 Carrier G 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT V2624 POLISHING/RESURFACING OF OCULAR PROSTHESIS 8 1 57.3 8 NA NA 4421 4421 Carrier G 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E1399 DURABLE MEDICAL EQUIPMENT MISCELLANEOUS 8 0.25 133.6 8 NA NA 4422 4422 Carrier G 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT K0108 OTHER ACCESSORIES 7 0.5714 114 7 NA NA 4423 4423 Carrier G 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT V2628 FABRICATION AND FITTING OF OCULAR CONFORMER 7 0.8571 55.9 7 NA NA 4424 4424 Carrier G 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58571 LAPS TOTAL HYSTERECT 250 GM OR LT W/RMVL TUBE/OVARY 1 1 0 1 NA NA 4425 4425 Carrier G 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A9274 EXTERNAL AMB INSULIN DEL SYSTEM DISPOSABLE EA 1 1 75.6 1 NA NA 4426 4426 Carrier G 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT B9998 NOC FOR ENTERAL SUPPLIES 1 1 48 1 NA NA 4427 4427 Carrier G 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0240 BATH/SHOWER CHAIR W/WO WHEELS ANY SIZE 1 1 32.1 1 NA NA 4428 4428 Carrier G 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0656 SEG PNEUMAT APPLIANCE USE W/PNEUMAT COMPRS TRUNK 1 1 93.5 1 NA NA 4429 4429 Carrier G 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0986 MNL WHEELCHAIR ACSS PUSH-RIM ACT PWR ASSIST SYS 1 1 1 NA NA 4430 4430 Carrier G 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E1020 RESIDUAL LIMB SUPPORT SYSTEM WHEELCHAIR ANY TYPE 1 1 96 1 NA NA 4431 4431 Carrier G 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E1161 MANUAL ADULT SIZE WHEELCHAIR INCLUDES TILT SPACE 1 1 150.1 1 NA NA 4432 4432 Carrier G 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E1815 DYN ADJ ANKLE EXT/FLEX DEVC INCL SOFT INTF MATL 1 1 99.2 1 NA NA 4433 4433 Carrier G 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E2325 PWR WC ACSS SIP AND PUFF INTERFCE NONPROPRTNAL 1 1 68 1 NA NA 4434 4434 Carrier G 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L2999 LOWER EXTREMITY ORTHOSES NOT OTHERWISE SPECIFIED 1 0 1 81 1 NA NA 4435 4435 Carrier G 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT B4157 ENTRAL F NUTRITION CMPL INHERITED DZ METAB 2 0 0.5 19 48 1 1 NA NA 4436 4436 Carrier G 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A4649 SURGICAL SUPPLY; MISCELLANEOUS 4 0 0.25 32 95 3 1 NA NA 4437 4437 Carrier G 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0486 ORL DEVC/APPL RDUC UP AIRWAY COLLAPSIBILITY CSTM 5 0 0.2 53.5 5 NA NA 4438 4438 Carrier G 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0760 OSTOGNS STIM LOW INTENS ULTRASOUND NON-INVASV 5 0 0.2 133.8 5 NA NA 4439 4439 Carrier G 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0766 ELEC STIM DVC U CANCER TX INCL ALL ACC ANY TYPE 5 0 0.2 159 92 1 4 NA NA 4440 4440 Carrier G 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT V2623 PROSTHETIC EYE PLASTIC CUSTOM 5 0 0.2 73.2 5 NA NA 4441 4441 Carrier G 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT V2628 FABRICATION AND FITTING OF OCULAR CONFORMER 7 0 0.1429 55.9 7 NA NA 4442 4442 Carrier G 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0466 HOME VENTILATOR ANY TYPE USED W/NON-INVASV INTF 8 0 0.125 19.8 80.3 4 4 NA NA 4443 4443 Carrier G 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT V2624 POLISHING/RESURFACING OF OCULAR PROSTHESIS 8 0 0.125 57.3 8 NA NA 4444 4444 Carrier J 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 49 0.88 1.783655699 73.67917831 5 44 NA NA 4445 4445 Carrier J 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 46 0.85 2.826288659 70.91364191 4 42 NA NA 4446 4446 Carrier J 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96416 Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump 36 0 0.129527067 6.065881022 13 23 NA NA 4447 4447 Carrier J 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63048 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; each additional segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure) 29 0.83 1.147280722 56.84775353 7 22 NA NA 4448 4448 Carrier J 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar 28 0.96 1.950920278 77.24536074 1 27 NA NA 4449 4449 Carrier J 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44207 Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) 27 0 0.551256722 1.804173671 4 23 NA NA 4450 4450 Carrier J 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) 23 0.91 2.107086606 62.80834108 2 21 NA NA 4451 4451 Carrier J 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) 23 0.83 0.347804643 86.78757963 3 20 NA NA 4452 4452 Carrier J 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC J9100 Cytarabine Hcl 100 Mg Inj 22 0 0.037033333 1.014778507 10 12 NA NA 4453 4453 Carrier J 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar 22 0.91 1.38484525 58.50804957 4 18 NA NA 4454 4454 Carrier J 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44204 Laparoscopy, surgical; colectomy, partial, with anastomosis 22 0 6.045091435 22 NA NA 4455 4455 Carrier J 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft 14 1 86.04741874 14 NA NA 4456 4456 Carrier J 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22843 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments (List separately in addition to code for primary procedure) 8 1 12.30354551 19.85377603 2 6 NA NA 4457 4457 Carrier J 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22610 Arthrodesis, posterior or posterolateral technique, single level; thoracic (with lateral transverse technique, when performed) 5 1 1.656845608 28.28057457 3 2 NA NA 4458 4458 Carrier J 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63012 Laminectomy with removal of abnormal facets and/or pars inter-articularis with decompression of cauda equina and nerve roots for spondylolisthesis, lumbar (Gill type procedure) 4 1 66.06901226 4 NA NA 4459 4459 Carrier J 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63052 Laminectomy, facetectomy, or foraminotomy with lumbar decompression of spinal cord, cauda equina and/or nerve root during posterior interbody arthrodesis, single segment 4 1 102.6514883 4 NA NA 4460 4460 Carrier J 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22325 Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; lumbar 4 1 10.54731758 4 NA NA 4461 4461 Carrier J 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 47135 Liver allotransplantation, orthotopic, partial or whole, from cadaver or living donor, any age 4 1 27.25222222 30.38243639 1 3 NA NA 4462 4462 Carrier J 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63046 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; thoracic 3 1 0.353683765 19.45549528 2 1 NA NA 4463 4463 Carrier J 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63053 Laminectomy, facetectomy, or foraminotomy with lumbar decompression of spinal cord, cauda equina and/or nerve root, during posterior interbody arthrodesis, each additional segment 3 1 103.1150832 3 NA NA 4464 4464 Carrier J 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 61867 Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array 3 1 37.56240741 3 NA NA 4465 4465 Carrier J 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63056 Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; lumbar (including transfacet, or lateral extraforaminal approach) (eg, far lateral herniated intervertebral disc) 3 1 51.61418883 3 NA NA 4466 4466 Carrier J 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22856 Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); single interspace, cervical 3 1 152.0604888 3 NA NA 4467 4467 Carrier J 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33361 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach 3 1 17.23751732 3 NA NA 4468 4468 Carrier J 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22856 Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); single interspace, cervical 3 0.33 152.0604888 3 NA NA 4469 4469 Carrier J 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar 28 0.07 1.950920278 77.24536074 1 27 NA NA 4470 4470 Carrier J 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 20931 Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure) 15 0.07 0.132777778 47.76105976 1 14 NA NA 4471 4471 Carrier J 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 46 0.07 2.826288659 70.91364191 4 42 NA NA 4472 4472 Carrier J 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 21 0.05 2.107086606 75.47881978 2 19 NA NA 4473 4473 Carrier J 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar 22 0.05 1.38484525 58.50804957 4 18 NA NA 4474 4474 Carrier J 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) 23 0.04 2.107086606 62.80834108 2 21 NA NA 4475 4475 Carrier J 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 49 0.04 1.783655699 73.67917831 5 44 NA NA 4476 4476 Carrier J 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 5448 0.7 1.967357631 23.23881386 2826.610024 15 5433 18 NA NA 4477 4477 Carrier J 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 5158 0.7 5.32882609 24.46614153 1535.854537 11 5147 11 NA NA 4478 4478 Carrier J 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97140 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes 4653 0.7 1.709303195 24.2642726 3871.851042 14 4639 11 NA NA 4479 4479 Carrier J 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97112 Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities 4186 0.69 0.706925945 23.99069922 2004.755235 4 4182 9 NA NA 4480 4480 Carrier J 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 ECHO, transthoracic w/doppler, complete 2961 0.94 4.254639698 2764.8 2961 5 NA NA 4481 4481 Carrier J 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74176 CT abd & pelvis 2851 0.94 0.434583333 4.213635609 12 2839 NA NA 4482 4482 Carrier J 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 MRI, lower extremity any joint; wo contr 2597 0.88 0.217361111 5.416698508 1622.934375 4 2593 3 NA NA 4483 4483 Carrier J 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72148 MRI of lumbar spine 1835 0.88 33.27722222 5.806029607 3096 2 1833 3 NA NA 4484 4484 Carrier J 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0399 Home sleep test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation 1743 0.96 6.877222222 2.820735736 1608 4 1739 2 NA NA 4485 4485 Carrier J 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 MRI of brain and further sequences 1573 0.96 0.129722222 3.445440212 1473.848889 2 1571 4 NA NA 4486 4486 Carrier J 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43249 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter) 33 1 5.877483102 4.548783045 6 27 NA NA 4487 4487 Carrier J 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29898 Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, extensive 27 1 0.037777778 2.33629316 5304 3 24 1 NA NA 4488 4488 Carrier J 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 75557 Cardiac MRI for morph 25 1 6.348544444 25 NA NA 4489 4489 Carrier J 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77435 Stereotactic body radiation therapy, treatment management, per treatment course, to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions 20 1 11.42528333 43.97194503 3 17 NA NA 4490 4490 Carrier J 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72142 Contrast MRI of cervical spine 20 1 0.018458333 20 NA NA 4491 4491 Carrier J 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 37243 Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction 20 1 10.20065083 17.92338387 2 18 NA NA 4492 4492 Carrier J 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77373 Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions 19 1 12.41307722 46.59385613 3 16 NA NA 4493 4493 Carrier J 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72149 Contrast MRI of lumbar spine 18 1 3.794228395 18 NA NA 4494 4494 Carrier J 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 75635 CTA abdm arta/lg artry w/o & w/cntrs 16 1 0.013003472 16 NA NA 4495 4495 Carrier J 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72147 Contrast MRI of thoracic spine 16 1 0.012777778 16 NA NA 4496 4496 Carrier J 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 15832 Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh 1 1 6351.911167 1 NA NA 4497 4497 Carrier J 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 15879 Suction assisted lipectomy; lower extremity 1 1 6351.911167 1 NA NA 4498 4498 Carrier J 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 15839 Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area 1 1 6351.911167 1 NA NA 4499 4499 Carrier J 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 15877 Suction assisted lipectomy; trunk 1 1 6351.911167 1 NA NA 4500 4500 Carrier J 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22849 Reinsertion of spinal fixation device 2 0.5 84.8055725 2 NA NA 4501 4501 Carrier J 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63655 Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural 2 0.5 72.49758195 2 NA NA 4502 4502 Carrier J 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22852 Removal of posterior segmental instrumentation 3 0.33 77.09756591 3 NA NA 4503 4503 Carrier J 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 29805 Arthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure) 5 0.2 5.458238057 163.6368785 1 4 NA NA 4504 4504 Carrier J 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63045 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; cervical 11 0.18 57.25166212 11 NA NA 4505 4505 Carrier J 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 29862 Arthroscopy, hip, surgical; with debridement/shaving of articular cartilage (chondroplasty), abrasion arthroplasty, and/or resection of labrum 7 0.14 51.25368665 7 NA NA 4506 4506 Carrier J 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1002 Residential treatment, Substance Use Disorder 256 0.98 13.43465713 29.23745095 4944 3 253 1 NA NA 4507 4507 Carrier J 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1001 Residential treatment, Psychiatric 55 0.8 32.15222222 42.34860677 5365.35762 3 52 2 NA NA 4508 4508 Carrier J 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 Room and board, Semi-Private, Psychiatric 19 1 536.301546 25.84960406 2 17 NA NA 4509 4509 Carrier J 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 126 Room and board, Semi Private Detoxification 2 1 12.06753056 4872 2 1 NA NA 4510 4510 Carrier J 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 99221 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. 2 0 0.08730875 2 NA NA 4511 4511 Carrier J 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 14302 Adjacent tissue transfer or rearrangement, any area; each additional 30.0 sq cm, or part thereof (List separately in addition to code for primary procedure) 1 0 238.9218658 1 NA NA 4512 4512 Carrier J 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 95714 Electroencephalogram with video (VEEG), review of data, technical description by EEG technologist, each increment of 12-26 hours; unmonitored 1 0 0.087204723 1 NA NA 4513 4513 Carrier J 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 54125 Amputation of penis; complete 1 0 238.9218658 1 NA NA 4514 4514 Carrier J 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 95720 Electroencephalogram (EEG), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, each increment of greater than 12 hours, up to 26 hours of EEG recording, interpret 1 0 0.087161112 1 NA NA 4515 4515 Carrier J 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC J9217 Leuprolide Acetate Suspnsion 1 0 0.085735277 1 NA NA 4516 4516 Carrier J 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0017 Alcohol And/Or Drug Services 1 0 0.005833334 1 NA NA 4517 4517 Carrier J 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 53430 Urethroplasty, reconstruction of female urethra 1 0 238.9218658 1 NA NA 4518 4518 Carrier J 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 14301 Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm 1 0 238.9218658 1 NA NA 4519 4519 Carrier J 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 54520 Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach 1 0 238.9218658 1 NA NA 4520 4520 Carrier J 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 99223 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded. 1 0 0.087500002 1 NA NA 4521 4521 Carrier J 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0018 Alcohol And/Or Drug Services 1 0 0.08719639 851.2 1 3 NA NA 4522 4522 Carrier J 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 99222 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded. 1 0 0.087500002 1 NA NA 4523 4523 Carrier J 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 Room and board, Semi-Private, Psychiatric 19 1 536.301546 25.84960406 2 17 NA NA 4524 4524 Carrier J 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 126 Room and board, Semi Private Detoxification 2 1 12.06753056 4872 2 1 NA NA 4525 4525 Carrier J 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1002 Residential treatment, Substance Use Disorder 256 0.98 13.43465713 29.23745095 4944 3 253 1 NA NA 4526 4526 Carrier J 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1001 Residential treatment, Psychiatric 55 0.8 32.15222222 42.34860677 5365.35762 3 52 2 NA NA 4527 4527 Carrier J 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99221 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. 2 0 0.08730875 2 NA NA 4528 4528 Carrier J 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 14302 Adjacent tissue transfer or rearrangement, any area; each additional 30.0 sq cm, or part thereof (List separately in addition to code for primary procedure) 1 0 238.9218658 1 NA NA 4529 4529 Carrier J 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95714 Electroencephalogram with video (VEEG), review of data, technical description by EEG technologist, each increment of 12-26 hours; unmonitored 1 0 0.087204723 1 NA NA 4530 4530 Carrier J 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 54125 Amputation of penis; complete 1 0 238.9218658 1 NA NA 4531 4531 Carrier J 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95720 Electroencephalogram (EEG), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, each increment of greater than 12 hours, up to 26 hours of EEG recording, interpret 1 0 0.087161112 1 NA NA 4532 4532 Carrier J 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC J9217 Leuprolide Acetate Suspnsion 1 0 0.085735277 1 NA NA 4533 4533 Carrier J 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0017 Alcohol And/Or Drug Services 1 0 0.005833334 1 NA NA 4534 4534 Carrier J 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 53430 Urethroplasty, reconstruction of female urethra 1 0 238.9218658 1 NA NA 4535 4535 Carrier J 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 14301 Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm 1 0 238.9218658 1 NA NA 4536 4536 Carrier J 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 54520 Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach 1 0 238.9218658 1 NA NA 4537 4537 Carrier J 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99223 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded. 1 0 0.087500002 1 NA NA 4538 4538 Carrier J 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0018 Alcohol And/Or Drug Services 1 0 0.08719639 851.2 1 3 NA NA 4539 4539 Carrier J 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99222 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded. 1 0 0.087500002 1 NA NA 4540 4540 Carrier J 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual 238 0.61 1.166890833 49.71417048 2088 1 237 1 NA NA 4541 4541 Carrier J 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 71271 Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s) 232 0.93 2.809104673 232 NA NA 4542 4542 Carrier J 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 204 1 13.41949509 14.00535917 3 201 NA NA 4543 4543 Carrier J 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 Mental Health Partial Hospitalization, Treatment, Less Than 24 Hours 115 0.91 40.940329 115 NA NA 4544 4544 Carrier J 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 104 0.93 28.84766406 36.95580354 3480 5 99 1 NA NA 4545 4545 Carrier J 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 104 0.93 35.43247868 37.27901375 4 100 NA NA 4546 4546 Carrier J 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H2036 Alcohol and/or other drug treatment program, per diem 91 0.97 18.28416667 26.99379394 1 90 NA NA 4547 4547 Carrier J 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 78 0.95 38.79774935 35.17500741 3 75 NA NA 4548 4548 Carrier J 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 53 0.6 37.99685158 53 NA NA 4549 4549 Carrier J 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 70551 MRI of brain 44 0.98 2.598333333 44 NA NA 4550 4550 Carrier J 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 92522 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); 8 1 18.12766878 8 NA NA 4551 4551 Carrier J 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81229 Cytogenomic constitutional (genome-wide) microarray analysis; interrogation of genomic regions for copy number and single nucleotide polymorphism (SNP) variants for chromosomal abnormalities 7 1 9.82712869 720 7 1 NA NA 4552 4552 Carrier J 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70450 CT, head or brain wo contrast 4 1 0.031527778 4 NA NA 4553 4553 Carrier J 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19318 Breast reduction 4 1 42.5827616 4 NA NA 4554 4554 Carrier J 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 41899 Unlisted procedure, dentoalveolar structures 3 1 43.04668055 3 NA NA 4555 4555 Carrier J 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81416 Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis, each comparator exome (eg, parents, siblings) (List separately in addition to code for primary procedure) 3 1 32.24690926 3 NA NA 4556 4556 Carrier J 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 92609 Therapeutic services for the use of speech-generating device, including programming and modification 3 1 28.34968239 3 NA NA 4557 4557 Carrier J 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81415 Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis 3 1 32.24690926 3 NA NA 4558 4558 Carrier J 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 21122 Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) 2 1 150.1566292 2 NA NA 4559 4559 Carrier J 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 17380 Electrolysis epilation, each 30 minutes 2 1 54.46004028 2 NA NA 4560 4560 Carrier J 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15769 Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia) 2 1 2949.905131 2 NA NA 4561 4561 Carrier J 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 21296 Reduction of masseter muscle and bone (eg, for treatment of benign masseteric hypertrophy); intraoral approach 2 1 173.1659833 2 NA NA 4562 4562 Carrier J 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81243 FMR1 (fragile X mental retardation 1) (eg, fragile X mental retardation) gene analysis; evaluation to detect abnormal (eg, expanded) alleles 2 1 12.36625 720 2 1 NA NA 4563 4563 Carrier J 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 Continuous airway pressure (CPAP) device [may be used for either CPAP or APAP] 3645 0.96 1.854224334 1440 3645 2 NA NA 4564 4564 Carrier J 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 187 1 0.342040998 187 NA NA 4565 4565 Carrier J 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate 102 0.99 20.49277778 0.210775 4872 2 100 1 NA NA 4566 4566 Carrier J 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0108 W/C Component-Accessory Nos 26 0.27 19.50730556 44.5256387 1 25 NA NA 4567 4567 Carrier J 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1399 Durable Medical Equipment Mi 26 0.27 82.60064437 26 NA NA 4568 4568 Carrier J 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0747 Elec Osteogen Stim Not Spine 15 0.2 142.5876372 15 NA NA 4569 4569 Carrier J 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2402 Negative pressure wound therapy electrical pump, stationary or portable 15 0.33 3.796158334 117.8163427 1 14 NA NA 4570 4570 Carrier J 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0739 Repair/svc DME non-oxygen eq 13 0 0.21648993 13 NA NA 4571 4571 Carrier J 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0760 Osteogen Ultrasound Stimltor 11 0.09 96.55618687 11 NA NA 4572 4572 Carrier J 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0040 Adjustable Angle Footplate 10 0 0.622384784 10 NA NA 4573 4573 Carrier J 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 187 1 0.342040998 187 NA NA 4574 4574 Carrier J 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0861 PWC gp 3 std mult pow opt s/b 3 1 23.04890343 3 NA NA 4575 4575 Carrier J 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0856 PWC gp 3 std sing pow opt s/b 1 1 1 NA NA 4576 4576 Carrier J 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate 102 0.99 20.49277778 0.210775 4872 2 100 1 NA NA 4577 4577 Carrier J 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0601 Continuous airway pressure (CPAP) device [may be used for either CPAP or APAP] 3645 0.96 1.854224334 1440 3645 2 NA NA 4578 4578 Carrier J 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0748 Elec Osteogen Stim Spinal 5 0.6 86.14078667 5 NA NA 4579 4579 Carrier J 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2599 Accessory for speech generating device, not otherwise classified 2 0.5 10.0750157 2 NA NA 4580 4580 Carrier J 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2402 Negative pressure wound therapy electrical pump, stationary or portable 15 0.33 3.796158334 117.8163427 1 14 NA NA 4581 4581 Carrier J 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0108 W/C Component-Accessory Nos 26 0.27 19.50730556 44.5256387 1 25 NA NA 4582 4582 Carrier J 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1399 Durable Medical Equipment Mi 26 0.27 82.60064437 26 NA NA 4583 4583 Carrier J 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0748 Elec Osteogen Stim Spinal 5 0.2 86.14078667 5 NA NA 4584 4584 Carrier J 2022 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0601 Continuous airway pressure (CPAP) device [may be used for either CPAP or APAP] 3645 0 1.854224334 1440 3645 2 NA NA 4585 4585 Carrier J 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 84 0.96 27.22983188 624 84 1 NA NA 4586 4586 Carrier J 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9277 Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system 7 0 0.800513849 7 NA NA 4587 4587 Carrier J 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4232 Syringe W/Needle Insulin 3cc 7 0 11.98567639 7 NA NA 4588 4588 Carrier J 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply 6 0 0.919602732 6 NA NA 4589 4589 Carrier J 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4230 Infus Insulin Pump Non Needl 6 0 13.35062761 6 NA NA 4590 4590 Carrier J 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4216 Sterile water/saline, 10 ml 5 0 0.069804833 5 NA NA 4591 4591 Carrier J 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4253 Blood Glucose/Reagent Strips 1 0 5.160955555 1 NA NA 4592 4592 Carrier J 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4231 Infusion Insulin Pump Needle 1 0 0.005900002 1 NA NA 4593 4593 Carrier J 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 84 0.96 27.22983188 624 84 1 NA NA 4594 4594 Carrier J 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9277 Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system 7 0 0.800513849 7 NA NA 4595 4595 Carrier J 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4232 Syringe W/Needle Insulin 3cc 7 0 11.98567639 7 NA NA 4596 4596 Carrier J 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply 6 0 0.919602732 6 NA NA 4597 4597 Carrier J 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4230 Infus Insulin Pump Non Needl 6 0 13.35062761 6 NA NA 4598 4598 Carrier J 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4216 Sterile water/saline, 10 ml 5 0 0.069804833 5 NA NA 4599 4599 Carrier J 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4253 Blood Glucose/Reagent Strips 1 0 5.160955555 1 NA NA 4600 4600 Carrier J 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4231 Infusion Insulin Pump Needle 1 0 0.005900002 1 NA NA 4601 4601 Carrier J 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 673 0.777 8.8 54 170 503 ADALIMUMAB NA 4602 4602 Carrier J 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 410 0.695 10.8 46.3 34 376 CYCLOSPORINE (OPHTH) NA 4603 4603 Carrier J 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 353 0.011 10.7 47.5 154 199 INSULIN GLARGINE NA 4604 4604 Carrier J 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 298 0.074 14 51.6 65 233 TIRZEPATIDE NA 4605 4605 Carrier J 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 295 0.519 9.8 134.8 129 166 OXYCODONE HCL NA 4606 4606 Carrier J 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 280 0.689 22.4 92.8 84 196 GALCANEZUMAB-GNLM NA 4607 4607 Carrier J 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 277 0.534 15.4 127.6 90 187 HYDROCODONE-ACETAMINOPHEN NA 4608 4608 Carrier J 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 266 0.331 28.3 63.8 51 215 DUPILUMAB NA 4609 4609 Carrier J 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 245 0.004 8.1 48.4 44 201 SEMAGLUTIDE NA 4610 4610 Carrier J 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 239 0.77 8.4 34.1 48 191 ETANERCEPT NA 4611 4611 Carrier J 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 1.7 34.7 2 5 TAFLUPROST NA 4612 4612 Carrier J 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 6 1 8.2 6 0 OSIMERTINIB MESYLATE NA 4613 4613 Carrier J 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 5 1 12.3 27.4 4 1 DABRAFENIB MESYLATE NA 4614 4614 Carrier J 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 5 1 14.6 28.9 1 4 TERIPARATIDE (RECOMBINANT) NA 4615 4615 Carrier J 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 5 1 1.8 69.4 4 1 IBRUTINIB NA 4616 4616 Carrier J 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 3 1 10.8 2.9 2 1 ANAKINRA NA 4617 4617 Carrier J 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 2 1 20.6 2 0 NINTEDANIB ESYLATE NA 4618 4618 Carrier J 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 2 1 27.7 2 0 REGORAFENIB NA 4619 4619 Carrier J 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 2 1 48.4 0 2 ABALOPARATIDE NA 4620 4620 Carrier J 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 1 1 50.9 0 1 DEUCRAVACITINIB NA 4621 4621 Carrier J 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 1 22.5 24.5 1 1 ALPELISIB NA 4622 4622 Carrier J 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 7 1 12.7 2 0 TRAMETINIB DIMETHYL SULFOXIDE NA 4623 4623 Carrier J 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 1 154.1 0 2 INSULIN GLULISINE NA 4624 4624 Carrier J 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 31 0.667 3.2 187.8 1 1 ABEMACICLIB NA 4625 4625 Carrier J 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 8 0.667 157.1 0 2 SARILUMAB NA 4626 4626 Carrier J 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 182 0.5 2.9 1 0 RISANKIZUMAB-RZAA NA 4627 4627 Carrier J 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 134 0.5 1.6 238.6 1 1 APREMILAST NA 4628 4628 Carrier J 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 32 0.5 2.4 1 0 PALBOCICLIB NA 4629 4629 Carrier J 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 16 0.5 15.9 1 0 INSULIN REGULAR (HUMAN) NA 4630 4630 Carrier J 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 12 0.5 150.1 0 1 SOFOSBUVIR-VELPATASVIR NA 4631 4631 Carrier I 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 69990 Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure) 5 0 0.084813842 5 NA NA 4632 4632 Carrier I 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 5 1 20.46583562 5 NA NA 4633 4633 Carrier I 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC J9100 Cytarabine Hcl 100 Mg Inj 4 0 0.060605 4 NA NA 4634 4634 Carrier I 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 47135 Liver allotransplantation, orthotopic, partial or whole, from cadaver or living donor, any age 4 1 2.43375 9.766398194 2 2 NA NA 4635 4635 Carrier I 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 61781 Stereotactic computer-assisted (navigational) procedure; cranial, intradural (List separately in addition to code for primary procedure) 4 0 0.084285722 4 NA NA 4636 4636 Carrier I 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99223 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded. 3 0 2.110233334 0.047420417 1 2 NA NA 4637 4637 Carrier I 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96415 Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure) 3 0 2.110233334 0.047501806 1 2 NA NA 4638 4638 Carrier I 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug 3 0 2.110233334 0.047449584 1 2 NA NA 4639 4639 Carrier I 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar 3 1 24.86217376 3 NA NA 4640 4640 Carrier I 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 3 1 21.49393272 3 NA NA 4641 4641 Carrier I 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 61519 Craniectomy for excision of brain tumor, infratentorial or posterior fossa; meningioma 3 0 0.082916389 3 NA NA 4642 4642 Carrier I 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 5 1 20.46583562 5 NA NA 4643 4643 Carrier I 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 47135 Liver allotransplantation, orthotopic, partial or whole, from cadaver or living donor, any age 4 1 2.43375 9.766398194 2 2 NA NA 4644 4644 Carrier I 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar 3 1 24.86217376 3 NA NA 4645 4645 Carrier I 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 3 1 21.49393272 3 NA NA 4646 4646 Carrier I 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 49560 Repair initial incisional or ventral hernia; reducible 2 1 121.2763403 2 NA NA 4647 4647 Carrier I 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22845 Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure) 2 1 1.415037038 2 NA NA 4648 4648 Carrier I 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 38240 Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor 1 1 6.402222223 1 NA NA 4649 4649 Carrier I 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27132 Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft 1 1 19.00441667 1 NA NA 4650 4650 Carrier I 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 1 1 2.101027778 1 NA NA 4651 4651 Carrier I 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 38205 Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; allogeneic 1 1 6.402222223 1 NA NA 4652 4652 Carrier I 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44238 Unlisted laparoscopy procedure, intestine (except rectum) 1 1 145.4329417 1 NA NA 4653 4653 Carrier I 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15769 Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia) 1 1 1.174722223 1 NA NA 4654 4654 Carrier I 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) 1 1 2.101027778 1 NA NA 4655 4655 Carrier I 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 49654 Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); reducible 1 1 14.82840278 1 NA NA 4656 4656 Carrier I 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) 1 1 26.49525639 1 NA NA 4657 4657 Carrier I 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22614 Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure) 1 1 26.49525639 1 NA NA 4658 4658 Carrier I 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63051 Laminoplasty, cervical, with decompression of the spinal cord, 2 or more vertebral segments; with reconstruction of the posterior bony elements (including the application of bridging bone graft and non-segmental fixation devices [eg, wire, suture, mini-plates], when performed) 1 1 0.043055556 1 NA NA 4659 4659 Carrier I 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63052 Laminectomy, facetectomy, or foraminotomy with lumbar decompression of spinal cord, cauda equina and/or nerve root during posterior interbody arthrodesis, single segment 1 1 23.81538417 1 NA NA 4660 4660 Carrier I 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63030 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar 1 1 26.49525639 1 NA NA 4661 4661 Carrier I 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63045 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; cervical 1 1 0.043055556 1 NA NA 4662 4662 Carrier I 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar 1 1 2.101027778 1 NA NA 4663 4663 Carrier I 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63048 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; each additional segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure) 1 1 2.101027778 1 NA NA 4664 4664 Carrier I 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63200 Laminectomy, with release of tethered spinal cord, lumbar 1 1 23.00301861 1 NA NA 4665 4665 Carrier I 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22551 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2 1 1 0.043055556 1 NA NA 4666 4666 Carrier I 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74176 CT abd & pelvis 186 0.91 3.457180484 72 186 1 NA NA 4667 4667 Carrier I 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 ECHO, transthoracic w/doppler, complete 185 0.93 5.466368528 185 NA NA 4668 4668 Carrier I 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 MRI, lower extremity any joint; wo contr 168 0.74 11.37845238 168 NA NA 4669 4669 Carrier I 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 MRI of brain and further sequences 135 0.93 6.374585346 2016 135 1 NA NA 4670 4670 Carrier I 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0399 Home sleep test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation 122 0.9 4.890858175 122 NA NA 4671 4671 Carrier I 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72148 MRI of lumbar spine 115 0.79 8.113943495 2400 115 1 NA NA 4672 4672 Carrier I 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 71250 DIAGNOSTIC CT THORAX W/O CNTRST 85 0.91 3.865003087 85 NA NA 4673 4673 Carrier I 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73221 MRI, any joint of upper extremity; wo co 78 0.76 11.34610776 78 NA NA 4674 4674 Carrier I 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70551 MRI of brain 66 0.85 7.230772947 66 NA NA 4675 4675 Carrier I 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93307 ECHO, transthoracic, heart, complete 64 0.97 10.20146032 64 NA NA 4676 4676 Carrier I 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 71260 DIAGNOSTIC CT THORAX W/CONTRAST 64 0.95 1.650824916 64 NA NA 4677 4677 Carrier I 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70491 Contrast CAT scan of neck tissue 19 1 7.883347953 19 NA NA 4678 4678 Carrier I 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 74177 CT abd & pelv w contrast 17 1 0.028070988 17 NA NA 4679 4679 Carrier I 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70544 MRA, head, w/o contrast 12 1 5.519935897 12 NA NA 4680 4680 Carrier I 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72157 MRI of thoracic spine 11 1 2.283383838 2016 11 1 NA NA 4681 4681 Carrier I 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70543 MRI orb/fc/nck w/o cntrst flwd cntr 8 1 15.97277778 8 NA NA 4682 4682 Carrier I 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 73223 MRI upr ext jnt w/o cntrst flwd cnt 7 1 14.35349206 7 NA NA 4683 4683 Carrier I 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77301 Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications 7 1 7.47025993 32.80474069 5 2 NA NA 4684 4684 Carrier I 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29827 Arthroscopy, shoulder, surgical; with rotator cuff repair 7 1 8.094536684 2520 7 1 NA NA 4685 4685 Carrier I 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 74181 MRI, abdomen; wo contrast material(s) 7 1 11.34635417 7 NA NA 4686 4686 Carrier I 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64491 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; second level (List separately in addition to code for primary procedure) 7 1 4.021460039 7 NA NA 4687 4687 Carrier I 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29823 Arthroscopy, shoulder, surgical; debridement, extensive, 3 or more discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular si 7 1 14.4030581 7 NA NA 4688 4688 Carrier I 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77338 Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per IMRT plan 7 1 7.47025993 32.80474069 5 2 NA NA 4689 4689 Carrier I 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 93350 Stress ECHO exam of heart 25 0.04 17.4485 25 NA NA 4690 4690 Carrier I 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 77049 MRI breast bilateral C-/+ w/CAD 39 0.03 10.82368056 39 NA NA 4691 4691 Carrier I 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 73221 MRI, any joint of upper extremity; wo co 78 0.01 11.34610776 78 NA NA 4692 4692 Carrier I 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 70553 MRI of brain and further sequences 135 0.01 6.374585346 2016 135 1 NA NA 4693 4693 Carrier I 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 73721 MRI, lower extremity any joint; wo contr 168 0.01 11.37845238 168 NA NA 4694 4694 Carrier I 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1002 Residential treatment, Substance Use Disorder 18 1 31.55648576 18 NA NA 4695 4695 Carrier I 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1001 Residential treatment, Psychiatric 5 1 63.93583333 5 NA NA 4696 4696 Carrier I 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 Room and board, Semi-Private, Psychiatric 3 1 1.971944445 12.63392264 1 2 NA NA 4697 4697 Carrier I 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1002 Residential treatment, Substance Use Disorder 18 1 31.55648576 18 NA NA 4698 4698 Carrier I 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1001 Residential treatment, Psychiatric 5 1 63.93583333 5 NA NA 4699 4699 Carrier I 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 Room and board, Semi-Private, Psychiatric 3 1 1.971944445 12.63392264 1 2 NA NA 4700 4700 Carrier I 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 12 1 83.13438671 12 NA NA 4701 4701 Carrier I 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H2036 Alcohol and/or other drug treatment program, per diem 11 1 26.97784694 11 NA NA 4702 4702 Carrier I 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 19350 Nipple/areola reconstruction 6 1 18.36854273 6 NA NA 4703 4703 Carrier I 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 19303 Mastectomy, simple, complete 6 1 18.36854213 6 NA NA 4704 4704 Carrier I 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 5 1 25.58472222 12.44678222 1 4 NA NA 4705 4705 Carrier I 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 5 1 25.58472222 12.44678222 1 4 NA NA 4706 4706 Carrier I 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 5 1 25.58472222 12.44678104 1 4 NA NA 4707 4707 Carrier I 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 Mental Health Partial Hospitalization, Treatment, Less Than 24 Hours 5 0.8 36.59735794 5 NA NA 4708 4708 Carrier I 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 MRI of brain and further sequences 4 1 0.000208333 4 NA NA 4709 4709 Carrier I 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 71271 Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s) 2 1 0.000277776 2 NA NA 4710 4710 Carrier I 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 17999 Unlisted procedure, skin, mucous membrane and subcutaneous tissue 2 0.5 45.86353792 2 NA NA 4711 4711 Carrier I 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 19318 Breast reduction 2 1 123.1842619 2 NA NA 4712 4712 Carrier I 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 12 1 83.13438671 12 NA NA 4713 4713 Carrier I 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H2036 Alcohol and/or other drug treatment program, per diem 11 1 26.97784694 11 NA NA 4714 4714 Carrier I 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19350 Nipple/areola reconstruction 6 1 18.36854273 6 NA NA 4715 4715 Carrier I 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19303 Mastectomy, simple, complete 6 1 18.36854213 6 NA NA 4716 4716 Carrier I 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 5 1 25.58472222 12.44678222 1 4 NA NA 4717 4717 Carrier I 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 5 1 25.58472222 12.44678222 1 4 NA NA 4718 4718 Carrier I 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 5 1 25.58472222 12.44678104 1 4 NA NA 4719 4719 Carrier I 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70553 MRI of brain and further sequences 4 1 0.000208333 4 NA NA 4720 4720 Carrier I 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 71271 Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s) 2 1 0.000277776 2 NA NA 4721 4721 Carrier I 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19318 Breast reduction 2 1 123.1842619 2 NA NA 4722 4722 Carrier I 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 Continuous airway pressure (CPAP) device [may be used for either CPAP or APAP] 281 0.95 1.995146947 281 NA NA 4723 4723 Carrier I 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 19 0.89 6.461608187 19 NA NA 4724 4724 Carrier I 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0108 W/C Component-Accessory Nos 5 0.4 81.35809017 5 NA NA 4725 4725 Carrier I 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate 4 1 0.000138889 4 NA NA 4726 4726 Carrier I 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0960 Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware 3 0 23.18757065 3 NA NA 4727 4727 Carrier I 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0739 Repair/svc DME non-oxygen eq 3 0 21.67603333 3 NA NA 4728 4728 Carrier I 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0955 Wheelchair accessory, headrest, cushioned, prefabricated, including fixed mounting hardware, each 3 0 23.18753028 3 NA NA 4729 4729 Carrier I 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1399 Durable Medical Equipment Mi 3 0 40.84433056 61.47392361 1 2 NA NA 4730 4730 Carrier I 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2607 Skin pro/pos wc cus wd <22in 2 0 32.47239861 2 NA NA 4731 4731 Carrier I 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2620 WC planar back cush wd <22in 2 0 0.044263472 2 NA NA 4732 4732 Carrier I 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0978 Wheelchair Belt W/Airplane B 2 0 34.77837083 2 NA NA 4733 4733 Carrier I 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1028 Wheelchair accessory, manual swingaway, retractable or removable mounting hardware 2 0 32.47245278 2 NA NA 4734 4734 Carrier I 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate 4 1 0.000138889 4 NA NA 4735 4735 Carrier I 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0760 Osteogen Ultrasound Stimltor 1 1 133.9513889 1 NA NA 4736 4736 Carrier I 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0601 Continuous airway pressure (CPAP) device [may be used for either CPAP or APAP] 281 0.95 1.995146947 281 NA NA 4737 4737 Carrier I 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 19 0.89 6.461608187 19 NA NA 4738 4738 Carrier I 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0108 W/C Component-Accessory Nos 5 0.4 81.35809017 5 NA NA 4739 4739 Carrier I 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0960 Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware 3 0 23.18757065 3 NA NA 4740 4740 Carrier I 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0739 Repair/svc DME non-oxygen eq 3 0 21.67603333 3 NA NA 4741 4741 Carrier I 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0955 Wheelchair accessory, headrest, cushioned, prefabricated, including fixed mounting hardware, each 3 0 23.18753028 3 NA NA 4742 4742 Carrier I 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1399 Durable Medical Equipment Mi 3 0 40.84433056 61.47392361 1 2 NA NA 4743 4743 Carrier I 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2607 Skin pro/pos wc cus wd <22in 2 0 32.47239861 2 NA NA 4744 4744 Carrier I 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2620 WC planar back cush wd <22in 2 0 0.044263472 2 NA NA 4745 4745 Carrier I 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0978 Wheelchair Belt W/Airplane B 2 0 34.77837083 2 NA NA 4746 4746 Carrier I 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1028 Wheelchair accessory, manual swingaway, retractable or removable mounting hardware 2 0 32.47245278 2 NA NA 4747 4747 Carrier I 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 12 0.58 0.614080555 26.50367164 1 11 NA NA 4748 4748 Carrier I 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 12 0.58 0.614080555 26.50367164 1 11 NA NA 4749 4749 Carrier I 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 39 0.846 2.1 60.7 9 30 ADALIMUMAB NA 4750 4750 Carrier I 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 26 0 3.8 13.6 5 21 RIMEGEPANT SULFATE NA 4751 4751 Carrier I 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 25 0.8 2 128 1 24 CYCLOSPORINE (OPHTH) NA 4752 4752 Carrier I 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 21 0.857 5.8 36.1 5 16 ETANERCEPT NA 4753 4753 Carrier I 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 20 0.25 21.2 45.2 9 11 RIFAXIMIN NA 4754 4754 Carrier I 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 20 0.6 6.2 554.9 3 17 RISANKIZUMAB-RZAA NA 4755 4755 Carrier I 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 18 0.278 21.6 36.2 4 14 DUPILUMAB NA 4756 4756 Carrier I 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 18 0.5 23.9 142 7 11 HYDROCODONE-ACETAMINOPHEN NA 4757 4757 Carrier I 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 17 0.706 45.2 52.5 1 16 GALCANEZUMAB-GNLM NA 4758 4758 Carrier I 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 16 0 1.1 12.3 1 15 UBROGEPANT NA 4759 4759 Carrier I 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 40.1 0 8 LIFITEGRAST NA 4760 4760 Carrier I 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 6 1 13.5 0 6 GUSELKUMAB NA 4761 4761 Carrier I 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 3 1 9.7 25.8 2 1 MORPHINE SULFATE NA 4762 4762 Carrier I 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 3 1 56 0 3 LEVALBUTEROL TARTRATE NA 4763 4763 Carrier I 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 3 1 41.1 0 3 ELEXACAFTOR-TEZACAFTOR-IVACAFTOR NA 4764 4764 Carrier I 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 2 1 2.2 66.6 1 1 HYDROCODONE BITARTRATE NA 4765 4765 Carrier I 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 2 1 613.9 0 2 TERIPARATIDE (RECOMBINANT) NA 4766 4766 Carrier I 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 2 1 23.3 0 2 ALIROCUMAB NA 4767 4767 Carrier I 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 1 1 64.6 0 1 TUCATINIB NA 4768 4768 Carrier I 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 1 1 45.2 0 1 FENTANYL NA 4769 4769 Carrier I 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 1 19.5 1 0 TOCILIZUMAB NA 4770 4770 Carrier I 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 44.2 1 0 IVABRADINE HCL NA 4771 4771 Carrier I 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 0.5 2.2 1 0 ABEMACICLIB NA 4772 4772 Carrier I 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 17 0.25 2.2 1 0 GALCANEZUMAB-GNLM NA 4773 4773 Carrier I 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 18 0.2 24.3 0 1 HYDROCODONE-ACETAMINOPHEN NA 4774 4774 Carrier I 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 20 0.1 329.7 0 1 RIFAXIMIN NA 4775 4775 Carrier A 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 7 0.71 2.791348054 70.39001822 1 6 NA NA 4776 4776 Carrier A 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 7 0.86 2.791348054 111.0486359 1 6 NA NA 4777 4777 Carrier A 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 6 0.83 2.791348054 77.45881962 1 5 NA NA 4778 4778 Carrier A 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar 5 1 2.791348054 117.0430522 1 4 NA NA 4779 4779 Carrier A 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) 5 1 2.791348054 78.1373829 1 4 NA NA 4780 4780 Carrier A 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 55866 Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed 4 0 18.41237042 4 NA NA 4781 4781 Carrier A 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44620 Closure of enterostomy, large or small intestine; 4 0 0.0869125 0.7616 2 2 NA NA 4782 4782 Carrier A 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22802 Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to 12 vertebral segments 3 0.67 69.37639917 3 NA NA 4783 4783 Carrier A 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC S2068 Breast DIEP flag reconstruct 3 0 0.086522222 0.785751388 1 2 NA NA 4784 4784 Carrier A 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 11971 Removal of tissue expander without insertion of implant 3 0 0.0866175 0.788512082 1 2 NA NA 4785 4785 Carrier A 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43280 Laparoscopy, surgical, esophagogastric fundoplasty (eg, Nissen, Toupet procedures) 3 0.67 139.3575947 3 NA NA 4786 4786 Carrier A 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 49000 Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure) 3 0 0.080127778 0.764777778 1 2 NA NA 4787 4787 Carrier A 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) 3 0.67 49.1706165 3 NA NA 4788 4788 Carrier A 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 49568 Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) 3 0 0.086561112 0.78579861 1 2 NA NA 4789 4789 Carrier A 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar 5 1 2.791348054 117.0430522 1 4 NA NA 4790 4790 Carrier A 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) 5 1 2.791348054 78.1373829 1 4 NA NA 4791 4791 Carrier A 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 20931 Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure) 2 1 2.791348054 289.3120186 1 1 NA NA 4792 4792 Carrier A 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27486 Revision of total knee arthroplasty, with or without allograft; 1 component 1 1 115.2717814 1 NA NA 4793 4793 Carrier A 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27487 Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component 1 1 115.2717814 1 NA NA 4794 4794 Carrier A 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 37215 Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection 1 1 0.694999999 1 NA NA 4795 4795 Carrier A 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63030 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar 1 1 93.06694444 1 NA NA 4796 4796 Carrier A 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22610 Arthrodesis, posterior or posterolateral technique, single level; thoracic (with lateral transverse technique, when performed) 1 1 97.46275917 1 NA NA 4797 4797 Carrier A 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar 1 1 289.3120186 1 NA NA 4798 4798 Carrier A 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63001 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; cervical 1 1 103.8729481 1 NA NA 4799 4799 Carrier A 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63045 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; cervical 1 1 0.138055555 1 NA NA 4800 4800 Carrier A 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63048 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; each additional segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure) 1 1 289.3120186 1 NA NA 4801 4801 Carrier A 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22830 Exploration of spinal fusion 1 1 97.46275917 1 NA NA 4802 4802 Carrier A 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 47370 Laparoscopy, surgical, ablation of 1 or more liver tumor(s); radiofrequency 1 1 0.015 1 NA NA 4803 4803 Carrier A 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22843 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments (List separately in addition to code for primary procedure) 1 1 101.6552175 1 NA NA 4804 4804 Carrier A 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 49565 Repair recurrent incisional or ventral hernia; reducible 1 1 18.58944444 1 NA NA 4805 4805 Carrier A 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63051 Laminoplasty, cervical, with decompression of the spinal cord, 2 or more vertebral segments; with reconstruction of the posterior bony elements (including the application of bridging bone graft and non-segmental fixation devices [eg, wire, suture, mini-plates], when performed) 1 1 0.138055555 1 NA NA 4806 4806 Carrier A 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 376 0.7 16.8683212 840 376 2 NA NA 4807 4807 Carrier A 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97140 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes 371 0.71 16.56013626 960 371 1 NA NA 4808 4808 Carrier A 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 275 0.67 19.31818752 720 275 1 NA NA 4809 4809 Carrier A 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 ECHO, transthoracic w/doppler, complete 263 0.9 7.545336257 4536 263 1 NA NA 4810 4810 Carrier A 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97112 Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities 236 0.63 19.74551118 720 236 1 NA NA 4811 4811 Carrier A 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 MRI, lower extremity any joint; wo contr 235 0.89 20.66222222 5.891002268 960 1 234 1 NA NA 4812 4812 Carrier A 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74176 CT abd & pelvis 217 0.92 0.072777778 6.737107843 1632 1 216 1 NA NA 4813 4813 Carrier A 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72148 MRI of lumbar spine 151 0.84 8.820283224 151 NA NA 4814 4814 Carrier A 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 MRI of brain and further sequences 136 0.95 4.436449716 136 NA NA 4815 4815 Carrier A 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0399 Home sleep test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation 135 0.97 4.253513072 135 NA NA 4816 4816 Carrier A 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72156 MRI of cervical spine 28 1 1.575935185 28 NA NA 4817 4817 Carrier A 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72157 MRI of thoracic spine 17 1 0.037679739 17 NA NA 4818 4818 Carrier A 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93303 ECHO, transthoracic, complete cng 16 1 2.667864584 16 NA NA 4819 4819 Carrier A 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29823 Arthroscopy, shoulder, surgical; debridement, extensive, 3 or more discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular si 15 1 57.91622694 15 NA NA 4820 4820 Carrier A 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81162 BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and full duplication/deletion analysis (ie, detection of large gene rearrangements) 11 1 18.944518 11 NA NA 4821 4821 Carrier A 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77338 Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per IMRT plan 11 1 0.985416666 7.284476667 2 9 NA NA 4822 4822 Carrier A 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77301 Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications 10 1 0.985277778 7.874306945 2 8 NA NA 4823 4823 Carrier A 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70480 CT, orbit, sella or pos fos wo contrast 10 1 1.978555555 10 NA NA 4824 4824 Carrier A 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70498 CTA, neck, w/o cntrst flwd by cntrst 10 1 3.707416667 10 NA NA 4825 4825 Carrier A 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70543 MRI orb/fc/nck w/o cntrst flwd cntr 10 1 6.893388889 10 NA NA 4826 4826 Carrier A 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L8614 Cochlear implant system 1 1 674.5363889 1 NA NA 4827 4827 Carrier A 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 69930 Cochlear device implantation, with or without mastoidectomy 1 1 674.5363889 1 NA NA 4828 4828 Carrier A 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 73721 MRI, lower extremity any joint; wo contr 235 0.01 20.66222222 5.891002268 960 1 234 1 NA NA 4829 4829 Carrier A 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 72148 MRI of lumbar spine 151 0.01 8.820283224 151 NA NA 4830 4830 Carrier A 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1002 Residential treatment, Substance Use Disorder 3 1 31.80842593 3 NA NA 4831 4831 Carrier A 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0011 Alcohol And/Or Drug Services 1 0 11.98046111 1 NA NA 4832 4832 Carrier A 2022 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1001 Residential treatment, Psychiatric 1 0 138.8416667 1 NA NA 4833 4833 Carrier A 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1002 Residential treatment, Substance Use Disorder 3 1 31.80842593 3 NA NA 4834 4834 Carrier A 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0011 Alcohol And/Or Drug Services 1 0 11.98046111 1 NA NA 4835 4835 Carrier A 2022 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1001 Residential treatment, Psychiatric 1 0 138.8416667 1 NA NA 4836 4836 Carrier A 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 71271 Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s) 32 0.88 4.858012153 32 NA NA 4837 4837 Carrier A 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual 15 0.6 30.65467244 15 NA NA 4838 4838 Carrier A 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 8 0.88 20.65861028 9.896249603 1 7 NA NA 4839 4839 Carrier A 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 70551 MRI of brain 4 0.75 12.01145833 4 NA NA 4840 4840 Carrier A 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 4 0.5 42.90027778 56.57980991 1 3 NA NA 4841 4841 Carrier A 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 4 0.5 42.90027778 56.5799025 1 3 NA NA 4842 4842 Carrier A 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 3 0.67 42.90027778 23.61735375 1 2 NA NA 4843 4843 Carrier A 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 Mental Health Partial Hospitalization, Treatment, Less Than 24 Hours 3 1 44.39453704 3 NA NA 4844 4844 Carrier A 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90834 Psychotherapy, 45 minutes with patient 2 0 25.08706903 2 NA NA 4845 4845 Carrier A 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 2 1 44.20490278 2 NA NA 4846 4846 Carrier A 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H2036 Alcohol and/or other drug treatment program, per diem 2 1 14.23416667 14.68944444 1 1 NA NA 4847 4847 Carrier A 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90853 Group psychotherapy (other than of a multiple-family group) 2 0 25.08706903 2 NA NA 4848 4848 Carrier A 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90847 Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes 2 0 25.08706903 2 NA NA 4849 4849 Carrier A 2022 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97113 Therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with therapeutic exercises 2 1 44.20490278 2 NA NA 4850 4850 Carrier A 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0035 Mental Health Partial Hospitalization, Treatment, Less Than 24 Hours 3 1 44.39453704 3 NA NA 4851 4851 Carrier A 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 2 1 44.20490278 2 NA NA 4852 4852 Carrier A 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H2036 Alcohol and/or other drug treatment program, per diem 2 1 14.23416667 14.68944444 1 1 NA NA 4853 4853 Carrier A 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97113 Therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with therapeutic exercises 2 1 44.20490278 2 NA NA 4854 4854 Carrier A 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S9131 Physical therapy, in the home, per diem 1 1 0.442930555 1 NA NA 4855 4855 Carrier A 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70450 CT, head or brain wo contrast 1 1 0 1 NA NA 4856 4856 Carrier A 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 71271 Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s) 32 0.88 4.858012153 32 NA NA 4857 4857 Carrier A 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 8 0.88 20.65861028 9.896249603 1 7 NA NA 4858 4858 Carrier A 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70551 MRI of brain 4 0.75 12.01145833 4 NA NA 4859 4859 Carrier A 2022 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 3 0.67 42.90027778 23.61735375 1 2 NA NA 4860 4860 Carrier A 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 Continuous airway pressure (CPAP) device [may be used for either CPAP or APAP] 245 0.94 2.69965873 245 NA NA 4861 4861 Carrier A 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 14 1 0.041626984 14 NA NA 4862 4862 Carrier A 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate 8 0.88 3.344930555 8 NA NA 4863 4863 Carrier A 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2402 Negative pressure wound therapy electrical pump, stationary or portable 5 0.4 68.2403285 5 NA NA 4864 4864 Carrier A 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0748 Elec Osteogen Stim Spinal 4 0.5 40.2791625 4 NA NA 4865 4865 Carrier A 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1399 Durable Medical Equipment Mi 3 0 130.2526389 3 NA NA 4866 4866 Carrier A 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0108 W/C Component-Accessory Nos 3 0 52.96021167 3 NA NA 4867 4867 Carrier A 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0747 Elec Osteogen Stim Not Spine 3 0 48.99296296 3 NA NA 4868 4868 Carrier A 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0760 Osteogen Ultrasound Stimltor 3 0 129.1766667 3 NA NA 4869 4869 Carrier A 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0040 Adjustable Angle Footplate 2 0 2.362090834 2 NA NA 4870 4870 Carrier A 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0971 Wheelchair Anti-Tipping Devi 2 0 2.362090834 2 NA NA 4871 4871 Carrier A 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0961 Wheelchair Brake Extension 2 0 2.362090834 2 NA NA 4872 4872 Carrier A 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0978 Wheelchair Belt W/Airplane B 2 0 2.362368611 2 NA NA 4873 4873 Carrier A 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0637 Combination sit to stand system, any size, with seat lift feature, with or without wheels 2 0 3.269207362 2 NA NA 4874 4874 Carrier A 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0955 Wheelchair accessory, headrest, cushioned, prefabricated, including fixed mounting hardware, each 2 0 2.362368611 2 NA NA 4875 4875 Carrier A 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1028 Wheelchair accessory, manual swingaway, retractable or removable mounting hardware 2 0 2.362229723 2 NA NA 4876 4876 Carrier A 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 14 1 0.041626984 14 NA NA 4877 4877 Carrier A 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0601 Continuous airway pressure (CPAP) device [may be used for either CPAP or APAP] 245 0.94 2.69965873 245 NA NA 4878 4878 Carrier A 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate 8 0.88 3.344930555 8 NA NA 4879 4879 Carrier A 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0748 Elec Osteogen Stim Spinal 4 0.5 40.2791625 4 NA NA 4880 4880 Carrier A 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2402 Negative pressure wound therapy electrical pump, stationary or portable 5 0.4 68.2403285 5 NA NA 4881 4881 Carrier A 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1399 Durable Medical Equipment Mi 3 0 130.2526389 3 NA NA 4882 4882 Carrier A 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0108 W/C Component-Accessory Nos 3 0 52.96021167 3 NA NA 4883 4883 Carrier A 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0747 Elec Osteogen Stim Not Spine 3 0 48.99296296 3 NA NA 4884 4884 Carrier A 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0760 Osteogen Ultrasound Stimltor 3 0 129.1766667 3 NA NA 4885 4885 Carrier A 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0040 Adjustable Angle Footplate 2 0 2.362090834 2 NA NA 4886 4886 Carrier A 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0971 Wheelchair Anti-Tipping Devi 2 0 2.362090834 2 NA NA 4887 4887 Carrier A 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0961 Wheelchair Brake Extension 2 0 2.362090834 2 NA NA 4888 4888 Carrier A 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0978 Wheelchair Belt W/Airplane B 2 0 2.362368611 2 NA NA 4889 4889 Carrier A 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0637 Combination sit to stand system, any size, with seat lift feature, with or without wheels 2 0 3.269207362 2 NA NA 4890 4890 Carrier A 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0955 Wheelchair accessory, headrest, cushioned, prefabricated, including fixed mounting hardware, each 2 0 2.362368611 2 NA NA 4891 4891 Carrier A 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1028 Wheelchair accessory, manual swingaway, retractable or removable mounting hardware 2 0 2.362229723 2 NA NA 4892 4892 Carrier A 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 10 1 14.01482231 10 NA NA 4893 4893 Carrier A 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4230 Infus Insulin Pump Non Needl 3 0 1.194520648 3 NA NA 4894 4894 Carrier A 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4232 Syringe W/Needle Insulin 3cc 3 0 1.194530834 3 NA NA 4895 4895 Carrier A 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9277 Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system 2 0 0.086330557 2 NA NA 4896 4896 Carrier A 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply 2 0 0.086365278 2 NA NA 4897 4897 Carrier A 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 10 1 14.01482231 10 NA NA 4898 4898 Carrier A 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4230 Infus Insulin Pump Non Needl 3 0 1.194520648 3 NA NA 4899 4899 Carrier A 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4232 Syringe W/Needle Insulin 3cc 3 0 1.194530834 3 NA NA 4900 4900 Carrier A 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9277 Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system 2 0 0.086330557 2 NA NA 4901 4901 Carrier A 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply 2 0 0.086365278 2 NA NA 4902 4902 Carrier A 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 68 0.853 12.6 39.2 8 60 ADALIMUMAB NA 4903 4903 Carrier A 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 50 0.68 25 33.6 3 47 CYCLOSPORINE (OPHTH) NA 4904 4904 Carrier A 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 47 0.851 9.2 26.6 20 27 INSULIN GLARGINE NA 4905 4905 Carrier A 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 31 0.581 9.9 54.2 5 26 HYDROCODONE-ACETAMINOPHEN NA 4906 4906 Carrier A 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 27 0.704 5.7 136.1 15 12 OXYCODONE W/ ACETAMINOPHEN NA 4907 4907 Carrier A 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 25 0.32 10.5 98.4 3 22 EVOLOCUMAB NA 4908 4908 Carrier A 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 25 0 22.7 48.4 1 24 TIRZEPATIDE NA 4909 4909 Carrier A 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 24 0.75 13.2 63.2 4 20 GALCANEZUMAB-GNLM NA 4910 4910 Carrier A 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 24 0.708 1.4 34.4 4 20 ETANERCEPT NA 4911 4911 Carrier A 2022 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 22 0.273 38.8 22.9 6 16 DUPILUMAB NA 4912 4912 Carrier A 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 4 1 2.9 23.6 1 3 FENTANYL NA 4913 4913 Carrier A 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 3 1 15.9 57.7 1 2 LIFITEGRAST NA 4914 4914 Carrier A 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 3 1 2.4 3 0 ACALABRUTINIB MALEATE NA 4915 4915 Carrier A 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 2 1 86.6 0 2 MAVACAMTEN NA 4916 4916 Carrier A 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 2 1 1.9 2 0 CANNABIDIOL NA 4917 4917 Carrier A 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 2 1 17.3 19.7 1 1 CANAGLIFLOZIN-METFORMIN HCL NA 4918 4918 Carrier A 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 2 1 31.8 0 2 INSULIN ASPART (WITH NIACINAMIDE) NA 4919 4919 Carrier A 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 2 1 16.1 45 1 1 ABALOPARATIDE NA 4920 4920 Carrier A 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 2 1 309.4 0 2 ELAGOLIX SODIUM NA 4921 4921 Carrier A 2022 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 2 1 56.7 0 2 TERIPARATIDE (RECOMBINANT) NA 4922 4922 Carrier A 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 222.9 1 0 SELEXIPAG NA 4923 4923 Carrier A 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 5.3 1 0 GLYCOPYRRONIUM TOSYLATE NA 4924 4924 Carrier A 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 23.9 1 0 ANAKINRA NA 4925 4925 Carrier A 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 24 0.667 83.8 0 2 GALCANEZUMAB-GNLM NA 4926 4926 Carrier A 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 13 0.5 234.6 0 1 ERENUMAB-AOOE NA 4927 4927 Carrier A 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 50 0.167 141.8 0 1 CYCLOSPORINE (OPHTH) NA 4928 4928 Carrier A 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 25 0.154 25.1 312.6 1 1 EVOLOCUMAB NA 4929 4929 Carrier L 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95716 Electroencephalogram with video (VEEG), review of data, technical description by EEG technologist, each increment of 12-26 hours; with continuous, real-time monitoring and maintenance 5 0.2 151.7 0 5 NA NA 4930 4930 Carrier L 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 19364 Breast reconstruction; with free flap� 4 1 49.2 0 4 NA NA 4931 4931 Carrier L 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 55866 Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed 4 1 69.6 0 4 NA NA 4932 4932 Carrier L 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s) 4 1 76.6 0 4 NA NA 4933 4933 Carrier L 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95720 Electroencephalogram (EEG), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, each increment of greater than 12 hours, up to 26 hours of EEG recording, interpretation and report after each 24-hour period; with video (VEEG) 4 0 189.5 0 4 NA NA 4934 4934 Carrier L 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 38571 Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy 3 1 92.6 0 3 NA NA 4935 4935 Carrier L 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58571 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) 3 1 379.8 0 3 NA NA 4936 4936 Carrier L 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 15860 Intravenous injection of agent (eg, fluorescein) to test vascular flow in flap or graft� 2 1 14.2 0 2 NA NA 4937 4937 Carrier L 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 21743 Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy 2 0 131.2 0 2 NA NA 4938 4938 Carrier L 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 32666 Thoracoscopy, surgical; with therapeutic wedge resection (eg, mass, nodule), initial unilateral 2 1 22.7 143.5 1 1 NA NA 4939 4939 Carrier L 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 33361 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach 2 0.5 67.3 134.2 1 1 NA NA 4940 4940 Carrier L 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 33362 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach 2 0.5 83.1 1 1 NA NA 4941 4941 Carrier L 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 38570 Laparoscopy, surgical; with retroperitoneal lymph node sampling (biopsy), single or multiple 2 1 490.3 0 2 NA NA 4942 4942 Carrier L 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 38900 Intraoperative identification (eg, mapping) of sentinel lymph node(s), includes injection of non-radioactive dye, when performed (List separately in addition to code for primary procedure) 2 1 490.3 0 2 NA NA 4943 4943 Carrier L 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44207 Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis)� 2 1 102.1 0 2 NA NA 4944 4944 Carrier L 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 49568 mplantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) 2 1 95.6 0 2 NA NA 4945 4945 Carrier L 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19364 Breast reconstruction; with free flap� 4 1 49.2 0 4 NA NA 4946 4946 Carrier L 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 55866 Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed 4 1 69.6 0 4 NA NA 4947 4947 Carrier L 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s) 4 1 76.6 0 4 NA NA 4948 4948 Carrier L 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 38571 Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy 3 1 92.6 0 3 NA NA 4949 4949 Carrier L 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58571 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) 3 1 379.8 0 3 NA NA 4950 4950 Carrier L 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15860 Intravenous injection of agent (eg, fluorescein) to test vascular flow in flap or graft� 2 1 14.2 0 2 NA NA 4951 4951 Carrier L 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 32666 Thoracoscopy, surgical; with therapeutic wedge resection (eg, mass, nodule), initial unilateral 2 1 22.7 143.5 1 1 NA NA 4952 4952 Carrier L 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 38570 Laparoscopy, surgical; with retroperitoneal lymph node sampling (biopsy), single or multiple 2 1 490.3 0 2 NA NA 4953 4953 Carrier L 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 38900 Intraoperative identification (eg, mapping) of sentinel lymph node(s), includes injection of non-radioactive dye, when performed (List separately in addition to code for primary procedure) 2 1 490.3 0 2 NA NA 4954 4954 Carrier L 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44207 Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis)� 2 1 102.1 0 2 NA NA 4955 4955 Carrier L 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 49568 mplantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) 2 1 95.6 0 2 NA NA 4956 4956 Carrier L 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 Colonoscopy, flexible; with biopsy, single or multiple 265 0.84 26.4 35.8 2 263 NA NA 4957 4957 Carrier L 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 264 0.82 32.4 37.2 3 261 NA NA 4958 4958 Carrier L 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique� 219 0.84 52.5 39.8 1 218 NA NA 4959 4959 Carrier L 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45384 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps 129 0.82 19.3 2 129 NA NA 4960 4960 Carrier L 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 91 1 0.1 2.8 1 90 NA NA 4961 4961 Carrier L 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple 90 1 0.1 2.2 3 87 NA NA 4962 4962 Carrier L 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 81479 Unlisted molecular pathology procedure 87 0.91 20.2 87 NA NA 4963 4963 Carrier L 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95810 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist 58 0.55 62 58 NA NA 4964 4964 Carrier L 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk 53 0.7 52.5 26.6 1 52 NA NA 4965 4965 Carrier L 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95811 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist 43 0.51 55 43 NA NA 4966 4966 Carrier L 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 91 1 0.1 2.8 1 90 NA NA 4967 4967 Carrier L 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple 90 1 0.1 2.2 3 87 NA NA 4968 4968 Carrier L 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43249 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter) 26 1 0.1 1.9 1 25 NA NA 4969 4969 Carrier L 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43248 Esophagogastroduodenoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) through esophagus over guide wire 25 1 1.8 25 NA NA 4970 4970 Carrier L 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 52356 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (eg, Gibbons or double-J type)� 23 1 0.2 0.1 10 13 NA NA 4971 4971 Carrier L 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 87799 Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; quantification, each organism 22 1 0.2 22 NA NA 4972 4972 Carrier L 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D and C 21 1 9.3 2.9 2 19 NA NA 4973 4973 Carrier L 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 52442 Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; each additional permanent adjustable transprostatic implant (List separately in addition to code for primary procedure) 18 1 12.8 18 NA NA 4974 4974 Carrier L 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81256 HFE (hemochromatosis) (eg, hereditary hemochromatosis) gene analysis, common variants (eg, C282Y, H63D) 16 1 9.1 16 NA NA 4975 4975 Carrier L 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43251 Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 14 1 0.2 14 NA NA 4976 4976 Carrier L 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 52332 Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type) 14 1 0.2 0.2 3 11 NA NA 4977 4977 Carrier L 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 87798 Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism 14 1 0.2 14 NA NA 4978 4978 Carrier L 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT Z12.11 Encounter for screening for malignant neoplasm of colon 2 1 228 0 2 0 NA NA 4979 4979 Carrier L 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT F64.9 Gender identity disorder, unspecified 1 1 240 0 1 0 NA NA 4980 4980 Carrier L 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT M26.6 Temporomandibular joint disorders 1 1 456 0 1 0 NA NA 4981 4981 Carrier L 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT M47.816 Spondylosis without myelopathy or radiculopathy, lumbar region 1 1 312 0 1 0 NA NA 4982 4982 Carrier L 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT N80.01 Superficial endometriosis of the uterus 1 1 336 0 1 0 NA NA 4983 4983 Carrier L 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT n80.13 Superficial endometriosis of bilateral ovaries 1 1 336 0 1 0 NA NA 4984 4984 Carrier L 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT N93.9 Abnormal uterine and vaginal bleeding, unspecified 1 1 336 0 1 0 NA NA 4985 4985 Carrier L 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT R41.83 Borderline intellectual functioning 1 1 696 0 1 0 NA NA 4986 4986 Carrier L 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT Z91.89 Other specified personal risk factors, not elsewhere classified 1 1 648 0 1 0 NA NA 4987 4987 Carrier L 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0760 Osteogenesis stimulator, low intensity ultrasound, non-invasive 4 0.5 40.2 0 4 NA NA 4988 4988 Carrier L 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1028 Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for joystick, other control interface or positioning accessory 3 0 97.3 0 3 NA NA 4989 4989 Carrier L 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2402 Negative pressure wound therapy electrical pump, stationary or portable 3 1 92.8 0 3 NA NA 4990 4990 Carrier L 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0486 Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment 2 1 81.8 0 2 NA NA 4991 4991 Carrier L 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0747 Osteogenesis stimulator, electrical, noninvasive, other than spinal applications 2 0 103 0 2 NA NA 4992 4992 Carrier L 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0748 Osteogenesis stimulator, electrical, noninvasive, spinal applications 2 1 13.4 0 2 NA NA 4993 4993 Carrier L 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0956 Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each 2 1 97.3 0 2 NA NA 4994 4994 Carrier L 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1002 Wheelchair accessory, power seating system, tilt only 2 1 85.7 0 2 NA NA 4995 4995 Carrier L 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L0482 TLSO, triplanar control, one piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated� 2 1 57.8 0 2 NA NA 4996 4996 Carrier L 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L8691 Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each 2 1 95 0 2 NA NA 4997 4997 Carrier L 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2402 Negative pressure wound therapy electrical pump, stationary or portable 3 1 92.8 0 3 NA NA 4998 4998 Carrier L 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0486 Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment 2 1 81.8 0 2 NA NA 4999 4999 Carrier L 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0748 Osteogenesis stimulator, electrical, noninvasive, spinal applications 2 1 13.4 0 2 NA NA 5000 5000 Carrier L 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L0482 TLSO, triplanar control, one piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated� 2 1 57.8 0 2 NA NA 5001 5001 Carrier L 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8691 Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each 2 1 95 0 2 NA NA 5002 5002 Carrier L 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0978 Wheelchair accessory, positioning belt/safety belt/pelvic strap, each 1 1 49 0 1 NA NA 5003 5003 Carrier L 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1802 Dynamic adjustable forearm pronation/supination device, includes soft interface material� 1 1 0.1 0 1 NA NA 5004 5004 Carrier L 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1805 Dynamic adjustable wrist extension / flexion device, includes soft interface material� 1 1 0.1 0 1 NA NA 5005 5005 Carrier L 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2510 Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access 1 1 7.4 0 1 NA NA 5006 5006 Carrier L 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0005 Ultralightweight wheelchair� 1 1 49 0 1 NA NA 5007 5007 Carrier L 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 7 1 4.06 11.04 4 3 0 STELARA INJ 90MG/ML NA 5008 5008 Carrier L 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 5 1 1.42 11.04 3 2 0 ENBREL SRCLK INJ 50MG/ML NA 5009 5009 Carrier L 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 5 0.8 10.91 0 4 0 TALTZ INJ 80MG/ML NA 5010 5010 Carrier L 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 9 0.44 3.47 10.32 1 3 0 DUPIXENT INJ 300/2ML NA 5011 5011 Carrier L 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 5 0.8 1.31 9.51 1 3 0 NURTEC TAB 75MG ODT NA 5012 5012 Carrier L 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 1 7.25 0 3 0 AIMOVIG INJ 140MG/ML NA 5013 5013 Carrier L 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 1 2.61 11.15 1 1 0 AJOVY INJ 225/1.5 NA 5014 5014 Carrier L 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 1 9.9 0 2 0 OZEMPIC INJ 4MG/3ML NA 5015 5015 Carrier L 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 1 9.4 0 2 0 ENTRESTO TAB 24-26MG NA 5016 5016 Carrier L 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 1 6.87 0 2 0 DUPIXENT INJ 200MG NA 5017 5017 Carrier L 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 External ambulatory infusion pump, insulin 8 1 59.8 0 8 NA NA 5018 5018 Carrier L 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0553 Supply allowance for therapeutic continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service 4 0.5 25.9 37.1 1 3 NA NA 5019 5019 Carrier L 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0554 Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system� 3 0.33 25.9 43.8 1 2 NA NA 5020 5020 Carrier L 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9274 External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories 2 1 23 71.7 1 1 NA NA 5021 5021 Carrier L 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with nondurable medical equipment interstitial continuous glucose monitoring system (CGM), one unit = 1 day supply 2 0.5 109.9 0 2 NA NA 5022 5022 Carrier L 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0607 Home blood glucose monitor 2 1 23 71.7 1 1 NA NA 5023 5023 Carrier L 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9277 Transmitter; external, for use with nondurable medical equipment interstitial continuous glucose monitoring system (CGM) 1 1 95.8 0 1 NA NA 5024 5024 Carrier L 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9278 Receiver (monitor); external, for use with nondurable medical equipment interstitial continuous glucose monitoring system (CGM) 1 1 95.8 0 1 NA NA 5025 5025 Carrier L 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 External ambulatory infusion pump, insulin 8 1 59.8 0 8 NA NA 5026 5026 Carrier L 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9274 External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories 2 1 23 71.7 1 1 NA NA 5027 5027 Carrier L 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0607 Home blood glucose monitor 2 1 23 71.7 1 1 NA NA 5028 5028 Carrier L 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9277 Transmitter; external, for use with nondurable medical equipment interstitial continuous glucose monitoring system (CGM) 1 1 95.8 0 1 NA NA 5029 5029 Carrier L 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9278 Receiver (monitor); external, for use with nondurable medical equipment interstitial continuous glucose monitoring system (CGM) 1 1 95.8 0 1 NA NA 5030 5030 Carrier L 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0553 Supply allowance for therapeutic continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service 4 0.5 25.9 37.1 1 3 NA NA 5031 5031 Carrier L 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with nondurable medical equipment interstitial continuous glucose monitoring system (CGM), one unit = 1 day supply 2 0.5 109.9 0 2 NA NA 5032 5032 Carrier L 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0554 Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system� 3 0.33 25.9 43.8 1 2 NA NA 5033 5033 Carrier L 2022 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E10.65 Dexcom - - TYPE 1 DIABETES MELLITUS WITHOUT COMPLICATIONS 4 0.5 1.51 8.61 1 1 NA NA 5034 5034 Carrier L 2022 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E10.65 FreeStyle- TYPE 1 DIABETES MELLITUS WITHOUT COMPLICATIONS 4 0.25 1.59 1 0 NA NA 5035 5035 Carrier K 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); 5 0.8 0.3 58.4 1 4 NA NA 5036 5036 Carrier K 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 19364 Breast reconstruction; with free flap 3 1 43.95 3 NA NA 5037 5037 Carrier K 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 15860 Intravenous injection of agent (eg, fluorescein) to test vascular flow in flap or graft� 2 1 42 2 NA NA 5038 5038 Carrier K 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 38562 Limited lymphadenectomy for staging (separate procedure); pelvic and para-aortic 2 0.5 90.1 2 NA NA 5039 5039 Carrier K 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 38900 Intraoperative identification (eg, mapping) of sentinel lymph node(s), includes injection of non-radioactive dye, when performed (List separately in addition to code for primary procedure)� 2 0.5 90.1 2 NA NA 5040 5040 Carrier K 2022 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 49255 Omentectomy, epiploectomy, resection of omentum (separate procedure) 2 0.5 90.1 2 NA NA 5041 5041 Carrier K 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19364 Breast reconstruction; with free flap 3 1 43.95 3 NA NA 5042 5042 Carrier K 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15860 Intravenous injection of agent (eg, fluorescein) to test vascular flow in flap or graft� 2 1 42 2 NA NA 5043 5043 Carrier K 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15770 Graft; derma-fat-fascia 1 1 45.9 1 NA NA 5044 5044 Carrier K 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 21615 Excision first and/or cervical rib 1 1 124.2 1 NA NA 5045 5045 Carrier K 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 21705 Division of scalenus anticus; with resection of cervical rib 1 1 124.2 1 NA NA 5046 5046 Carrier K 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 31622 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure) 1 1 8.4 1 NA NA 5047 5047 Carrier K 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 32100 Thoracotomy; with exploration 1 1 8.4 1 NA NA 5048 5048 Carrier K 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 32607 Thoracoscopy; with diagnostic biopsy(ies) of lung infiltrate(s) (eg, wedge, incisional), unilateral 1 1 8.4 1 NA NA 5049 5049 Carrier K 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 38530 Biopsy or excision of lymph node(s); open, internal mammary node(s) 1 1 45.9 1 NA NA 5050 5050 Carrier K 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 39200 Resection of mediastinal cyst 1 1 8.4 1 NA NA 5051 5051 Carrier K 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 45400 Laparoscopy, surgical; proctopexy (for prolapse) 1 1 98 1 NA NA 5052 5052 Carrier K 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 57250 Posterior colporrhaphy, repair of rectocele with or without perineorrhaphy 1 1 98 1 NA NA 5053 5053 Carrier K 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 57288 Sling operation for stress incontinence (eg, fascia or synthetic)� 1 1 98 1 NA NA 5054 5054 Carrier K 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 57425 Laparoscopy, surgical, colpopexy (suspension of vaginal apex)� 1 1 98 1 NA NA 5055 5055 Carrier K 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58571 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) 1 1 98 1 NA NA 5056 5056 Carrier K 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58700 Salpingectomy, complete or partial, unilateral or bilateral (separate procedure)� 1 1 98.4 1 NA NA 5057 5057 Carrier K 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95714 Electroencephalogram with video (VEEG), review of data, technical description by EEG technologist, each increment of 12-26 hours; unmonitored� 1 1 90.7 1 NA NA 5058 5058 Carrier K 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95720 Electroencephalogram (EEG), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, each increment of greater than 12 hours, up to 26 hours of EEG recording, interpretation and report after each 24-hour period; with video (VEEG) 1 1 90.7 1 NA NA 5059 5059 Carrier K 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour� 1 1 48.1 1 NA NA 5060 5060 Carrier K 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96366 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)� 1 1 48.1 1 NA NA 5061 5061 Carrier K 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99221 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. 1 1 90.7 1 NA NA 5062 5062 Carrier K 2022 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT C1771 Repair device, urinary, incontinence, with sling graft 1 1 98 1 NA NA 5063 5063 Carrier K 2022 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT Q67.6 Pectus excavatum 1 1 1248 0 1 0 NA NA 5064 5064 Carrier K 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 130 0.81 49.4 22.7 5 125 NA NA 5065 5065 Carrier K 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 Colonoscopy, flexible; with biopsy, single or multiple 120 0.82 49.4 19.9 5 115 NA NA 5066 5066 Carrier K 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 111 0.81 49.4 20.7 4 107 NA NA 5067 5067 Carrier K 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45384 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps 58 0.76 24.9 58 NA NA 5068 5068 Carrier K 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 81479 Unlisted molecular pathology procedure 53 0.92 12.9 53 NA NA 5069 5069 Carrier K 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 35 0.91 0.2 10.4 1 34 NA NA 5070 5070 Carrier K 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple 35 0.91 0.2 8.4 1 34 NA NA 5071 5071 Carrier K 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95810 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist 35 0.71 42.5 114.6 1 34 NA NA 5072 5072 Carrier K 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk 27 0.7 24.5 32.3 3 34 NA NA 5073 5073 Carrier K 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95811 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist 24 0.67 145.9 24 NA NA 5074 5074 Carrier K 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99499 Chiropractic Care 237 0.996 237 NA NA 5075 5075 Carrier K 2022 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99499 Therapy Care 389 0.982 389 NA NA 5076 5076 Carrier K 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81162 BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and full duplication/deletion analysis (ie, detection of large gene rearrangements) 15 1 13.4 0 15 NA NA 5077 5077 Carrier K 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43248 �Esophagogastroduodenoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) through esophagus over guide wire 13 1 0.2 11.3 1 12 NA NA 5078 5078 Carrier K 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81420 Fetal chromosomal aneuploidy (eg, trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18, and 21 12 1 10.3 0 12 NA NA 5079 5079 Carrier K 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 52332 Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type) 10 1 0.15 8.9 2 8 NA NA 5080 5080 Carrier K 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81256 HFE (hemochromatosis) (eg, hereditary hemochromatosis) gene analysis, common variants (eg, C282Y, H63D)� 10 1 0.35 0 10 NA NA 5081 5081 Carrier K 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43249 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter) 9 1 2.3 0 9 NA NA 5082 5082 Carrier K 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64490 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level� 9 1 0.14 0 9 NA NA 5083 5083 Carrier K 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43251 Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 8 1 0.2 0.14 1 7 NA NA 5084 5084 Carrier K 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58571 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)� 8 1 27.9 62.1 1 7 NA NA 5085 5085 Carrier K 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 52353 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included) 7 1 0.2 0.13 1 6 NA NA 5086 5086 Carrier K 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81401 MOLECULAR PATHOLOGY PROCEDURE LEVEL 2 7 1 0.11 0 7 NA NA 5087 5087 Carrier K 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81519 Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 21 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as recurrence score 7 1 2.87 0 7 NA NA 5088 5088 Carrier K 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99499 Chiropractic Care 237 0.996 237 NA NA 5089 5089 Carrier K 2022 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99499 Therapy Care 389 0.982 389 NA NA 5090 5090 Carrier K 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT F64.9 Gender identity disorder, unspecified 1 0.5 264 0 2 0 NA NA 5091 5091 Carrier K 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT G47.30 Sleep apnea, unspecified 1 1 336 0 1 0 NA NA 5092 5092 Carrier K 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT I47.1 Supraventricular tachycardia 1 1 360 0 1 0 NA NA 5093 5093 Carrier K 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT M26.02 Maxillary hypoplasia 1 1 336 0 1 0 NA NA 5094 5094 Carrier K 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT M47.812 Spondylosis without myelopathy or radiculopathy, cervical region 1 1 240 0 1 0 NA NA 5095 5095 Carrier K 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT R07.9 Chest pain, unspecified 1 1 2448 0 1 0 NA NA 5096 5096 Carrier K 2022 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT Z12.11 Encounter for screening for malignant neoplasm of colon 1 1 336 0 1 0 NA NA 5097 5097 Carrier K 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0766 Electrical stimulation device used for cancer treatment, includes all accessories, any type 4 1 0.6 81.9 1 3 NA NA 5098 5098 Carrier K 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1399 Durable medical equipment, miscellaneous 3 0 70.9 3 NA NA 5099 5099 Carrier K 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L8614 Cochlear device, includes all internal and external components 2 0 165.1 2 NA NA 5100 5100 Carrier K 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC B4087 Gastrostomy/jejunostomy tube, standard, any material, any type, each 1 1 167.5 1 NA NA 5101 5101 Carrier K 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC B4088 Gastrostomy/jejunostomy tube, low-profile, any material, any type, each 1 1 167.5 1 NA NA 5102 5102 Carrier K 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC B4149 Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit 1 1 167.5 1 NA NA 5103 5103 Carrier K 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC B4153 Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, May include fiber, administered through an enteral feeding tube, 100 calories = 1 unit 1 1 167.5 1 NA NA 5104 5104 Carrier K 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0642 Standing frame/table system, mobile (dynamic stander), any size including pediatric 1 1 70.9 1 NA NA 5105 5105 Carrier K 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1805 Dynamic adjustable wrist extension / flexion device, includes soft interface material 1 1 0.2 1 NA NA 5106 5106 Carrier K 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L2330 Addition to lower extremity, lacer molded to Patient model, for custom fabricated orthosis only 1 1 4.1 1 NA NA 5107 5107 Carrier K 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L8615 Headset/headpiece for Use with cochlear implant device, replacement 1 1 25.1 1 NA NA 5108 5108 Carrier K 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L8616 Microphone for Use with cochlear implant device, replacement 1 1 25.1 1 NA NA 5109 5109 Carrier K 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L8619 Cochlear implant, external speech processor and controller, integrated system, replacement 1 1 25.1 1 NA NA 5110 5110 Carrier K 2022 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L8624 Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement, each 1 1 25.1 1 NA NA 5111 5111 Carrier K 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC B4087 Gastrostomy/jejunostomy tube, standard, any material, any type, each 1 1 167.5 1 NA NA 5112 5112 Carrier K 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC B4088 Gastrostomy/jejunostomy tube, low-profile, any material, any type, each 1 1 167.5 1 NA NA 5113 5113 Carrier K 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC B4149 Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit 1 1 167.5 1 NA NA 5114 5114 Carrier K 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC B4153 Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, May include fiber, administered through an enteral feeding tube, 100 calories = 1 unit 1 1 167.5 1 NA NA 5115 5115 Carrier K 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0642 Standing frame/table system, mobile (dynamic stander), any size including pediatric 1 1 70.9 1 NA NA 5116 5116 Carrier K 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0766 Electrical stimulation device used for cancer treatment, includes all accessories, any type 4 1 0.6 81.9 1 3 NA NA 5117 5117 Carrier K 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1805 Dynamic adjustable wrist extension / flexion device, includes soft interface material 1 1 0.2 1 NA NA 5118 5118 Carrier K 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L2330 Addition to lower extremity, lacer molded to Patient model, for custom fabricated orthosis only 1 1 4.1 1 NA NA 5119 5119 Carrier K 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8615 Headset/headpiece for Use with cochlear implant device, replacement 1 1 25.1 1 NA NA 5120 5120 Carrier K 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8616 Microphone for Use with cochlear implant device, replacement 1 1 25.1 1 NA NA 5121 5121 Carrier K 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8619 Cochlear implant, external speech processor and controller, integrated system, replacement 1 1 25.1 1 NA NA 5122 5122 Carrier K 2022 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8624 Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement, each 1 1 25.1 1 NA NA 5123 5123 Carrier K 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 External ambulatory infusion pump, insulin 4 0.5 52.4 4 NA NA 5124 5124 Carrier K 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9274 External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories 1 1 39.9 1 NA NA 5125 5125 Carrier K 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0607 Home blood glucose monitor 1 1 39.9 1 NA NA 5126 5126 Carrier K 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0553 Supply allowance for therapeutic continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service 1 0 45.2 1 NA NA 5127 5127 Carrier K 2022 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0554 Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system 1 0 45.2 1 NA NA 5128 5128 Carrier K 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9274 External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories 1 1 39.9 1 NA NA 5129 5129 Carrier K 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0607 Home blood glucose monitor 1 1 39.9 1 NA NA 5130 5130 Carrier K 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 External ambulatory infusion pump, insulin 4 0.5 52.4 4 NA NA 5131 5131 Carrier K 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0553 Supply allowance for therapeutic continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service 1 0 45.2 1 NA NA 5132 5132 Carrier K 2022 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0554 Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system 1 0 45.2 1 NA NA 5133 5133 Carrier K 2022 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E10.65 Dexcom - - TYPE 1 DIABETES MELLITUS WITHOUT COMPLICATIONS 6 0.83 10.22 0 5 NA NA 5134 5134 Carrier K 2022 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E10.66 FreeStyle - - TYPE 1 DIABETES MELLITUS WITHOUT COMPLICATIONS 2 1 13.57 0 2 NA NA 5135 5135 Carrier K 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 13 0.92 2.44 9.48 1 11 0 DUPIXENT INJ 300/2ML NA 5136 5136 Carrier K 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 11 0.91 2.1 11.49 7 3 0 STELARA INJ 90MG/ML NA 5137 5137 Carrier K 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 9 1 1.9 10.5 3 6 0 EMGALITY INJ 120MG/ML NA 5138 5138 Carrier K 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 8 1 9.1 0 8 0 XIFAXAN TAB 550MG NA 5139 5139 Carrier K 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 10 0.6 2.43 9.9 2 4 0 SKYRIZI PEN INJ 150MG/ML NA 5140 5140 Carrier K 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 5 1 1.64 12.5 2 3 0 ENBREL SRCLK INJ 50MG/ML NA 5141 5141 Carrier K 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 7 0.57 8.54 0 4 0 TALTZ INJ 80MG/ML NA 5142 5142 Carrier K 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 4 1 3.18 10.75 3 1 0 AIMOVIG INJ 140MG/ML NA 5143 5143 Carrier K 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 5 0.8 2.57 11.52 1 3 0 HUMIRA INJ 40/0.4ML NA 5144 5144 Carrier K 2022 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 6 0.5 11.76 0 3 0 UBRELVY TAB 100MG NA 5145 5145 Carrier M 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44207 LAPS COLECTOMY PRTL W/COLOPXTSTMY LW ANAST 10 1 17.84466667 0 10 NA NA 5146 5146 Carrier M 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20930 ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED 8 0.25 143.2235069 0 8 NA NA 5147 5147 Carrier M 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44213 LAPS MOBLJ SPLENIC FLXR PFRMD W/PRTL COLECTOMY 7 1 18.97309524 0 7 NA NA 5148 5148 Carrier M 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY 7 1 92.39472222 11.49472222 1 6 NA NA 5149 5149 Carrier M 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45330 SIGMOIDOSCOPY FLX DX W/WO COLLJ SPECIMENS 5 1 24.09572222 0 5 NA NA 5150 5150 Carrier M 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22842 POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG 5 0.8 63.41777778 123.3530556 1 4 NA NA 5151 5151 Carrier M 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95720 ELECTROENCEPHALOGRAM (EEG), CONTINUOUS RECORDING, PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL REVIEW OF RECORDED EVENTS, ANALYSIS OF SPIKE AND SEIZURE DETECTION, EACH INCREMENT OF GREATER TH 5 0.6 25.88944444 0 5 NA NA 5152 5152 Carrier M 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44204 LAPAROSCOPY COLECTOMY PARTIAL W/ANASTOMOSIS 4 1 7.779166667 0 4 NA NA 5153 5153 Carrier M 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT 4 0.25 55.84805556 0 4 NA NA 5154 5154 Carrier M 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20936 AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION 4 0.5 88.14319444 0 4 NA NA 5155 5155 Carrier M 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44207 LAPS COLECTOMY PRTL W/COLOPXTSTMY LW ANAST 10 1 17.84466667 0 10 NA NA 5156 5156 Carrier M 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58150 TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY 7 1 92.39472222 11.49472222 1 6 NA NA 5157 5157 Carrier M 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44213 LAPS MOBLJ SPLENIC FLXR PFRMD W/PRTL COLECTOMY 7 1 18.97309524 0 7 NA NA 5158 5158 Carrier M 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 45330 SIGMOIDOSCOPY FLX DX W/WO COLLJ SPECIMENS 5 1 24.09572222 0 5 NA NA 5159 5159 Carrier M 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58140 MYOMECTOMY 1-4 MYOMAS W/250 GM/< ABDOMINAL APPR 4 1 21.99340278 0 4 NA NA 5160 5160 Carrier M 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22614 ARTHRD PST TQ 1NTRSPC EA ADD 4 1 122.2299306 0 4 NA NA 5161 5161 Carrier M 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44204 LAPAROSCOPY COLECTOMY PARTIAL W/ANASTOMOSIS 4 1 7.779166667 0 4 NA NA 5162 5162 Carrier M 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J0185 INJ., APREPITANT, 1 MG 3 1 150.8003704 0 3 NA NA 5163 5163 Carrier M 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33405 RPLCMT PROST AORTIC VALVE XCP HOMOGRF/STENT 3 1 1.111944444 13.40486111 1 2 NA NA 5164 5164 Carrier M 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 55866 LAPS PROSTECT RETROPUBIC RAD W/NRV SPARING ROBOT 3 1 6.489722222 2.689305556 1 2 NA NA 5165 5165 Carrier M 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 20930 ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED 8 0.25 143.2235069 0 8 NA NA 5166 5166 Carrier M 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22842 POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG 5 0.8 63.41777778 123.3530556 1 4 NA NA 5167 5167 Carrier M 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 20936 AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION 4 0.5 88.14319444 0 4 NA NA 5168 5168 Carrier M 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT 4 0.25 55.84805556 0 4 NA NA 5169 5169 Carrier M 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22633 ARTHRD CMBN 1NTRSPC LUMBAR 4 0.25 63.39555556 77.29768519 1 3 NA NA 5170 5170 Carrier M 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22840 POSTERIOR NON-SEGMENTAL INSTRUMENTATION 3 0.3333 114.5568519 0 3 NA NA 5171 5171 Carrier M 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43644 LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM 2 0.5 70.25777778 52.61138889 1 1 NA NA 5172 5172 Carrier M 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 20931 ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL 1 0 25.34638889 0 1 NA NA 5173 5173 Carrier M 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22802 ARTHRODESIS POSTERIOR SPINAL DFRM 7-12 VRT SEG 1 0 161.6419444 0 1 NA NA 5174 5174 Carrier M 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22843 POSTERIOR SEGMENTAL INSTRUMENTATION 7-12 VRT SEG 1 0 161.6752778 0 1 NA NA 5175 5175 Carrier M 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC J0585 Botox 212 0.89 6 33 16 196 NA NA 5176 5176 Carrier M 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC Q5103 Inflectra 111 0.95 29 47 32 79 NA NA 5177 5177 Carrier M 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 66984 EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION); WITHOUT ENDOSCO 62 1 4 31.38857013 1 61 NA NA 5178 5178 Carrier M 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC J3380 Entyvio 57 0.98 16 59 11 46 NA NA 5179 5179 Carrier M 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC J7323 Euflexxa 52 0.85 0.3 60 1 51 NA NA 5180 5180 Carrier M 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC J0178 Eylea 50 0.92 27 54 8 42 NA NA 5181 5181 Carrier M 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC J9217 Lupron Depot/eligard 47 0.83 16 45 11 36 NA NA 5182 5182 Carrier M 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 30520 SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF 40 0.8 52.8568125 0 40 NA NA 5183 5183 Carrier M 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 89253 ASSTD EMBRYO HATCHING MICROTQS ANY METH 40 0.55 140.8267361 0 40 NA NA 5184 5184 Carrier M 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27447 ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS 39 0.6667 31.19041311 0 39 NA NA 5185 5185 Carrier M 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 66984 EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION); WITHOUT ENDOSCO 62 1 4 31.38857013 1 61 NA NA 5186 5186 Carrier M 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC J2350 Ocrevus 29 1 16 42 7 22 NA NA 5187 5187 Carrier M 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58558 HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C 19 1 19.11361111 135.8474074 1 18 NA NA 5188 5188 Carrier M 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 36475 ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN 19 1 37.16324561 0 19 NA NA 5189 5189 Carrier M 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC J2777 Vabysmo 16 1 6 29 2 14 NA NA 5190 5190 Carrier M 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 52000 CYSTOURETHROSCOPY (SEPARATE PROCEDURE) 12 1 72.62516204 0 12 NA NA 5191 5191 Carrier M 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 21196 RECONSTRUCTION OF MANDIBULAR RAMUS, SAGITTAL SPLIT; IN INTERNAL RIGID FIXATION 11 1 57.66227273 0 11 NA NA 5192 5192 Carrier M 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99354 PROLNG SVC O/P 1ST HOUR 10 1 33.89736111 53.6059375 2 8 NA NA 5193 5193 Carrier M 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 66982 EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1-STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION), COMPLEX, REQUIR 10 1 14.24536111 0 10 NA NA 5194 5194 Carrier M 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC J9299 Opdivo 10 1 24 22 4 6 NA NA 5195 5195 Carrier M 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 89253 ASSTD EMBRYO HATCHING MICROTQS ANY METH 40 0.55 140.8267361 0 40 NA NA 5196 5196 Carrier M 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27447 ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS 39 0.6667 31.19041311 0 39 NA NA 5197 5197 Carrier M 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT 38 0.7895 58.55517544 0 38 NA NA 5198 5198 Carrier M 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 89258 CRYOPRSRV EMBRYO 27 0.6296 131.0831276 0 27 NA NA 5199 5199 Carrier M 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 89342 STORAGE, (PER YEAR); EMBRYO(S) 23 0.6522 106.5142633 0 23 NA NA 5200 5200 Carrier M 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT S4011 IVF PACKAGE 22 0.5 105.7116667 0 22 NA NA 5201 5201 Carrier M 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 31267 NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS 21 0.4762 1.895277778 64.18061111 1 20 NA NA 5202 5202 Carrier M 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 31276 NASAL/SINUS NDSC W/FRONTAL SINUS EXPLORATION 20 0.55 9.720138889 92.69424383 2 18 NA NA 5203 5203 Carrier M 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 31255 NASAL/SINUS ENDOSCOPY W/ETHMOIDECTOMY TOTAL 9 0.4444 97.52666667 0 9 NA NA 5204 5204 Carrier M 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 23472 ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER 7 0.5714 53.75230159 0 7 NA NA 5205 5205 Carrier M 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year NA NA MENTAL HEALTH RESIDENTIAL TREATMENT FACILITY 25 0.92 26.83916667 12.8031746 4 21 NA NA 5206 5206 Carrier M 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year NA NA CHEMICAL DEPENDENCY RESIDENTIAL TREATMENT FACILITY 9 1 11.36972222 14.952 4 5 NA NA 5207 5207 Carrier M 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year NA NA DETOXIFICATION 1 1 0.093611111 0 1 NA NA 5208 5208 Carrier M 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA CHEMICAL DEPENDENCY RESIDENTIAL TREATMENT FACILITY 9 1 11.36972222 14.952 4 5 NA NA 5209 5209 Carrier M 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA DETOXIFICATION 1 1 0.093611111 0 1 NA NA 5210 5210 Carrier M 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA MENTAL HEALTH RESIDENTIAL TREATMENT FACILITY 25 0.92 26.83916667 12.8031746 4 21 NA NA 5211 5211 Carrier M 2023 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NA NA MENTAL HEALTH RESIDENTIAL TREATMENT FACILITY 25 0.92 26.83916667 12.8031746 4 21 NA NA 5212 5212 Carrier M 2023 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NA NA CHEMICAL DEPENDENCY RESIDENTIAL TREATMENT FACILITY 9 1 11.36972222 14.952 4 5 NA NA 5213 5213 Carrier M 2023 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NA NA DETOXIFICATION 1 1 0.093611111 0 1 NA NA 5214 5214 Carrier M 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY, 60 MINUTES WITH PATIENT 50 1 839.5197833 0 50 NA NA 5215 5215 Carrier M 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN 45 0.9556 130.0407222 0 45 NA NA 5216 5216 Carrier M 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97155 ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN 42 0.9286 158.0830952 0 42 NA NA 5217 5217 Carrier M 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97156 FAMILY ADAPT BHV TX GDN PHYS/QHP EA 15 MIN 42 0.9524 155.3306085 0 42 NA NA 5218 5218 Carrier M 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97153 ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN 39 0.9744 163.1087892 0 39 NA NA 5219 5219 Carrier M 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT H0035 MH PARTIAL HOSP TX UNDER 24H 33 1 9.801805556 65.04741936 2 31 NA NA 5220 5220 Carrier M 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT H2036 A/D TX PROGRAM, PER DIEM 21 0.9524 81.18569444 28.45656433 2 19 NA NA 5221 5221 Carrier M 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 THERAP REPETITIVE TMS TX SUBSEQ DELIVERY & MNG 13 0.6923 312.391047 0 13 NA NA 5222 5222 Carrier M 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90834 PSYCHOTHERAPY, 45 MINUTES WITH PATIENT 12 1 1.035833333 22.5030303 1 11 NA NA 5223 5223 Carrier M 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL&M 12 0.6667 331.9065972 0 12 NA NA 5224 5224 Carrier M 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY, 60 MINUTES WITH PATIENT 50 1 839.5197833 0 50 NA NA 5225 5225 Carrier M 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT H0035 MH PARTIAL HOSP TX UNDER 24H 33 1 9.801805556 65.04741936 2 31 NA NA 5226 5226 Carrier M 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90834 PSYCHOTHERAPY, 45 MINUTES WITH PATIENT 12 1 1.035833333 22.5030303 1 11 NA NA 5227 5227 Carrier M 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION 9 1 103.9694753 0 9 NA NA 5228 5228 Carrier M 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90832 PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES 5 1 10.91311111 0 5 NA NA 5229 5229 Carrier M 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90847 FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 3 1 1645.739074 0 3 NA NA 5230 5230 Carrier M 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99215 OFFICE O/P EST HI 40-54 MIN 3 1 84.96925926 0 3 NA NA 5231 5231 Carrier M 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99214 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES A MEDICALLY APPROPRIATE HISTORY AND/OR EXAMINATION AND MODERATE LEVEL OF MEDICAL DECISION MAKING. WHEN USING TIME FOR CODE SELECTION, 30-39 MINUT 3 1 431.1512963 0 3 NA NA 5232 5232 Carrier M 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90846 FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 2 1 2292.1175 0 2 NA NA 5233 5233 Carrier M 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90833 PSYCHOTHERAPY, 30 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE (LIST SEPARATELY IN ADDITION TO THE CODE FOR PRIMARY PROCEDURE) 2 1 46.73347222 0 2 NA NA 5234 5234 Carrier M 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97151 BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN 45 0.9556 130.0407222 0 45 NA NA 5235 5235 Carrier M 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97156 FAMILY ADAPT BHV TX GDN PHYS/QHP EA 15 MIN 42 0.9524 155.3306085 0 42 NA NA 5236 5236 Carrier M 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97155 ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN 42 0.9286 158.0830952 0 42 NA NA 5237 5237 Carrier M 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90868 THERAP REPETITIVE TMS TX SUBSEQ DELIVERY & MNG 13 0.6923 312.391047 0 13 NA NA 5238 5238 Carrier M 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90867 REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL&M 12 0.6667 331.9065972 0 12 NA NA 5239 5239 Carrier M 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90832 PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES 5 1 10.91311111 0 5 NA NA 5240 5240 Carrier M 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90836 PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 45 MIN 4 0.75 29.37972222 0 4 NA NA 5241 5241 Carrier M 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 96130 PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR 1 0 21.6475 0 1 NA NA 5242 5242 Carrier M 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 99205 OFFICE O/P NEW HI 60-74 MIN 1 0 115.6119444 0 1 NA NA 5243 5243 Carrier M 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97158 GRP ADAPT BHV PRTCL MODIFCAJ PHYS/QHP EA 15 MIN 1 0 119.2194444 0 1 NA NA 5244 5244 Carrier M 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0486 ORAL DEVICE/APPLIANCE CUSFAB 2 0 59.67041667 0 2 NA NA 5245 5245 Carrier M 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L5845 KNEE-SHIN SYS STANCE FLEXION 1 1 28.26305556 0 1 NA NA 5246 5246 Carrier M 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L5920 ENDO AK/HIP ALIGNABLE SYSTEM 1 1 28.19777778 0 1 NA NA 5247 5247 Carrier M 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L5968 MULTIAXIAL ANKLE W DORSIFLEX 1 1 21.89944444 0 1 NA NA 5248 5248 Carrier M 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L5652 SUCTION SUSP AK/KNEE DISART 1 1 28.25111111 0 1 NA NA 5249 5249 Carrier M 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L5649 ISCH CONTAINMT/NARROW M-L SO 1 1 28.21222222 0 1 NA NA 5250 5250 Carrier M 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L5650 TOT CONTACT AK/KNEE DISART S 1 1 28.18277778 0 1 NA NA 5251 5251 Carrier M 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L5631 AK/KNEE DISARTIC ACRYLIC SOC 1 1 28.27666667 0 1 NA NA 5252 5252 Carrier M 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L5999 LOWR EXTREMITY PROSTHES NOS 1 1 28.08805556 0 1 NA NA 5253 5253 Carrier M 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L5828 ENDO KNEE-SHIN FLUID SWG/STA 1 1 28.2575 0 1 NA NA 5254 5254 Carrier M 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L5845 KNEE-SHIN SYS STANCE FLEXION 1 1 28.26305556 0 1 NA NA 5255 5255 Carrier M 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L5652 SUCTION SUSP AK/KNEE DISART 1 1 28.25111111 0 1 NA NA 5256 5256 Carrier M 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L5920 ENDO AK/HIP ALIGNABLE SYSTEM 1 1 28.19777778 0 1 NA NA 5257 5257 Carrier M 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L5968 MULTIAXIAL ANKLE W DORSIFLEX 1 1 21.89944444 0 1 NA NA 5258 5258 Carrier M 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L8460 SHRINKER ABOVE KNEE 1 1 28.23888889 0 1 NA NA 5259 5259 Carrier M 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L5649 ISCH CONTAINMT/NARROW M-L SO 1 1 28.21222222 0 1 NA NA 5260 5260 Carrier M 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L5650 TOT CONTACT AK/KNEE DISART S 1 1 28.18277778 0 1 NA NA 5261 5261 Carrier M 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L5651 AK FLEX INNER SOCKET EXT FRA 1 1 28.20472222 0 1 NA NA 5262 5262 Carrier M 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L5999 LOWR EXTREMITY PROSTHES NOS 1 1 28.08805556 0 1 NA NA 5263 5263 Carrier M 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L5631 AK/KNEE DISARTIC ACRYLIC SOC 1 1 28.27666667 0 1 NA NA 5264 5264 Carrier M 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0486 ORAL DEVICE/APPLIANCE CUSFAB 2 1 59.67041667 0 2 NA NA 5265 5265 Carrier M 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L5845 KNEE-SHIN SYS STANCE FLEXION 1 1 28.26305556 0 1 NA NA 5266 5266 Carrier M 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L5920 ENDO AK/HIP ALIGNABLE SYSTEM 1 1 28.19777778 0 1 NA NA 5267 5267 Carrier M 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L5968 MULTIAXIAL ANKLE W DORSIFLEX 1 1 21.89944444 0 1 NA NA 5268 5268 Carrier M 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L5652 SUCTION SUSP AK/KNEE DISART 1 1 28.25111111 0 1 NA NA 5269 5269 Carrier M 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L5649 ISCH CONTAINMT/NARROW M-L SO 1 1 28.21222222 0 1 NA NA 5270 5270 Carrier M 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L5650 TOT CONTACT AK/KNEE DISART S 1 1 28.18277778 0 1 NA NA 5271 5271 Carrier M 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L5631 AK/KNEE DISARTIC ACRYLIC SOC 1 1 28.27666667 0 1 NA NA 5272 5272 Carrier M 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L5999 LOWR EXTREMITY PROSTHES NOS 1 1 28.08805556 0 1 NA NA 5273 5273 Carrier M 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L5828 ENDO KNEE-SHIN FLUID SWG/STA 1 1 28.2575 0 1 NA NA 5274 5274 Carrier M 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 797 0.522 6.477589012 14.70088325 0 179 618 0 SEMAGLUTIDE RYBELSUS,OZEMPIC 5275 5275 Carrier M 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 351 0.7265 1.472544038 7.279893469 0 80 271 0 TESTOSTERONE ANDROGEL 5276 5276 Carrier M 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 303 0.8218 6.566422056 10.36717708 0 67 236 0 SEMAGLUTIDE WEGOVY 5277 5277 Carrier M 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 294 0.3912 13.86616466 13.64884643 0 74 220 0 TIRZEPATIDE MOUNJARO 5278 5278 Carrier M 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 238 0.8992 1.48001773 11.4857375 0 47 191 0 OMEPRAZOLE OMEPRAZOLE 5279 5279 Carrier M 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 227 0.5815 14.35487558 19.51986299 0 90 137 0 AMPHET/DEXTR ADDERALL,MYDAYIS 5280 5280 Carrier M 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 189 0.7354 2.533647343 12.01464661 0 23 166 0 TACROLIMUS PROTOPIC 5281 5281 Carrier M 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 178 0.6742 8.015108025 36.25770651 0 34 144 0 DUPILUMAB DUPIXENT 5282 5282 Carrier M 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 156 0.7628 5.242064394 9.855296771 0 43 113 0 DULAGLUTIDE TRULICITY 5283 5283 Carrier M 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 143 0.8881 0.764269547 9.454905093 0 27 116 0 PANTOPRAZOLE PANTOPRAZOLE 5284 5284 Carrier M 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 36 1 0.1 6.75 0 4 32 0 CLASCOTERONE WINLEVI 5285 5285 Carrier M 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 17 1 0.1 14.66666667 0 1 16 0 LANSOPRAZOLE LANSOPRAZOLE 5286 5286 Carrier M 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 14 1 0.1 18 0 2 12 0 RABEPRAZOLE RABEPRAZOLE,PANTOPRAZOLE,OMEPRAZOLE 5287 5287 Carrier M 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 13 1 36 15.27272727 0 2 11 0 IMMUNE GLOBULIN HIZENTRA 5288 5288 Carrier M 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 12 1 0.1 0.1 0 1 11 0 PLECANATIDE TRULANCE 5289 5289 Carrier M 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 11 1 14.4 12 0 5 6 0 DIROXIMEL FUMARATE VUMERITY 5290 5290 Carrier M 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 11 1 0.1 14.4 0 1 10 0 TAZAROTENE TOPICAL ARAZLO 5291 5291 Carrier M 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 10 1 0.1 378 0 6 4 0 MORPHINE SUL MORPHINE 5292 5292 Carrier M 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 9 1 6 28 0 4 5 0 BUPROPION/DEXTROMETHORPHAN AUVELITY 5293 5293 Carrier M 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 3 6 0 8 0 0 VALGANCICLOVIR VALGANCICLOVIR 5294 5294 Carrier M 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 9 1 48 0.1 0 2 7 0 SEMIGLUTIDE WEGOVY 5295 5295 Carrier M 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 4 1 24 0.1 0 1 3 0 SEMIGLUTIDE RYBELSUS,OZEMPIC 5296 5296 Carrier M 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 4 1 120 16 0 1 3 0 LIRAGLUTIDE SAXENDA 5297 5297 Carrier M 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 4 1 0.1 40 0 1 3 0 USTEKINUMAB STELARA 5298 5298 Carrier M 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 1 0.1 24 0 1 2 0 TESTOSTERONE TESTOSTERONE,DEPO-TESTOSTERONE 5299 5299 Carrier M 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 1 0.1 36 0 1 2 0 METHYLPHENIDATE CONCERTA,JORNAY,QUILLIVANT,RELEXXII 5300 5300 Carrier M 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 1 0.1 0.1 0 2 1 0 MODAFINIL MODAFINIL 5301 5301 Carrier M 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 1 16 0 3 0 FREMANEZUMAB-VFRM AJOVY 5302 5302 Carrier M 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 1 32 0 3 0 DUPILUMAB DUPIXENT 5303 5303 Carrier M 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 1 24 0 2 0 TIRZEPATIDE MOUNJARO,TIRZEPATIDE 5304 5304 Carrier A 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 8 0.625 14.49 40.71 1 7 1 NA NA 5305 5305 Carrier A 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 6 0.8333 14.49 30.4 1 5 NA NA 5306 5306 Carrier A 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) 5 0.8 37.13 5 1 NA NA 5307 5307 Carrier A 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar 5 0.8 49.32 5 1 NA NA 5308 5308 Carrier A 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar 4 0.75 14.49 37.68 1 3 NA NA 5309 5309 Carrier A 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 33533 Coronary artery bypass, using arterial graft(s); single arterial graft 4 0 0.01 2.16 1 3 NA NA 5310 5310 Carrier A 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 4 0.75 40.88 4 1 NA NA 5311 5311 Carrier A 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22614 Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure) 3 0.6667 57.79 972 3 2 NA NA 5312 5312 Carrier A 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) 3 1 81.65 972 3 2 NA NA 5313 5313 Carrier A 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22585 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); each additional interspace (List separately in addition to code for primary procedure) 2 0.5 59.87 2 1 NA NA 5314 5314 Carrier A 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 47563 Laparoscopy, surgical; cholecystectomy with cholangiography 2 0 1.26 2 NA NA 5315 5315 Carrier A 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44205 Laparoscopy, surgical; colectomy, partial, with removal of terminal ileum with ileocolostomy 2 0 5.02 0.01 1 1 NA NA 5316 5316 Carrier A 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 33508 Endoscopy, surgical, including video-assisted harvest of vein(s) for coronary artery bypass procedure (List separately in addition to code for primary procedure) 2 0 0.09 2 NA NA 5317 5317 Carrier A 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22845 Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure) 2 0.5 58.67 2 NA NA 5318 5318 Carrier A 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 33518 Coronary artery bypass, using venous graft(s) and arterial graft(s); 2 venous grafts (List separately in addition to code for primary procedure) 2 0 0.09 2 NA NA 5319 5319 Carrier A 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63048 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; each additional segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure) 2 0.5 56.33 2 NA NA 5320 5320 Carrier A 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44213 Laparoscopy, surgical, mobilization (take-down) of splenic flexure performed in conjunction with partial colectomy (List separately in addition to primary procedure) 2 0 1.24 0.09 1 1 NA NA 5321 5321 Carrier A 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) 3 1 81.65 972 3 2 NA NA 5322 5322 Carrier A 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22610 Arthrodesis, posterior or posterolateral technique, single level; thoracic (with lateral transverse technique, when performed) 1 1 107.89 768 1 1 NA NA 5323 5323 Carrier A 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27134 Revision of total hip arthroplasty; both components, with or without autograft or allograft 1 1 20.75 1 NA NA 5324 5324 Carrier A 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33340 Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, when performed, and radiological supervision and interpretation 1 1 1.63 1 NA NA 5325 5325 Carrier A 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33361 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach 1 1 63.6 1 NA NA 5326 5326 Carrier A 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22830 Exploration of spinal fusion 1 1 107.89 1 NA NA 5327 5327 Carrier A 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63042 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar 1 1 2.54 768 1 1 NA NA 5328 5328 Carrier A 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15769 Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia) 1 1 6.94 1 NA NA 5329 5329 Carrier A 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64999 Unlisted procedure, nervous system 1 1 6.94 1 NA NA 5330 5330 Carrier A 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22600 Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment 1 1 53.63 1 NA NA 5331 5331 Carrier A 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 49593 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); 3 cm to 10 cm, reducible 1 1 91.06 1 NA NA 5332 5332 Carrier A 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 425 0.68 20.69 425 NA NA 5333 5333 Carrier A 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97140 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes 380 0.6789 21.57 380 NA NA 5334 5334 Carrier A 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 Colonoscopy, flexible; with biopsy, single or multiple 359 0.9666 4.66 14.27 10 349 1 NA NA 5335 5335 Carrier A 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 336 0.9554 4.66 19.3 240 10 326 1 NA NA 5336 5336 Carrier A 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 327 0.6483 22.03 327 NA NA 5337 5337 Carrier A 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 ECHO, transthoracic w/doppler, complete 308 0.9123 5.65 308 NA NA 5338 5338 Carrier A 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97112 Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities 256 0.6523 19.94 256 NA NA 5339 5339 Carrier A 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 MRI, lower extremity any joint; wo contr 231 0.8831 6.61 231 NA NA 5340 5340 Carrier A 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 220 0.9773 7.49 14.89 276 6 214 2 NA NA 5341 5341 Carrier A 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74177 CT abd & pelv w contrast 167 0.9521 0.28 4.83 1 166 NA NA 5342 5342 Carrier A 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27447 Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) 33 1 34.36 33 NA NA 5343 5343 Carrier A 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93303 ECHO, transthoracic, complete cng 26 1 0.69 120 26 1 NA NA 5344 5344 Carrier A 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70552 Contrast MRI of brain 20 1 0 20 NA NA 5345 5345 Carrier A 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 45384 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps 19 1 11.23 19 NA NA 5346 5346 Carrier A 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93312 ECHO, transesophageal, heart, compl 18 1 0.01 18 NA NA 5347 5347 Carrier A 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72157 MRI of thoracic spine 16 1 1.47 16 NA NA 5348 5348 Carrier A 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29823 Arthroscopy, shoulder, surgical; debridement, extensive, 3 or more discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular si 16 1 42.16 16 1 NA NA 5349 5349 Carrier A 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 45381 Colonoscopy, flexible; with directed submucosal injection(s), any substance 14 1 0.02 18.05 1 13 NA NA 5350 5350 Carrier A 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 78816 Imaging PET/CT full body 13 1 7.69 13 NA NA 5351 5351 Carrier A 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70543 MRI orb/fc/nck w/o cntrst flwd cntr 11 1 8.95 11 NA NA 5352 5352 Carrier A 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 72196 MRI, pelvis; with contrast material(s) 6 0.1667 0.66 14.73 1 5 NA NA 5353 5353 Carrier A 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 72148 MRI of lumbar spine 163 0.0123 16.27 163 NA NA 5354 5354 Carrier A 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 71250 DIAGNOSTIC CT THORAX W/O CNTRST 95 0.0105 0.27 8.18 168 1 94 1 NA NA 5355 5355 Carrier A 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 73721 MRI, lower extremity any joint; wo contr 231 0.0043 6.61 231 NA NA 5356 5356 Carrier A 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1002 Residential treatment, Substance Use Disorder 7 1 36.66 7 NA NA 5357 5357 Carrier A 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1002 Residential treatment, Substance Use Disorder 7 1 36.66 7 NA NA 5358 5358 Carrier A 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 71271 CT THORAX LW DOSE LNG CA SCR C- 36 0.8889 3.38 36 NA NA 5359 5359 Carrier A 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual 20 0.45 42.26 20 NA NA 5360 5360 Carrier A 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 20 1 17.36 20 NA NA 5361 5361 Carrier A 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 8 0.75 34.72 136.73 2 6 NA NA 5362 5362 Carrier A 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 8 0.75 34.72 136.73 2 6 NA NA 5363 5363 Carrier A 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 8 0.75 34.72 136.73 2 6 NA NA 5364 5364 Carrier A 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H2036 Alcohol and/or other drug treatment program, per diem 6 0.8333 54.38 6 NA NA 5365 5365 Carrier A 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 Mental Health Partial Hospitalization, Treatment, Less Than 24 Hours 5 1 38.04 5 NA NA 5366 5366 Carrier A 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 92523 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language) 2 1 19.39 2 NA NA 5367 5367 Carrier A 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 70551 MRI of brain 2 1 0.07 2 NA NA 5368 5368 Carrier A 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90834 Psychotherapy, 45 minutes with patient 2 0 4.15 2 NA NA 5369 5369 Carrier A 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 20 1 17.36 20 NA NA 5370 5370 Carrier A 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0035 Mental Health Partial Hospitalization, Treatment, Less Than 24 Hours 5 1 38.04 5 NA NA 5371 5371 Carrier A 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 92523 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language) 2 1 19.39 2 NA NA 5372 5372 Carrier A 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70551 MRI of brain 2 1 0.07 2 NA NA 5373 5373 Carrier A 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 67900 Repair of brow ptosis (supraciliary, mid-forehead or coronal approach) 1 1 114.66 1 NA NA 5374 5374 Carrier A 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70553 MRI of brain and further sequences 1 1 0 1 NA NA 5375 5375 Carrier A 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 21209 Osteoplasty, facial bones; reduction 1 1 114.66 1 NA NA 5376 5376 Carrier A 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 21137 Reduction forehead; contouring only 1 1 114.66 1 NA NA 5377 5377 Carrier A 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 21270 Malar augmentation, prosthetic material 1 1 114.66 1 NA NA 5378 5378 Carrier A 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 1 1 19.14 1 NA NA 5379 5379 Carrier A 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19303 Mastectomy, simple, complete 1 1 22.64 1 NA NA 5380 5380 Carrier A 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97140 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes 1 1 19.14 1 NA NA 5381 5381 Carrier A 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H2035 Alcohol and/or other drug treatment program, per hour 1 1 72.13 1 NA NA 5382 5382 Carrier A 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 30400 Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tip 1 1 114.66 1 NA NA 5383 5383 Carrier A 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19350 Nipple/areola reconstruction 1 1 22.64 1 NA NA 5384 5384 Carrier A 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 Continuous airway pressure (CPAP) device [may be used for either CPAP or APAP] 300 0.95 2.13 300 NA NA 5385 5385 Carrier A 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 14 0.9286 4.05 14 NA NA 5386 5386 Carrier A 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 7 0.8571 6.57 7 NA NA 5387 5387 Carrier A 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0748 Elec Osteogen Stim Spinal 2 0.5 12.99 2 NA NA 5388 5388 Carrier A 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2402 Negative pressure wound therapy electrical pump, stationary or portable 1 1 46.44 1 NA NA 5389 5389 Carrier A 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2402 Negative pressure wound therapy electrical pump, stationary or portable 1 1 46.44 1 NA NA 5390 5390 Carrier A 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0601 Continuous airway pressure (CPAP) device [may be used for either CPAP or APAP] 300 0.95 2.13 300 NA NA 5391 5391 Carrier A 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 14 0.9286 4.05 14 NA NA 5392 5392 Carrier A 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 7 0.8571 6.57 7 NA NA 5393 5393 Carrier A 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0748 Elec Osteogen Stim Spinal 2 0.5 12.99 2 NA NA 5394 5394 Carrier A 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0601 Continuous airway pressure (CPAP) device [may be used for either CPAP or APAP] 300 0.0033 2.13 300 NA NA 5395 5395 Carrier A 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 5 0.6 12.01 5 NA NA 5396 5396 Carrier A 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4216 Sterile water/saline, 10 ml 4 0 4.54 0.01 3 1 NA NA 5397 5397 Carrier A 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4232 Syringe W/Needle Insulin 3cc 1 0 20.26 1 NA NA 5398 5398 Carrier A 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4217 Sterile water/saline, 500 ml 1 0 0.01 1 NA NA 5399 5399 Carrier A 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4230 Infus Insulin Pump Non Needl 1 0 20.26 1 NA NA 5400 5400 Carrier A 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 5 0.6 12.01 5 NA NA 5401 5401 Carrier A 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4216 Sterile water/saline, 10 ml 4 0 4.54 0.01 3 1 NA NA 5402 5402 Carrier A 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4232 Syringe W/Needle Insulin 3cc 1 0 20.26 1 NA NA 5403 5403 Carrier A 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4217 Sterile water/saline, 500 ml 1 0 0.01 1 NA NA 5404 5404 Carrier A 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4230 Infus Insulin Pump Non Needl 1 0 20.26 1 NA NA 5405 5405 Carrier A 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 52 0.6346 28.19 46.09 27 25 HYDROCODONE-ACETAMINOPHEN HYDROCODONE-ACETAMINOPHEN 5406 5406 Carrier A 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 52 0.3077 7.4 32 8 44 SEMAGLUTIDE OZEMPIC, RYBELSUS 5407 5407 Carrier A 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 50 0.82 34.58 52.45 11 39 ADALIMUMAB HUMIRA 5408 5408 Carrier A 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 46 0.1957 18.69 41.79 4 42 TIRZEPATIDE MOUNJARO 5409 5409 Carrier A 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 32 0.875 1.68 28.39 1 31 CYCLOSPORINE (OPHTH) CEQUA, CYCLOSPORINE, RESTASIS 5410 5410 Carrier A 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 24 0.8333 10.67 79.91 6 18 DUPILUMAB DUPIXENT, DUPIXENT DUPILUMAB 5411 5411 Carrier A 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 24 0 6.3 10.21 3 21 SEMAGLUTIDE (WEIGHT MANAGEMENT) WEGOVY 5412 5412 Carrier A 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 22 0.6364 6.73 42.8 9 13 OXYCODONE HCL OXYCODONE HCL, OXYCONTIN 5413 5413 Carrier A 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 16 0.75 6.09 192.26 5 11 GALCANEZUMAB-GNLM EMGALITY 5414 5414 Carrier A 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 16 0.8125 2.49 40.85 2 14 ETANERCEPT ENBREL 5415 5415 Carrier A 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 12 1 18.01 62.83 4 8 FREMANEZUMAB-VFRM AJOVY 5416 5416 Carrier A 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 12 1 8.31 27.14 3 9 PLECANATIDE TRULANCE 5417 5417 Carrier A 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 9 1 37.57 41.59 1 8 RISANKIZUMAB-RZAA SKYRIZI 5418 5418 Carrier A 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 5.18 1.7 6 1 OXYCODONE W/ ACETAMINOPHEN OXYCODONE-ACETAMINOPHEN 5419 5419 Carrier A 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 6 1 33.93 0 6 TOCILIZUMAB ACTEMRA 5420 5420 Carrier A 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 5 1 13.04 24.66 4 1 BUPRENORPHINE BUPRENORPHINE 5421 5421 Carrier A 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 5 1 1.43 6.52 1 4 DULAGLUTIDE TRULICITY 5422 5422 Carrier A 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 4 1 14.73 40.74 1 3 UPADACITINIB RINVOQ/ER 5423 5423 Carrier A 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 4 1 10.1 4 0 BUPRENORPHINE HCL BELBUCA 5424 5424 Carrier A 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 3 1 1.98 37.83 1 2 LIFITEGRAST XIIDRA 5425 5425 Carrier A 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 1 7.73 2 0 HYDROCODONE BITARTRATE HYDROCODONE BITARTRATE 5426 5426 Carrier A 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 309.76 0 1 SIPONIMOD FUMARATE MAYZENT 5427 5427 Carrier A 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 265.86 0 1 NICOTINE NICOTROL 5428 5428 Carrier A 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 234.62 0 1 ERENUMAB-AOOE AIMOVIG 5429 5429 Carrier A 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 0.4 25.05 97.18 1 1 EVOLOCUMAB REPATHA SURECLICK 5430 5430 Carrier A 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 0.3333 267.93 101.67 2 1 ADALIMUMAB HUMIRA 5431 5431 Carrier A 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 0.3333 76.77 0 1 ETANERCEPT ENBREL 5432 5432 Carrier A 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 0.25 2.77 1 0 DUPILUMAB DUPIXENT DUPILUMAB 5433 5433 Carrier A 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 0.125 306.26 1 0 OXYCODONE HCL OXYCODONE HCL 5434 5434 Carrier A 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 0.0769 5.89 1 0 FLUTICASONE PROPIONATE HFA FLOVENT HFA 5435 5435 Carrier N 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44205 LAP COLECTOMY PART W/ILEUM 2 1 0 0 0 0 2 0 NA NA 5436 5436 Carrier N 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44207 L COLECTOMY/COLOPROCTOSTOMY 2 1 0 0 0 0 2 0 NA NA 5437 5437 Carrier N 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43644 LAP GASTRIC BYPASS/ROUX-EN-Y 1 1 0 24 0 0 1 0 NA NA 5438 5438 Carrier N 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27299 UNLISTED PX PELVIS/HIP JOINT 1 1 0 24 0 0 1 0 NA NA 5439 5439 Carrier N 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 51590 REMOVE BLADDER/REVISE TRACT 1 1 0 0 0 0 1 0 NA NA 5440 5440 Carrier N 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 62165 REMOVE PITUIT TUMOR W/SCOPE 1 1 0 0 0 0 1 0 NA NA 5441 5441 Carrier N 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93654 COMPRE EP EVAL TX VT 1 1 0 24 0 0 1 0 NA NA 5442 5442 Carrier N 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44204 LAPARO PARTIAL COLECTOMY 1 1 0 0 0 0 1 0 NA NA 5443 5443 Carrier N 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 19361 BRST RCNSTJ LATSMS DRSI FLAP 1 1 0 24 0 0 1 0 NA NA 5444 5444 Carrier N 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96416 CHEMO PROLONG INFUSE W/PUMP 1 1 0 48 0 0 1 0 NA NA 5445 5445 Carrier N 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44205 LAP COLECTOMY PART W/ILEUM 2 1 0 0 0 0 2 0 NA NA 5446 5446 Carrier N 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44207 L COLECTOMY/COLOPROCTOSTOMY 2 1 0 0 0 0 2 0 NA NA 5447 5447 Carrier N 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43644 LAP GASTRIC BYPASS/ROUX-EN-Y 1 1 0 24 0 0 1 0 NA NA 5448 5448 Carrier N 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27299 UNLISTED PX PELVIS/HIP JOINT 1 1 0 24 0 0 1 0 NA NA 5449 5449 Carrier N 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 51590 REMOVE BLADDER/REVISE TRACT 1 1 0 0 0 0 1 0 NA NA 5450 5450 Carrier N 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 62165 REMOVE PITUIT TUMOR W/SCOPE 1 1 0 0 0 0 1 0 NA NA 5451 5451 Carrier N 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93654 COMPRE EP EVAL TX VT 1 1 0 24 0 0 1 0 NA NA 5452 5452 Carrier N 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44204 LAPARO PARTIAL COLECTOMY 1 1 0 0 0 0 1 0 NA NA 5453 5453 Carrier N 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19361 BRST RCNSTJ LATSMS DRSI FLAP 1 1 0 24 0 0 1 0 NA NA 5454 5454 Carrier N 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96416 CHEMO PROLONG INFUSE W/PUMP 1 1 0 48 0 0 1 0 NA NA 5455 5455 Carrier N 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 92507 SPEECH/HEARING THERAPY 39 0.974 0 12.9 0 0 39 0 NA NA 5456 5456 Carrier N 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT J0585 INJECTION,ONABOTULINUMTOXINA 30 0.767 342 108.9 0 4 26 0 NA NA 5457 5457 Carrier N 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95810 POLYSOM 6/> YRS 4/> PARAM 21 0.905 24 85.2 0 1 20 0 NA NA 5458 5458 Carrier N 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64615 CHEMODENERV MUSC MIGRAINE 17 0.824 240 114 0 1 16 0 NA NA 5459 5459 Carrier N 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT J7323 EUFLEXXA INJ PER DOSE 15 0.867 24 54.9 0 1 14 0 NA NA 5460 5460 Carrier N 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT Q5103 INJECTION, INFLECTRA 14 0.929 102 1032 0 8 6 0 NA NA 5461 5461 Carrier N 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 OFFICE O/P EST MOD 30 MIN 13 0.769 0 79.4 0 0 13 0 NA NA 5462 5462 Carrier N 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 81479 UNLISTED MOLECULAR PATHOLOGY 12 0.833 0 46 0 0 12 0 NA NA 5463 5463 Carrier N 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT J9035 BEVACIZUMAB INJECTION 8 1 0 33 0 0 8 0 NA NA 5464 5464 Carrier N 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT J0178 AFLIBERCEPT INJECTION 7 0.857 0 24 0 0 7 0 NA NA 5465 5465 Carrier N 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 92507 SPEECH/HEARING THERAPY 38 0.974 0 10.1 0 0 38 0 NA NA 5466 5466 Carrier N 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J0585 INJECTION,ONABOTULINUMTOXINA 23 0.767 552 117.8 0 1 22 0 NA NA 5467 5467 Carrier N 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95810 POLYSOM 6/> YRS 4/> PARAM 19 0.905 24 62.7 0 1 18 0 NA NA 5468 5468 Carrier N 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64615 CHEMODENERV MUSC MIGRAINE 14 0.824 0 113.1 0 0 14 0 NA NA 5469 5469 Carrier N 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J7323 EUFLEXXA INJ PER DOSE 13 0.867 24 38 0 1 12 0 NA NA 5470 5470 Carrier N 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT Q5103 INJECTION, INFLECTRA 13 0.929 113.1 1032 0 7 6 0 NA NA 5471 5471 Carrier N 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81479 UNLISTED MOLECULAR PATHOLOGY 10 0.833 0 36 0 0 10 0 NA NA 5472 5472 Carrier N 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99214 OFFICE O/P EST MOD 30 MIN 10 0.769 0 74.4 0 0 10 0 NA NA 5473 5473 Carrier N 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J9035 BEVACIZUMAB INJECTION 8 1 0 33 0 0 8 0 NA NA 5474 5474 Carrier N 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A9276 DISPOSABLE SENSOR, CGM SYS 7 1 48 44 0 1 6 0 NA NA 5475 5475 Carrier N 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22633 Arthrodesis 2 1 48 0 0 2 0 0 NA NA 5476 5476 Carrier N 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT J0585 INJECTION, ONABOTULINUMTOXINA, 1 UNIT; Other complications of pregnancy 2 1 24 0 0 2 0 0 NA NA 5477 5477 Carrier N 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 30465 Under Repair Procedures on the Nose 1 1 24 0 0 1 0 0 NA NA 5478 5478 Carrier N 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 36476 �Endovascular Ablation Therapy of Incompetent Extremity Veins� 1 1 0 432 0 0 1 0 NA NA 5479 5479 Carrier N 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27279 ARTHRODESIS, SACROILIAC JOINT, PERCUTANEOUS OR MINIMALLY INVASIVE (INDIRECT VISUALIZATION), WITH IMAGE GUIDANCE, INCLUDES OBTAINING BONE GRAFT WHEN PERFORMED, AND PLACEMENT OF TRANSFIXING DEVICE 1 1 0 840 0 0 1 0 NA NA 5480 5480 Carrier N 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 31599 Endoscopic laryngoplasty, Percutaneous laryngeal injections, and Removal of a keel or stent. 1 1 0 144 0 0 1 0 NA NA 5481 5481 Carrier N 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 73221 Magnetic resonance imaging (MRI) of the upper extremity without contrast material 1 1 0 984 0 0 1 0 NA NA 5482 5482 Carrier N 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L2055 Hip-knee-ankle-foot Orthotics 1 1 0 2448 0 0 1 0 NA NA 5483 5483 Carrier N 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 42975 drug-induced sleep endoscopy (DISE) that includes a dynamic evaluation of the tongue base, velum, pharynx, and larynx to assess sleep-disordered breathing. 1 1 0 3096 0 0 1 0 NA NA 5484 5484 Carrier N 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT Q5103 INFLECTRA 1 1 0 264 0 0 1 0 NA NA 5485 5485 Carrier N 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 MENTAL HEALTH INPATIENT 3 1 0 0 3 0 0 NA NA 5486 5486 Carrier N 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1002 SUBSTANCE ABUSE RESIDENTIAL 2 1 0 0 2 0 0 NA NA 5487 5487 Carrier N 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1001 MENTAL HEALTH RESIDENTIAL 1 0 0 0 1 0 0 NA NA 5488 5488 Carrier N 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 MENTAL HEALTH INPATIENT 3 1 0 0 3 0 0 NA NA 5489 5489 Carrier N 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1002 SUBSTANCE ABUSE RESIDENTIAL 2 1 0 0 2 0 0 NA NA 5490 5490 Carrier N 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 TRANSCRANIAL MAGNETIC STIMULATION (TMS) 4 1 0 0 0 4 0 NA NA 5491 5491 Carrier N 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 SUBSTANCE ABUSE PARTIAL HOSPITALIZATION PROGRAM 2 1 0 0 0 2 0 NA NA 5492 5492 Carrier N 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 PSYCHIATRIC TREATMENT PARTIAL HOSPITALIZATION 2 1 0 0 0 2 0 NA NA 5493 5493 Carrier N 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90853 MENTAL HEALTH GROUP THERAPY 1 1 0 0 0 1 0 NA NA 5494 5494 Carrier N 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 EATING DISORDER PARTIAL HOSPITALIZATION PROGRAM 1 1 0 0 0 1 0 NA NA 5495 5495 Carrier N 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 036T APPLIED BEHAVIORAL ANALYSIS 1 1 0 0 0 1 0 NA NA 5496 5496 Carrier N 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90867 TRANSCRANIAL MAGNETIC STIMULATION (TMS) 4 1 0 0 0 4 0 NA NA 5497 5497 Carrier N 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0035 SUBSTANCE ABUSE PARTIAL HOSPITALIZATION PROGRAM 2 1 0 0 0 2 0 NA NA 5498 5498 Carrier N 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0035 PSYCHIATRIC TREATMENT PARTIAL HOSPITALIZATION 2 1 0 0 0 2 0 NA NA 5499 5499 Carrier N 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90853 MENTAL HEALTH GROUP THERAPY 1 1 0 0 0 1 0 NA NA 5500 5500 Carrier N 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0035 EATING DISORDER PARTIAL HOSPITALIZATION PROGRAM 1 1 0 0 0 1 0 NA NA 5501 5501 Carrier N 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 036T APPLIED BEHAVIORAL ANALYSIS 1 1 0 0 0 1 0 NA NA 5502 5502 Carrier N 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97151 ABA Therapy 1 1 0 264 0 0 1 0 NA NA 5503 5503 Carrier N 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L5645 BK FLEX INNER SOCKET EXT FRA 1 1 0 144 0 0 1 0 NA NA 5504 5504 Carrier N 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L5301 BK MOLD SOCKET SACH FT ENDO 1 1 0 144 0 0 1 0 NA NA 5505 5505 Carrier N 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L5679 SOCKET INSERT W/O LOCK MECH 1 1 0 144 0 0 1 0 NA NA 5506 5506 Carrier N 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L5629 BELOW KNEE ACRYLIC SOCKET 1 1 0 144 0 0 1 0 NA NA 5507 5507 Carrier N 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L8699 PROSTHETIC IMPLANT NOS 1 0 0 0 0 0 1 0 NA NA 5508 5508 Carrier N 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L5637 BELOW KNEE TOTAL CONTACT 1 1 0 144 0 0 1 0 NA NA 5509 5509 Carrier N 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L5940 ENDO BK ULTRA-LIGHT MATERIAL 1 1 0 144 0 0 1 0 NA NA 5510 5510 Carrier N 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L8680 IMPLT NEUROSTIM ELCTR EACH 1 1 0 96 0 0 1 0 NA NA 5511 5511 Carrier N 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L5685 BELOW KNEE SUS/SEAL SLEEVE 1 1 0 144 0 0 1 0 NA NA 5512 5512 Carrier N 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L5620 TEST SOCKET BELOW KNEE 1 1 0 144 0 0 1 0 NA NA 5513 5513 Carrier N 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L5645 BK FLEX INNER SOCKET EXT FRA 1 1 0 144 0 0 1 0 NA NA 5514 5514 Carrier N 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L5301 BK MOLD SOCKET SACH FT ENDO 1 1 0 144 0 0 1 0 NA NA 5515 5515 Carrier N 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L5679 SOCKET INSERT W/O LOCK MECH 1 1 0 144 0 0 1 0 NA NA 5516 5516 Carrier N 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L5629 BELOW KNEE ACRYLIC SOCKET 1 1 0 144 0 0 1 0 NA NA 5517 5517 Carrier N 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L5637 BELOW KNEE TOTAL CONTACT 1 1 0 144 0 0 1 0 NA NA 5518 5518 Carrier N 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L5940 ENDO BK ULTRA-LIGHT MATERIAL 1 1 0 144 0 0 1 0 NA NA 5519 5519 Carrier N 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L8680 IMPLT NEUROSTIM ELCTR EACH 1 1 0 96 0 0 1 0 NA NA 5520 5520 Carrier N 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L5685 BELOW KNEE SUS/SEAL SLEEVE 1 1 0 144 0 0 1 0 NA NA 5521 5521 Carrier N 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L5620 TEST SOCKET BELOW KNEE 1 1 0 144 0 0 1 0 NA NA 5522 5522 Carrier N 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT K0861 PWC GP3 STD MULT POW OPT S/B 1 1 0 96 0 0 1 0 NA NA 5523 5523 Carrier N 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 79 0.37 1.38 28.53 0 9 70 0 Semaglutide OZEMPIC 5524 5524 Carrier N 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 63 0.8413 1.03 38.58 0 16 47 0 Rimegepant NURTEC 5525 5525 Carrier N 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 45 0.8 2.34 40.825 0 8 37 0 Ssemaglutide WEGOVY 5526 5526 Carrier N 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 43 0.47 0.2625 2.875 0 7 36 0 Ssemaglutide OZEMPIC 5527 5527 Carrier N 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 38 0.92 8.07 29.725 0 10 28 0 Ssemaglutide OZEMPIC 5528 5528 Carrier N 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 36 0.56 10.985 52.64 0 15 21 0 Lisdexamfetamine VYVANSE 5529 5529 Carrier N 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 36 0.89 1.34 20.695 0 15 21 0 Deucravacitinib STELARA 5530 5530 Carrier N 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 34 0.56 0.96 33.92 0 6 28 0 Ruxolitinib OPZELURA 5531 5531 Carrier N 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 33 0.39 1.44 19.25 0 2 31 0 Tirzepatide MOUNJARO 5532 5532 Carrier N 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 31 0.29 57.625 60.77 0 16 15 0 EmtricitabineTenofovir Alafenamide) DESCOVY 5533 5533 Carrier N 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 27 1 1 16.64 0 6 21 0 Adalimumab HUMIRA 5534 5534 Carrier N 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 24 1 0.01 23.5 0 16 8 0 Apixaban ELIQUIS 5535 5535 Carrier N 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 16 1 0.01 0.02 0 2 14 0 Dupilumab DUPIXENT 5536 5536 Carrier N 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 15 1 1.05 13.72 0 6 9 0 Amphetamine and Dextroamphetamine DEXTROAMPHETAMINE 5537 5537 Carrier N 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 13 1 11.51 17.07 0 2 11 0 Evolocumab REPATHA SURECLICK 5538 5538 Carrier N 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 13 1 0.01 34.53 0 4 9 0 Risankizumab-rzaa SKYRIZI PEN 5539 5539 Carrier N 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 10 1 0.01 0.01 0 5 5 0 Concerta METHYLPHENIDATE ER 5540 5540 Carrier N 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 10 1 6.7 0 0 10 0 Ssemaglutide WEGOVY 5541 5541 Carrier N 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 9 1 8.86 0.04 0 7 2 0 Menotropins MENOPUR 5542 5542 Carrier N 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 9 1 1.62 47 0 3 6 0 Erenumab-aooe AIMOVIG 5543 5543 Carrier N 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 1 32 0 0 3 0 0 Ustekinumab STELARA 5544 5544 Carrier B 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 METALLIC MESH BETWEEN VERTEBRAE 13 0.9231 0 189.88 0 0 13 0 NA NA 5545 5545 Carrier B 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20930 BONE GRAFT MATERIAL ATTACHED TO SPINE 10 0.7 0 54.02 0 0 10 0 NA NA 5546 5546 Carrier B 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 SPINAL FUSION TO JOIN TWO VERTEBRAE IN LOW BACK 10 1 0 61.22 0 0 10 0 NA NA 5547 5547 Carrier B 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22842 SPINAL INSTRUMENTATION PLACE AT BACK OF SPINE TO CORRECT DEFORMITY 9 1 0 40.12 0 0 9 0 NA NA 5548 5548 Carrier B 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22614 SPINAL FUSION TO JOIN TWO VERTEBRAE 9 1 0 49.39 0 0 9 0 NA NA 5549 5549 Carrier B 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63048 ADDITIONAL VERTEBRAE SEGMENT DURING ANOTHER PROCEDURE 9 0.8889 0 56.06 0 0 9 0 NA NA 5550 5550 Carrier B 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22612 LUMBAR SPINE FUSION 9 1 0 245.01 0 0 9 0 NA NA 5551 5551 Carrier B 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22845 SPINAL INSTRUMENTATION PLACE AT FRONT OF SPINE TO CORRECT DEFORMITY 9 0.4444 0 244.27 0 0 9 0 NA NA 5552 5552 Carrier B 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63047 INCISION AT A SINGLE VERTEBREA TO CORRECT SPINAL STENOSIS 8 0.875 0 270.73 0 0 8 0 NA NA 5553 5553 Carrier B 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20936 AUTOGRAFT TO BONE DURING SPINAL SURGERY 7 1 0 55.36 0 0 7 0 NA NA 5554 5554 Carrier B 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22848 SPINAL DEVICE FIXATION TO PELVIC BONES 1 1 0 11.93 0 0 1 0 NA NA 5555 5555 Carrier B 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63046 SINGLE THORACIC VERTEBRAL TO CORRECT STENOSIS 2 1 0 94.06 0 0 2 0 NA NA 5556 5556 Carrier B 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27487 REVISION OF KNEE JOINT WITH FEMORAL AND TIBIAL COMPONENTS 1 1 0 77.87 0 0 1 0 NA NA 5557 5557 Carrier B 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15769 HARVESTING OF SKIN WITH AUTOLOGOUS SOFT TISSUE 1 1 164.83 0 0 1 0 0 NA NA 5558 5558 Carrier B 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22840 PLACEMENT OF SPINAL INSTRUMENTATION IN THE NECK ACROSS C1-C2. 7 1 0 317.79 0 0 7 0 NA NA 5559 5559 Carrier B 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 20939 AUTOGRAFT TO BONE DURING SPINAL SURGERY 2 1 0 22.28 0 0 2 0 NA NA 5560 5560 Carrier B 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15734 MUSCLE FLAP FROM AN AREA OF THE TRUNK 1 1 0.89 0 0 1 0 0 NA NA 5561 5561 Carrier B 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 20939 BONE MARROW HARVEST TO USE AS A BONE GRAFT 2 1 0 22.28 0 0 2 0 NA NA 5562 5562 Carrier B 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63045 SINGLE CERVICAL VERTEBRAL PROCEDURE 2 1 0 33.39 0 0 2 0 NA NA 5563 5563 Carrier B 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22551 CERVICAL DISC REMOVAL FROM FRONT OF NECK TO RELIEVE PAIN 1 1 0 50.88 0 0 1 0 NA NA 5564 5564 Carrier B 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 44204 LAPAROSCOPIC PARTIAL REMOVAL OF COLON 1 1 0 0.12 0 0 1 0 NA NA 5565 5565 Carrier B 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95810 SLEEP STUDY GREATER THAN 6 YRS OLD 141 0.7305 0 83.31 0 0 141 0 NA NA 5566 5566 Carrier B 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95811 SLEEP STUDY GREATER THAN 6 YRS OLD WITH CPAP MACHINE 111 0.7027 0 72.27 0 0 111 0 NA NA 5567 5567 Carrier B 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99212 OFFICE/OUTPATIENT ESTABLISHED MEMBER LASTING 10-19 MIN 97 0.5321 47.77 131.12 0.07 10 86 1 NA NA 5568 5568 Carrier B 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0481 DEFINITIVE DRUG TEST OF CLASSES 8-14 58 0.5347 0 78.58 0 0 58 0 NA NA 5569 5569 Carrier B 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0480 DEFINITIVE DRUG TEST OF CLASSES 1-7 56 0.5053 0 77.23 0 0 56 0 NA NA 5570 5570 Carrier B 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0483 DEFINITIVE DRUG TEST OF CLASSES 22+ 56 0.0215 0 78.51 0 0 56 0 NA NA 5571 5571 Carrier B 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC J0585 INJECTION,ONABOTULINUMTOXINA 93 0.8172 11.6 34.17 0 7 86 0 NA NA 5572 5572 Carrier B 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0482 DEFINITIVE DRUG TEST OF CLASSES 15-22 55 0.022 0 78.92 0 0 55 0 NA NA 5573 5573 Carrier B 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0299 DIRECT SKILLED NURSING SERVICES OF A REGISTERED NURSE IN HOME OR HOSPICE SETTING 65 1 0 116.5 0 0 65 0 NA NA 5574 5574 Carrier B 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC J3489 ZOLEDRONIC ACID 1MG (ZOMETA) 83 0.9157 28.67 19.47 0 3 80 0 NA NA 5575 5575 Carrier B 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72110 X-RAY OF AT LEAST 4 VIEWS OF THE LUMBOSACRAL SPINE 0 1 0 0 0 0 0 0 NA NA 5576 5576 Carrier B 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9607 LUTETIUM LU 177 VIPIVOTIDE TETRAXETAN THER 1 MCI (PLUVICTO) 1 1 4.19 0 0 1 0 0 NA NA 5577 5577 Carrier B 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC G6002 STEREOSCOPIC X-RAY GUIDANCE TO ASSIST WITH RADIATION THERAPY TARGETING 1 1 24.58 0 0 1 0 0 NA NA 5578 5578 Carrier B 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC J9145 INJECTION DARATUMUMAB 10 MG (DARZALEX)-CHEMOTHERAPY 1 1 0 44.58 0 0 1 0 NA NA 5579 5579 Carrier B 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 31575 LARYNGOSCOPY FLEXIBLE FIBEROPTIC TO LOOK INSIDE THE LARYNX 0 1 0 0 0 0 0 0 NA NA 5580 5580 Carrier B 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81379 GENETIC TEST TO FOR HIGH RESOLUTION OF HUMAN LEUKOCYTE ANTIGEN GENES 3 1 0 209.25 0 0 3 0 NA NA 5581 5581 Carrier B 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC J9304 INJECTION PEMETREXED PEMFEXY 10 MG FOR CHEMOTHERAPY 1 1 0 0.03 0 0 1 0 NA NA 5582 5582 Carrier B 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81380 GENETIC TEST TO FOR HIGH RESOLUTION OF HUMAN LEUKOCYTE ANTIGEN GENES, FOR CLASS 1, USING MOLECULAR TECHNIQUES 2 1 0 228.85 0 0 2 0 NA NA 5583 5583 Carrier B 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 650 ROUTINE HOME HOSPICE CARE DELIVERED IN A NURSING FACILITY 0 1 0 0 0 0 0 0 NA NA 5584 5584 Carrier B 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81383 GENETIC TEST TO FOR HIGH RESOLUTION OF HUMAN LEUKOCYTE ANTIGEN GENES, FOR CLASS 2 ALLELE GROUP 2 1 0 228.85 0 0 2 0 NA NA 5585 5585 Carrier B 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 1480 ANESTHESIA SERVICES FOR OPEN PROCEDURE OF THE LOWER LEG, ANKLE, AND FOOT 0 1 0 0 0 0 0 0 NA NA 5586 5586 Carrier B 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 95024 ALLERGY SKIN TESTING 0 1 0 0 0 0 0 0 NA NA 5587 5587 Carrier B 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 99385 WELL-PATIENT VISIT FOR PATIENT 18-39 YEARS OLD. 0 1 0 0 0 0 0 0 NA NA 5588 5588 Carrier B 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC H0031 MENTAL HEALTH ASSESSMENT BY A NON-PHYSICIAN 0 1 0 0 0 0 0 0 NA NA 5589 5589 Carrier B 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 30435 SURGURY TO REPAIR OR CHANGE SHAPE OF THE NOSE ON A PATIENT WHO HAS HAD THE SURGERY BEFORE 1 1 0 75.47 0 0 1 0 NA NA 5590 5590 Carrier B 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC H2015 COMPREHENSIVE COMMUNITY SUPPORT SERVICES, PER 15 MINUTES 0 1 0 0 0 0 0 0 NA NA 5591 5591 Carrier B 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27829 SURGIICAL REPAIR INJURY TO THE TIBIOFIBULAR JOINT AND SECURES THE TIBIA AND FIBULA WITH PLATES AND SCREWS, WIRES OR PINS 0 1 0 0 0 0 0 0 NA NA 5592 5592 Carrier B 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90677 PNEUMONIA VACCINE FOR INTRAMUSCULAR USE 0 1 0 0 0 0 0 0 NA NA 5593 5593 Carrier B 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 99125 RISK OR PHYISICAL STATUS FOR ANESTHESIA 0 1 0 0 0 0 0 0 NA NA 5594 5594 Carrier B 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 80050 LAB TEST FOR A GENERAL HEALTH PANEL 0 1 0 0 0 0 0 0 NA NA 5595 5595 Carrier B 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 SEMI-PRIVATE PYSCHIATRIC INPATIENT STAY 113 0.9187 0 22.18 0 0 113 0 NA NA 5596 5596 Carrier B 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1002 BEHAVIORAL HEALTH ACCOMODATIONS-RELATED TO CHEMICAL DEPENDANCY 67 0.9851 0 14.17 0 0 67 0 NA NA 5597 5597 Carrier B 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 126 DETOXIFICATION BED 34 1 0 7.83 0 0 34 0 NA NA 5598 5598 Carrier B 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 100 ROOM AND BOARD-ALL INCLUSIVE PLUS ANCILLARY 3 1 0 11.21 0 0 3 0 NA NA 5599 5599 Carrier B 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1001 BEHAVIORAL HEALTH ACCOMODATIONS-RESIDENTIAL TREATMENT PSYCHIATRIC 1 1 0 30.67 0 0 1 0 NA NA 5600 5600 Carrier B 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 126 DETOXIFICATION BED 34 1 0 7.83 0 0 34 0 NA NA 5601 5601 Carrier B 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1001 BEHAVIORAL HEALTH ACCOMODATIONS-RESIDENTIAL TREATMENT PSYCHIATRIC 1 1 0 30.67 0 0 1 0 NA NA 5602 5602 Carrier B 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 100 ROOM AND BOARD-ALL INCLUSIVE PLUS ANCILLARY 3 1 0 11.21 0 0 3 0 NA NA 5603 5603 Carrier B 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1002 BEHAVIORAL HEALTH ACCOMODATIONS-RELATED TO CHEMICAL DEPENDANCY 67 0.9851 0 14.17 0 0 67 0 NA NA 5604 5604 Carrier B 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 SEMI-PRIVATE PYSCHIATRIC INPATIENT STAY 113 0.9187 0 22.18 0 0 113 0 NA NA 5605 5605 Carrier B 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 912 PARTIAL HOSPITALIZATION PSYCHIATRIC PROGRAM 48 1 0 45.72 0 0 48 0 NA NA 5606 5606 Carrier B 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 905 INTENSIVE BEHAVIORAL HEALTH TREATMENT SERVICES 29 1 0 40.65 0 0 29 0 NA NA 5607 5607 Carrier B 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 906 PROFESSIONAL FEE FOR PSYCHOLOGY 13 1 0 38.28 0 0 13 0 NA NA 5608 5608 Carrier B 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96101 PSYCHOLOGICAL TESTING PER HOUR FACE TO FACE TIME WITH PATIENT 10 1 0 48.96 0 0 10 0 NA NA 5609 5609 Carrier B 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 MENTAL HEALTH PARTIAL HOSPITALIZATION, LESS THAN 24 HOURS 9 1 0 106.91 0 0 9 0 NA NA 5610 5610 Carrier B 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90791 PSYCHOLOGICAL DIAGNOSTIC EVALUATION 1 1 0 189.8 0 0 1 0 NA NA 5611 5611 Carrier B 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC S9480 INTENSIVE OUTPATIENT PSYCHIATRIC SERVICES PER DIEM 2 1 0 0 0 0 2 0 NA NA 5612 5612 Carrier B 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96132 NEUROPSYCHOLOGICAL TEST EVALUATION BY A PHYSICIAN/QUALIFIED HEALTH PROFESSIONAL UP TO 1 HOUR. 2 1 0 61.37 0 0 2 0 NA NA 5613 5613 Carrier B 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97156 ADAPTIVE BEHAVIOR TREATMENT PROCEDURES 2 1 0 0.12 0 0 2 0 NA NA 5614 5614 Carrier B 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H2012 BEHAVIORAL HEALTH DAY TREATMENT, PER HOUR 2 1 0 23.19 0 0 2 0 NA NA 5615 5615 Carrier B 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0035 MENTAL HEALTH PARTIAL HOSPITALIZATION, LESS THAN 24 HOURS 9 1 0 106.91 0 0 9 0 NA NA 5616 5616 Carrier B 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97156 ADAPTIVE BEHAVIOR TREATMENT PROCEDURES 2 1 0 0.12 0 0 2 0 NA NA 5617 5617 Carrier B 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90792 PSYCHIATRIC EVALUATION IN ADDITION TO RENDERING ADDITIONAL MEDICAL SERVICES 0 1 0 0 0 0 0 0 NA NA 5618 5618 Carrier B 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 906 PROFESSIONAL FEE FOR PSYCHOLOGY 13 1 0 38.28 0 0 13 0 NA NA 5619 5619 Carrier B 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99213 OFFICE/OUTPATIENT VISIT TO AN ESTABLISHED PATIENT 1 1 0 0 0 0 1 0 NA NA 5620 5620 Carrier B 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90791 PSYCHOLOGICAL DIAGNOSTIC EVALUATION 1 1 0 189.8 0 0 1 0 NA NA 5621 5621 Carrier B 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96132 NEUROPSYCHOLOGICAL TEST EVALUATION BY A PHYSICIAN/QUALIFIED HEALTH PROFESSIONAL UP TO 1 HOUR. 2 1 0 61.37 0 0 2 0 NA NA 5622 5622 Carrier B 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90867 TRANSCRANIAL MAGNETIC STIMULATION USED TO IMPROVE DEPRESSION 1 1 0 23.62 0 0 1 0 NA NA 5623 5623 Carrier B 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97155 ADAPTIVE BEHAVIOR TREATMENT FACE TO FACE TO MODIFY TARGETS AND TREATMENT TECHNIQUES, 15 MINUTES 2 1 0 0.12 0 0 2 0 NA NA 5624 5624 Carrier B 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90869 TRANSCRANIAL MAGNETIC STIMULATION SUBSQUENT REDETERMINATION 1 1 0 24.62 0 0 1 0 NA NA 5625 5625 Carrier B 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 906 PROFESSIONAL FEE FOR PSYCHOLOGY 13 0.0714 0 38.28 0 0 13 0 NA NA 5626 5626 Carrier B 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE 549 0.927 54.61 75.54 0 5 544 0 NA NA 5627 5627 Carrier B 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1390 PORTABLE OXYGEN CONCENTRATOR 100 0.8304 28.02 81.77 0 8 92 0 NA NA 5628 5628 Carrier B 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4239 CONTINUOUS GLUCOSE MONITORING SUPPLIES BY MONTH 59 0.9153 39.92 76.82 0 1 58 0 NA NA 5629 5629 Carrier B 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0781 AMBULATORY INFUSION PUMP 1 OR MULTIPLE CHANNELS PATIENT WEARS 41 0.8913 12.1 56.88 0 2 39 0 NA NA 5630 5630 Carrier B 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0470 BI-PAP RESPIRATORY ASSIST DEVICE WITH OUT BACKUP 32 0.8788 17.85 70.76 0 1 31 0 NA NA 5631 5631 Carrier B 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0935 PASSIVE MOTION EXERCISE DEVICE 16 0.5 23.65 97.52 0 2 14 0 NA NA 5632 5632 Carrier B 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2402 NEGATIVE PRESSURE WOUND PUMP 10 1 0 70.3 0 0 10 0 NA NA 5633 5633 Carrier B 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1399 DURABLE MEDICAL EQUIPMENT NOT CLASSIFIED ELSEWHERE 11 0.8182 32.11 71.45 0 1 10 0 NA NA 5634 5634 Carrier B 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0471 BI-PAP RESPIRATORY ASSIST DEVICE WITH BACKUP 9 1 0 61.05 0 0 9 0 NA NA 5635 5635 Carrier B 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0466 HOME VENTILATOR, USED WITH NON-INVASIVE INTERFACE (MASK, CHEST SHELL) 8 0.75 0 116.74 0 0 8 0 NA NA 5636 5636 Carrier B 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2313 POWER WHEELCHAIR HARNESS 1 1 0 44.76 0 0 1 0 NA NA 5637 5637 Carrier B 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8690 AUDITORY OSSEOINTEGRATED DEVICE INCLUDES ALL INTERNAL & EXTERNAL COMPONENTS 3 1 0 73.94 0 0 3 0 NA NA 5638 5638 Carrier B 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0005 ULTRALIGHTWEIGHT WHEELCHAIR 2 1 0 113.67 0 0 2 0 NA NA 5639 5639 Carrier B 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC B9002 ENTERAL NUTRITION INFUSION PUMP WITH ALARM 1 1 0 0 0 0 1 0 NA NA 5640 5640 Carrier B 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0188 SYNTHETIC SHEEPSKIN PAD 1 1 0 140.54 0 0 1 0 NA NA 5641 5641 Carrier B 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0261 HOSPITAL BED SEMI-ELECTRIC WITH ANY RAILS AND WITHOUT MATTRESS 2 1 0 193.26 0 0 2 0 NA NA 5642 5642 Carrier B 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2402 NEGATIVE PRESSURE WOUND PUMP 10 1 0 70.3 0 0 10 0 NA NA 5643 5643 Carrier B 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0277 POWERED PRESS-REDUCING AIR MATRESS 1 1 32.11 0 0 1 0 0 NA NA 5644 5644 Carrier B 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0861 POWER WH EELCHAIR, GROUP 3 , STANDARD, MULTIPLE POWER OPTION, SLING/SOLID SEAT/BACK, UP TO 300LBS IN WEIGHT 1 1 0 44.76 0 0 1 0 NA NA 5645 5645 Carrier B 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0303 HEAVY DUTY HOSPITAL BED, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN 350 POUNDS BUT LESS THAN OR EQUAL TO 600 POINS, WITH ANY TYPE SIDE RAILS AND MATTRESS 4 1 7.75 67.66 0 1 3 0 NA NA 5646 5646 Carrier B 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E1161 MANUAL ADLUT SIZE WHEELCHAIR INCLUIDING TILT SPACE 2 0.5 0 70.06 0 0 2 0 NA NA 5647 5647 Carrier B 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC K0108 OTHER ACCESSORY NOT LISTED 4 0.25 0 81.18 0 0 4 0 NA NA 5648 5648 Carrier B 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC K0001 STANDARD WHEELCHAIR 5 0.2 0 57.77 0 0 5 0 NA NA 5649 5649 Carrier B 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0630 PATIENT LIFT HYDRAULIC 5 0.2 50.39 70.57 0 1 4 0 NA NA 5650 5650 Carrier B 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0562 HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE 7 0.125 0 82.96 0 0 7 0 NA NA 5651 5651 Carrier B 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0935 PASSIVE MOTION EXERCISE DEVICE 16 0.125 23.65 97.52 0 2 14 0 NA NA 5652 5652 Carrier B 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E1399 DURABLE MEDICAL EQUIPMENT NOT CLASSIFIED ELSEWHERE 11 0.0909 32.11 71.45 0 1 10 0 NA NA 5653 5653 Carrier B 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E1390 PORTABLE OXYGEN CONCENTRATOR 100 0.0446 28.02 81.77 0 8 92 0 NA NA 5654 5654 Carrier B 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0601 CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE 549 0.0196 54.61 75.54 0 5 544 0 NA NA 5655 5655 Carrier B 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC A4239 CONTINUOUS GLUCOSE MONITORING SUPPLIES BY MONTH 59 0.0169 39.92 76.82 0 1 58 0 NA NA 5656 5656 Carrier B 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9277 EXTERNAL TRANSMITTER CONTINOUS GLUCOSE MONITOR DAILY 39 0.975 13.79 71.49 0 2 37 0 NA NA 5657 5657 Carrier B 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 EXTERNAL AMBULATORY INFUSION PUMP, INSULIN 14 1 0 63.38 0 0 14 0 NA NA 5658 5658 Carrier B 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9278 EXTERNAL RECEIVER FOR CONTINOUS GLUCOSE MONITORING 7 1 0 64.28 0 0 7 0 NA NA 5659 5659 Carrier B 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9274 EXTERNAL AMBULATORY INSULIN DELIVERY SYSTEM 2 1 0 100.74 0 0 2 0 NA NA 5660 5660 Carrier B 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 EXTERNAL AMBULATORY INFUSION PUMP, INSULIN 14 1 0 63.38 0 0 14 0 NA NA 5661 5661 Carrier B 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9278 EXTERNAL RECEIVER FOR CONTINOUS GLUCOSE MONITORING 7 1 0 64.28 0 0 7 0 NA NA 5662 5662 Carrier B 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9274 EXTERNAL AMBULATORY INSULIN DELIVERY SYSTEM 2 1 0 100.74 0 0 2 0 NA NA 5663 5663 Carrier B 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9277 EXTERNAL TRANSMITTER CONTINOUS GLUCOSE MONITOR DAILY 39 0.975 13.79 71.49 0 2 37 0 NA NA 5664 5664 Carrier B 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 1160 0.6276 13 606 221 939 Semaglutide Ozempic 5665 5665 Carrier B 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 531 0.307 19 943 69 462 Clobetasol Propionate Clobetasol 5666 5666 Carrier B 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 358 0.6872 9 417 87 271 Liraglutide Victoza 5667 5667 Carrier B 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 355 0.8901 11 281 70 285 Dulaglutide Trulicity 5668 5668 Carrier B 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 345 0.313 42 963 100 245 Pregabalin Pregabalin 5669 5669 Carrier B 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 255 0.9176 39 653 113 142 Hydrocodone-Acetaminophen Hydroco/apap 5670 5670 Carrier B 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 233 0.8155 17 233 70 163 Lisdexamfetamine Dimesylate Vyvanse 5671 5671 Carrier B 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 202 0.7921 27 1074 36 166 Adalimumab Humira Pen 5672 5672 Carrier B 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 183 0.8907 75 537 97 86 Oxycodone HCl Oxycodone 5673 5673 Carrier B 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 182 0.5549 19 1143 24 158 Continuous Glucose System Sensor Freesty Libr 5674 5674 Carrier B 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 16 1 55 155 7 9 Sodium Zirconium Cyclosilicate Lokelma 5675 5675 Carrier B 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 11 1 283 0 11 Oxybutynin Chloride Oxybutynin 5676 5676 Carrier B 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 11 1 427 56 3 8 Segesterone Acetate-Ethinyl Estradiol Annovera 5677 5677 Carrier B 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 10 1 783 0 10 Fluticasone Propionate HFA Flovent Hfa 5678 5678 Carrier B 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 9 1 49 356 5 4 Insulin Aspart Novolog 5679 5679 Carrier B 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 1 0 2 6 Etonogestrel Nexplanon 5680 5680 Carrier B 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 77 0 7 1 Dasatinib Sprycel 5681 5681 Carrier B 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 1 0 3 5 Levonorgestrel (IUD) Mirena 5682 5682 Carrier B 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 749 0 7 Ketoconazole (Topical) Ketoconazole 5683 5683 Carrier B 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 178 769 5 2 Trifluridine-Tipiracil Lonsurf 5684 5684 Carrier E 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 150 ROOM & BOARD, WARD - GENERAL 12 1 21.2 17.8 2 10 NA NA 5685 5685 Carrier E 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99223 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES 10 1 1.06 17.3 1 9 NA NA 5686 5686 Carrier E 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99291 CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN 5 1 11.6 5 NA NA 5687 5687 Carrier E 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99222 1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES 5 1 10.6 5 NA NA 5688 5688 Carrier E 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27447 ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS 3 1 14.6 3 NA NA 5689 5689 Carrier E 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT 3 1 18.2 3 NA NA 5690 5690 Carrier E 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 762 SPECIALTY SERVICES, OBSERVATION HOURS 3 1 20.6 3 NA NA 5691 5691 Carrier E 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 158 ROOM & BOARD, WARD - REHABILITATION 3 1 16.7 3 NA NA 5692 5692 Carrier E 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99232 SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES 2 1 0 2 NA NA 5693 5693 Carrier E 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 71045 RADIOLOGIC EXAM CHEST SINGLE VIEW 2 1 8.1 2 NA NA 5694 5694 Carrier E 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 150 ROOM & BOARD, WARD - GENERAL 12 1 21.2 17.8 2 10 NA NA 5695 5695 Carrier E 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99223 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES 10 1 1.06 17.3 1 9 NA NA 5696 5696 Carrier E 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99291 CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN 5 1 11.6 5 NA NA 5697 5697 Carrier E 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99222 1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES 5 1 10.6 5 NA NA 5698 5698 Carrier E 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27447 ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS 3 1 14.6 3 NA NA 5699 5699 Carrier E 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT 3 1 18.2 3 NA NA 5700 5700 Carrier E 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 762 SPECIALTY SERVICES, OBSERVATION HOURS 3 1 20.6 3 NA NA 5701 5701 Carrier E 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 158 ROOM & BOARD, WARD - REHABILITATION 3 1 16.7 3 NA NA 5702 5702 Carrier E 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99232 SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES 2 1 0 2 NA NA 5703 5703 Carrier E 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 71045 RADIOLOGIC EXAM CHEST SINGLE VIEW 2 1 8.1 2 NA NA 5704 5704 Carrier E 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99203 OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES 300 0.9933 7.8 60.7 20 280 NA NA 5705 5705 Carrier E 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97161 PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS 187 0.9679 0.8 77.4 5 182 NA NA 5706 5706 Carrier E 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99204 OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES 140 0.9929 9.4 52.2 5 135 NA NA 5707 5707 Carrier E 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97530 THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN 118 0.8983 17.4 219.6 4 114 NA NA 5708 5708 Carrier E 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72148 MRI LUMBAR SPINE NO CONTRAST 118 1 17 42.8 40 78 NA NA 5709 5709 Carrier E 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 MRI BRAIN WO/W CONTRAST 82 1 7.2 17.9 16 66 NA NA 5710 5710 Carrier E 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45378 COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD 77 0.987 106.6 77 NA NA 5711 5711 Carrier E 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 MRI RIGHT KNEE NO CONTRAST 72 1 13 30.6 35 37 NA NA 5712 5712 Carrier E 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 MRI LEFT KNEE NO CONTRAST 69 1 7.5 22.2 36 33 NA NA 5713 5713 Carrier E 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72141 MRI CERVICAL SPINE NO CONTRAST 66 1 14.4 16.4 14 52 NA NA 5714 5714 Carrier E 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72148 MRI LUMBAR SPINE NO CONTRAST 118 1 17 42.8 40 78 NA NA 5715 5715 Carrier E 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70553 MRI BRAIN WO/W CONTRAST 82 1 7.2 17.9 16 66 NA NA 5716 5716 Carrier E 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 73721 MRI RIGHT KNEE NO CONTRAST 72 1 13 30.6 35 37 NA NA 5717 5717 Carrier E 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 73721 MRI LEFT KNEE NO CONTRAST 69 1 7.5 22.2 36 33 NA NA 5718 5718 Carrier E 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72141 MRI CERVICAL SPINE NO CONTRAST 66 1 14.4 16.4 14 52 NA NA 5719 5719 Carrier E 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97162 PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS 63 1 1.4 29.2 5 58 NA NA 5720 5720 Carrier E 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 73221 MRI RIGHT SHOULDER NO CONTRAST 55 1 8.4 20.6 29 26 NA NA 5721 5721 Carrier E 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ 52 1 19.8 52 NA NA 5722 5722 Carrier E 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC G0151 SERVICE PHYS THERAP HOME HLTH/HOSPICE EA 15 MIN 43 1 5.6 43 NA NA 5723 5723 Carrier E 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70551 MRI BRAIN NO CONTRAST 43 1 12.3 24.4 16 27 NA NA 5724 5724 Carrier E 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC A56589 BARIUM SWALLOW STUDIES, MODIFIED 1 1 1466.5 1 NA NA 5725 5725 Carrier E 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64615 CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE 1 1 315 1 NA NA 5726 5726 Carrier E 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC J3490 UNCLASSIFIED DRUGS 2 0.5 15.3 2 NA NA 5727 5727 Carrier E 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 99201 OFFICE OUTPATIENT NEW 10 MINUTES 2 0.5 505.2 2 NA NA 5728 5728 Carrier E 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 25043 REFERRAL PHYSICAL THERAPY CANCER REHAB 5 0.2 303.6 5 NA NA 5729 5729 Carrier E 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43239 EGD TRANSORAL BIOPSY SINGLE/MULTIPLE 10 0.1 52.6 64.2 1 9 NA NA 5730 5730 Carrier E 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 23660 EXT REFERRAL PEDS 13 0.08 20.2 231.3 4 9 NA NA 5731 5731 Carrier E 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 20041 REFERRAL THERAPY, SPEECH AND LANGUAGE 29 0.07 1 259.4 5 24 NA NA 5732 5732 Carrier E 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 99205 OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES 31 0.06 25.7 405.8 4 27 NA NA 5733 5733 Carrier E 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97110 THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES 25 0.04 324.6 25 NA NA 5734 5734 Carrier E 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 ROOM & BOARD, SEMIPRIVATE TWO-BED - PSYCHIATRIC 53 1 17.1 21.6 44 9 NA NA 5735 5735 Carrier E 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 126 ROOM & BOARD, SEMIPRIVATE TWO-BED - DETOXIFICATION 26 1 37.6 35.5 17 9 NA NA 5736 5736 Carrier E 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1002 BEHAVIORAL HEALTH ACCOMMODATIONS, RESIDENTIAL TREATMENT, CHEM DEP 21 1 43.9 88.4 19 2 NA NA 5737 5737 Carrier E 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1001 BEHAVIORAL HEALTH ACCOMMODATIONS, RESIDENTIAL TREATMENT, PSYCHIATRIC 13 1 36.6 81 12 1 NA NA 5738 5738 Carrier E 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 194 SUBACUTE CARE, LEVEL IV 5 1 72 5 NA NA 5739 5739 Carrier E 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90792 PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES 1 1 74.5 1 NA NA 5740 5740 Carrier E 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 200 INTENSIVE CARE, GENERAL 1 1 2.6 1 NA NA 5741 5741 Carrier E 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 ROOM & BOARD, SEMIPRIVATE TWO-BED - PSYCHIATRIC 53 1 17.1 21.6 44 9 NA NA 5742 5742 Carrier E 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 126 ROOM & BOARD, SEMIPRIVATE TWO-BED - DETOXIFICATION 26 1 37.6 35.5 17 9 NA NA 5743 5743 Carrier E 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1002 BEHAVIORAL HEALTH ACCOMMODATIONS, RESIDENTIAL TREATMENT, CHEM DEP 21 1 43.9 88.4 19 2 NA NA 5744 5744 Carrier E 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1001 BEHAVIORAL HEALTH ACCOMMODATIONS, RESIDENTIAL TREATMENT, PSYCHIATRIC 13 1 36.6 81 12 1 NA NA 5745 5745 Carrier E 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 194 SUBACUTE CARE, LEVEL IV 5 1 72 5 NA NA 5746 5746 Carrier E 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90792 PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES 1 1 74.5 1 NA NA 5747 5747 Carrier E 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 200 INTENSIVE CARE, GENERAL 1 1 2.6 1 NA NA 5748 5748 Carrier E 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION 69 0.9565 106.2 69 NA NA 5749 5749 Carrier E 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97153 ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN 52 1 53.6 52 NA NA 5750 5750 Carrier E 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES 37 1 69.2 37 NA NA 5751 5751 Carrier E 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 99205 OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES 25 1 75.7 25 NA NA 5752 5752 Carrier E 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN 23 1 27.8 23 NA NA 5753 5753 Carrier E 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0001 ALCOHOL AND/OR DRUG ASSESS 19 1 50.8 430.2 18 1 NA NA 5754 5754 Carrier E 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96116 NEUROBEHAVIORAL STATUS XM PHYS/QHP 1ST HOUR 18 1 42.9 18 NA NA 5755 5755 Carrier E 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97155 ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN 17 1 56.5 17 NA NA 5756 5756 Carrier E 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97156 FAMILY ADAPT BHV TX GDN PHYS/QHP EA 15 MIN 16 1 59.3 16 NA NA 5757 5757 Carrier E 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC S9480 INTENSIVE OUTPATIENT PSYCHIA 13 1 34.5 109.1 12 1 NA NA 5758 5758 Carrier E 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97153 ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN 52 1 53.6 52 NA NA 5759 5759 Carrier E 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES 37 1 69.2 37 NA NA 5760 5760 Carrier E 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99205 OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES 25 1 75.7 25 NA NA 5761 5761 Carrier E 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97151 BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN 23 1 27.8 23 NA NA 5762 5762 Carrier E 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0001 ALCOHOL AND/OR DRUG ASSESS 19 1 50.8 430.2 18 1 NA NA 5763 5763 Carrier E 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96116 NEUROBEHAVIORAL STATUS XM PHYS/QHP 1ST HOUR 18 1 42.9 18 NA NA 5764 5764 Carrier E 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97155 ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN 17 1 56.5 17 NA NA 5765 5765 Carrier E 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97156 FAMILY ADAPT BHV TX GDN PHYS/QHP EA 15 MIN 16 1 59.3 16 NA NA 5766 5766 Carrier E 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S9480 INTENSIVE OUTPATIENT PSYCHIA 13 1 34.5 109.1 12 1 NA NA 5767 5767 Carrier E 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90899 UNLISTED PSYCHIATRIC SERVICE/PROCEDURE 11 1 0.6 33.7 1 10 NA NA 5768 5768 Carrier E 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION 69 0.01 270.9 107.7 1 68 NA NA 5769 5769 Carrier E 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0143 WALKER FOLDING WHEELED W/O S 161 1 4.7 7.6 5 156 NA NA 5770 5770 Carrier E 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4239 SPLY ALW NONADJUNC NONIMPL CGM 1 MO SPLY= 1 UOS 118 1 23.4 118 NA NA 5771 5771 Carrier E 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0604 BREAST PUMP HEAVY DUTY HOSP GRADE PISTON OP 116 0.9914 8.6 63.3 21 95 NA NA 5772 5772 Carrier E 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0570 NEBULIZER WITH COMPRESSOR 89 1 11.2 2.9 5 84 NA NA 5773 5773 Carrier E 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0730 TENS DEVICE 4/MORE LEADS MULTI NERVE STIMULATION 79 1 20.3 79 NA NA 5774 5774 Carrier E 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A5500 DIAB ONLY FIT CSTM PREP&SPL SHOE MX DNSITY INSRT PER SHOE 60 1 24.4 60 NA NA 5775 5775 Carrier E 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1390 OXYGEN CONCENTRATOR 55 1 7.6 11.2 2 53 NA NA 5776 5776 Carrier E 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L1852 KNEE ORTHOSIS DOUBLE UPRIGHT THIGH AND CALF 53 1 0.7 24.3 1 52 NA NA 5777 5777 Carrier E 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0202 PHOTOTHERAPY LIGHT W/ PHOTOM 29 1 11.2 15.3 7 22 NA NA 5778 5778 Carrier E 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC B4161 ENTERAL F PED HYDROLYZED/AA&PEPTIDE CHAIN PROTS 29 1 5.6 29 NA NA 5779 5779 Carrier E 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0143 WALKER FOLDING WHEELED W/O S 161 1 4.7 7.6 5 156 NA NA 5780 5780 Carrier E 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4239 SPLY ALW NONADJUNC NONIMPL CGM 1 MO SPLY= 1 UOS 118 1 23.4 118 NA NA 5781 5781 Carrier E 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0570 NEBULIZER WITH COMPRESSOR 89 1 11.2 2.9 5 84 NA NA 5782 5782 Carrier E 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0730 TENS DEVICE 4/MORE LEADS MULTI NERVE STIMULATION 79 1 20.3 79 NA NA 5783 5783 Carrier E 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A5500 DIAB ONLY FIT CSTM PREP&SPL SHOE MX DNSITY INSRT PER SHOE 60 1 24.4 60 NA NA 5784 5784 Carrier E 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1390 OXYGEN CONCENTRATOR 55 1 7.6 11.2 2 53 NA NA 5785 5785 Carrier E 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L1852 KNEE ORTHOSIS DOUBLE UPRIGHT THIGH AND CALF 53 1 0.7 24.3 1 52 NA NA 5786 5786 Carrier E 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0202 PHOTOTHERAPY LIGHT W/ PHOTOM 29 1 11.2 15.3 7 22 NA NA 5787 5787 Carrier E 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC B4161 ENTERAL F PED HYDROLYZED/AA&PEPTIDE CHAIN PROTS 29 1 5.6 29 NA NA 5788 5788 Carrier E 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0691 UV LIGHT TX SYS BULB/LAMP TIMER; TX 2 SQ FT/LESS 28 1 21.5 28 NA NA 5789 5789 Carrier E 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0604 BREAST PUMP HEAVY DUTY HOSP GRADE PISTON OP 116 0.01 8.6 63.3 21 95 NA NA 5790 5790 Carrier E 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT 95250 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneou 97 0.3814 38.2 97 NA NA 5791 5791 Carrier E 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0553 SUPPLY ALLOW FOR TX CGM1 MO SPL = 1 U OF SERVICE 18 1 18.1 18 NA NA 5792 5792 Carrier E 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4230 INFUS INSULIN PUMP NON NEEDL 11 1 33.6 11 NA NA 5793 5793 Carrier E 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 EXT AMB INFUSN PUMP INSULIN 9 1 38.8 9 NA NA 5794 5794 Carrier E 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4232 SYRINGE W/NEEDLE INSULIN 3CC 5 1 11.1 5 NA NA 5795 5795 Carrier E 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A6257 TRANSPARENT FILM STERL 16 SQ IN OR LESS EA DRESS 1 1 44.3 1 NA NA 5796 5796 Carrier E 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A5120 SKIN BARRIER WIPES OR SWABS EACH 1 1 69 1 NA NA 5797 5797 Carrier E 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0553 SUPPLY ALLOW FOR TX CGM1 MO SPL = 1 U OF SERVICE 18 1 18.1 18 NA NA 5798 5798 Carrier E 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4230 INFUS INSULIN PUMP NON NEEDL 11 1 33.6 11 NA NA 5799 5799 Carrier E 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 EXT AMB INFUSN PUMP INSULIN 9 1 38.8 9 NA NA 5800 5800 Carrier E 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4232 SYRINGE W/NEEDLE INSULIN 3CC 5 1 11.1 5 NA NA 5801 5801 Carrier E 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A6257 TRANSPARENT FILM STERL 16 SQ IN OR LESS EA DRESS 1 1 44.3 1 NA NA 5802 5802 Carrier E 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A5120 SKIN BARRIER WIPES OR SWABS EACH 1 1 69 1 NA NA 5803 5803 Carrier E 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95250 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneou 97 0.3814 38.2 97 NA NA 5804 5804 Carrier E 2023 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 95250 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneou 97 0.03 38.2 97 NA NA 5805 5805 Carrier E 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 197 0.8071 79.32117315 0 197 0 EMPAGLIFLOZIN JARDIANCE 5806 5806 Carrier E 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 87 0.3218 67.43068966 0 87 0 SEMAGLUTIDE OZEMPIC, RYBELSUS 5807 5807 Carrier E 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 69 0.913 24.14852657 0 69 0 UBROGEPANT UBRELVY 5808 5808 Carrier E 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 66 0.7121 33.74263047 0 66 0 LISDEXAMFETAMINE DIMESYLATE VYVANSE 5809 5809 Carrier E 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 52 0.4615 40.6425 0 52 0 VARENICLINE TARTRATE APO-VARENICLINE 5810 5810 Carrier E 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 46 0.9783 31.74908213 0 46 0 RIVAROXABAN XARELTO 5811 5811 Carrier E 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 46 1 27.57171498 0 46 0 FREMANEZUMAB-VFRM AJOVY 5812 5812 Carrier E 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 36 0.4722 31.19655093 0 36 0 LIRAGLUTIDE VICTOZA 5813 5813 Carrier E 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 33 1 22.99237374 0 33 0 SECUKINUMAB COSENTYX 5814 5814 Carrier E 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 32 0.7813 46.11569444 0 32 0 TESTOSTERONE CYPIONATE DEPO-TESTOST 5815 5815 Carrier E 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 46 1 27.6 0 46 0 FREMANEZUMAB-VFRM AJOVY 5816 5816 Carrier E 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 33 1 23 0 33 0 SECUKINUMAB COSENTYX 5817 5817 Carrier E 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 22 1 13.6 0 22 0 TESTOSTERONE ANDRODERM, TESTOSTERONE 5818 5818 Carrier E 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 22 1 77.3 0 22 0 TICAGRELOR BRILINTA 5819 5819 Carrier E 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 20 1 59 0 20 0 SACUBITRIL-VALSARTAN ENTRESTO 5820 5820 Carrier E 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 12 1 23.5 0 12 0 TOFACITINIB CITRATE XELJANZ 5821 5821 Carrier E 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 12 1 23.8 0 12 0 CARIPRAZINE HCL VRAYLAR 5822 5822 Carrier E 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 12 1 27.1 0 12 0 GUSELKUMAB TREMFYA 5823 5823 Carrier E 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 33.6 0 8 0 ERENUMAB-AOOE AIMOVIG 5824 5824 Carrier E 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 21.6 0 7 0 APREMILAST OTEZLA 5825 5825 Carrier E 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 0.5 68.78 0 2 0 ZOLMITRIPTAN ZOMIG 5826 5826 Carrier E 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 7 0.2857 33.75 0 7 0 RIFAXIMIN XIFAXAN 5827 5827 Carrier E 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 52 0.0385 40.64 0 52 0 VARENICLINE TARTRATE APO-VARENICLINE 5828 5828 Carrier E 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 36 0.0278 31.2 0 36 0 LIRAGLUTIDE VICTOZA 5829 5829 Carrier E 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 197 0.0152 79.32 0 197 0 EMPAGLIFLOZIN JARDIANCE 5830 5830 Carrier E 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 69 0.0145 24.15 0 69 0 UBROGEPANT UBRELVY 5831 5831 Carrier C 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 59400 FULL ROUT OBSTE CARE,VAGINAL DELIV 45 1 13 7.5 1 44 0 NA NA 5832 5832 Carrier C 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 59510 FULL ROUT OBSTE CARE,CESAREAN DELIV 29 1 22.5 33.4 2 27 0 NA NA 5833 5833 Carrier C 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44204 COLECTOMY LAP PARTIAL W/ ANAST 16 1 11 14.5 1 15 0 NA NA 5834 5834 Carrier C 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 ARTHRODESIS ANT INTERBODY W/ DISKECTOMY LU 12 0.75 93.5 0 12 0 NA NA 5835 5835 Carrier C 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43644 LAP GASTRIC BYPASS/ROUX-EN-Y 12 1 75.2 0 12 0 NA NA 5836 5836 Carrier C 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99404 PREV MED COUNSELING IND 53-67 MIN 8 1 61 0 8 0 NA NA 5837 5837 Carrier C 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 32650 THORACOSCOPY SURG W/ PLEURODESIS (MECHANICA 7 1 13 17.4 2 5 0 NA NA 5838 5838 Carrier C 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 TOTAL ABDOM HYSTERECTOMY 7 1 1 39.3 1 6 0 NA NA 5839 5839 Carrier C 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44207 LAP SURG; COLECT PART W/ANASTOM W/COLOPROCTOST 6 1 13 32.8 2 4 0 NA NA 5840 5840 Carrier C 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 33405 REPLACE PROSTH AORTIC VALVE, OPEN, W/BYPASS NON-HOMO 6 1 38.2 0 6 0 NA NA 5841 5841 Carrier C 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 59400 FULL ROUT OBSTE CARE,VAGINAL DELIV 45 1 13 7.5 1 44 0 NA NA 5842 5842 Carrier C 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 59510 FULL ROUT OBSTE CARE,CESAREAN DELIV 29 1 22.5 33.4 2 27 0 NA NA 5843 5843 Carrier C 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44204 COLECTOMY LAP PARTIAL W/ ANAST 16 1 11 14.5 1 15 0 NA NA 5844 5844 Carrier C 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43644 LAP GASTRIC BYPASS/ROUX-EN-Y 12 1 75.2 0 12 0 NA NA 5845 5845 Carrier C 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99404 PREV MED COUNSELING IND 53-67 MIN 8 1 61 0 8 0 NA NA 5846 5846 Carrier C 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 32650 THORACOSCOPY SURG W/ PLEURODESIS (MECHANICA 7 1 13 17.4 2 5 0 NA NA 5847 5847 Carrier C 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58150 TOTAL ABDOM HYSTERECTOMY 7 1 1 39.3 1 6 0 NA NA 5848 5848 Carrier C 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44207 LAP SURG; COLECT PART W/ANASTOM W/COLOPROCTOST 6 1 13 32.8 2 4 0 NA NA 5849 5849 Carrier C 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33405 REPLACE PROSTH AORTIC VALVE, OPEN, W/BYPASS NON-HOMO 6 1 38.2 0 6 0 NA NA 5850 5850 Carrier C 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 50360 TRANSPLANTATION OF KIDNEY 6 1 46.8 0 6 0 NA NA 5851 5851 Carrier C 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 OFFICE VISIT E&M EST PT, MODERATE MDM, 30-39 MINS 79701 0.971 19.7 29.4 7679 72022 0 NA NA 5852 5852 Carrier C 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97110 THERA PROC 1+ AREAS EA 15 MIN THERA EXERCISES 11199 0.9711 14.6 26.8 372 10827 0 NA NA 5853 5853 Carrier C 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97124 THERA PROC 1+ AREAS EA 15 MIN MASSAGE 7564 0.9901 12.9 19.3 126 7438 0 NA NA 5854 5854 Carrier C 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 COLONOSCOPY W/ BX SINGLE/MULT 3994 0.996 12.8 16.8 81 3913 0 NA NA 5855 5855 Carrier C 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 TTE (ECHO) WITH SPECTRAL & COLOR FLOW DOPPLER 1896 0.9895 26.6 57 248 1648 0 NA NA 5856 5856 Carrier C 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97530 THERA ACTVI DIRECT PAT CONTACT EA 15 MIN 1736 0.9804 15.5 32.2 82 1654 0 NA NA 5857 5857 Carrier C 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96040 GENETICS COUNSELING, EACH 30 MIN, W/ PT/FAMILY 1635 0.9976 13.9 21.2 203 1432 0 NA NA 5858 5858 Carrier C 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97802 MED NUTRIT THRPY INIT ASSESS 15 MIN 1435 0.9686 16.4 25.3 78 1357 0 NA NA 5859 5859 Carrier C 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99202 OFFICE VISIT E&M NEW PT STRAIGHTFORWARD MDM, 15-29 MINS 1414 0.9187 19.5 38.7 208 1206 0 NA NA 5860 5860 Carrier C 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 MRI BRAIN W/ & W/O CONTRAST, 1413 0.8273 16.8 72.4 242 1171 0 NA NA 5861 5861 Carrier C 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 52000 CYSTOURETHROSCOPY (SEP PROC) 322 1 12.2 24 56 266 0 NA NA 5862 5862 Carrier C 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 17000 DESTRUCT 1ST AK PREMALIG LESION 281 1 14 14.8 5 276 0 NA NA 5863 5863 Carrier C 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29881 KNEE SCOPE,MED/LAT MENISECTOMY W/DEBRIDE/CHONDRO 169 1 14 26.5 8 161 0 NA NA 5864 5864 Carrier C 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 20550 INJECT TENDON SHEATH / TRIGGER FINGER 150 1 12.5 33.3 4 146 0 NA NA 5865 5865 Carrier C 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J3301 TRIAMCINOLONE ACETONIDE INJ PER 10 MG 146 1 14.5 26.4 6 140 0 NA NA 5866 5866 Carrier C 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 14000 ADJ TIS TRANS/REARRANGE TRUNK DEFECT <10 SQCM 143 1 19.8 0 143 0 NA NA 5867 5867 Carrier C 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93303 ECHO CONGEN CARDIAC ANOMALIES 133 1 46.8 0 133 0 NA NA 5868 5868 Carrier C 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93270 EVENT MONITOR - HOOKUP RECORD & DISCON ONLY 124 1 11.9 20.7 23 101 0 NA NA 5869 5869 Carrier C 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 76885 ECHOGRAPHY OF INFANT HIPS, DYNAMIC 112 1 12.5 10.7 4 108 0 NA NA 5870 5870 Carrier C 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93922 NON-INVASIVE STUDY EXTREMITY ARTERY BILAT SINGLE 109 1 8 31.6 3 106 0 NA NA 5871 5871 Carrier C 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 93321 ECHOCARDIOGRAPHY DOPPLER F/UP/LTD 2 0.5 81 0 2 0 NA NA 5872 5872 Carrier C 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 61885 INSRT/REDO NEUROSTIM 1 ARRAY 2 0.5 85.5 0 2 0 NA NA 5873 5873 Carrier C 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 85999 UNLISTED HEMATOLOGY AND COAGULATION PRO 3 0.333 83.7 0 3 0 NA NA 5874 5874 Carrier C 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 58559 HYSTEROSCOPY W/ LYSIS INTRAUTERINE ADHES 5 0.2 12 48.7 2 3 0 NA NA 5875 5875 Carrier C 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 19316 MASTOPEXY 5 0.2 37 75 1 4 0 NA NA 5876 5876 Carrier C 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90868 TRANSCRANIAL MAG STIMJ TX DLVR & MGMT 6 0.167 119 112.2 1 5 0 NA NA 5877 5877 Carrier C 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 78608 BRAIN IMAGING PET METABOLIC 7 0.143 26.3 138.3 3 4 0 NA NA 5878 5878 Carrier C 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22551 ARTHRODESIS ANT INTERBODY CERVICAL BELOW C2 16 0.125 13 110.5 1 15 0 NA NA 5879 5879 Carrier C 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 81415 EXOME ; SEQUENCE ANALYSIS 10 0.1 25 89.1 2 8 0 NA NA 5880 5880 Carrier C 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 77373 STEREOTACTIC BODY RADIATION DELIVERY 21 0.095 19.33 83 9 12 0 NA NA 5881 5881 Carrier C 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 128.102 REF IP CD RESIDENTIAL TREATMENT CENTER 3 1 10.3 3 0 0 NA NA 5882 5882 Carrier C 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90853 GROUP PSYCHOTHERAPY 1 1 70 1 0 0 NA NA 5883 5883 Carrier C 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 128.102 REF IP CD RESIDENTIAL TREATMENT CENTER 3 1 10.3 3 0 0 NA NA 5884 5884 Carrier C 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90853 GROUP PSYCHOTHERAPY 1 1 70 1 0 0 NA NA 5885 5885 Carrier C 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY 60 MIN PATIENT 10091 0.9944 2.9 2.9 322 9769 0 NA NA 5886 5886 Carrier C 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90836 PSYCHOTHERAPY 45 MIN PATIENT WITH MEDICAL SVCS 3482 0.9951 3 2.9 138 3344 0 NA NA 5887 5887 Carrier C 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90791 PSYCHIATRIC DIAGNOSTIC EVAL W/O MEDICAL SERVICES 696 0.9641 18.5 22 34 662 0 NA NA 5888 5888 Carrier C 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90853 GROUP PSYCHOTHERAPY 597 0.9983 17.3 5.3 3 594 0 NA NA 5889 5889 Carrier C 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96130 PSYCHOLOGICAL TESTING EVAL BY PHYS OR QUAL PROF; FIRST HOUR 253 0.9684 9.4 17.7 5 248 0 NA NA 5890 5890 Carrier C 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 BEHAV IDENTIFICATION ASSESSMNT, ADM BY PHYS OR QUAL PROF, EA 15 MINS 242 0.8802 55 152.4 3 239 0 NA NA 5891 5891 Carrier C 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 TRANSCRANIAL MAG STIMJ TX DLVR & MGMT 228 0.807 63.7 0 228 0 NA NA 5892 5892 Carrier C 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96132 NEUROPSYCHOLOGICAL TEST EVAL BY PHYS OR QUAL PROF; FIRST HOUR 114 0.8684 9 44.2 2 112 0 NA NA 5893 5893 Carrier C 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90792 PSYCHIATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES 114 0.9211 35.4 59.9 7 107 0 NA NA 5894 5894 Carrier C 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97153 ADAPTIVE BEHAV TX BY PROTOCOL, ADM BY TECH/SUP BY PHYS, EA 15 MINS 88 0.9659 75 119.5 1 87 0 NA NA 5895 5895 Carrier C 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96156 HEALTH BEHAVIOR ASSESSMENT, OR RE-ASSESSMENT 19 1 29 0 19 0 NA NA 5896 5896 Carrier C 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90806.102 REF MENTAL HEALTH EXTERNAL 7 1 25.6 0 7 0 NA NA 5897 5897 Carrier C 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90849 MULT-FAMILY GROUP PSYCHOTHERAPY 5 1 41.8 0 5 0 NA NA 5898 5898 Carrier C 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96164 HEALTH BEHAVIOR INTERVENTION, GROUP (2 OR MORE PTS), FTF; INIT 30 MINS 3 1 13.3 0 3 0 NA NA 5899 5899 Carrier C 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90867 TRANSCRANIAL MAG STIMJ TX PLANNING 2 1 32 33 1 1 0 NA NA 5900 5900 Carrier C 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97152 BEHAV IDENT-SUPPORT ASSESSMNT, ADM BY TECH/SUPV OF PHYS, EA 15 MINS 1 1 15 0 1 0 NA NA 5901 5901 Carrier C 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96167 HEALTH BEHAVIOR INTERVENTION, FAMILY (WITH THE PATIENT PRESENT),FTF; INIT 30 MINS 1 1 15 0 1 0 NA NA 5902 5902 Carrier C 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96158 HEALTH BEHAVIOR INTERVENTION, INDIVIDUAL, FACE-TO-FACE; INITIAL 30 MINS 1 1 11 0 1 0 NA NA 5903 5903 Carrier C 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64568 INC IMPLTJ CRNL NRV NSTIM ELTRDS & PULSE GENER 1 1 2 0 1 0 NA NA 5904 5904 Carrier C 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90806 IND PSYCHOTHERAPY OFFICE 45-50 MIN 1 1 33 0 1 0 NA NA 5905 5905 Carrier C 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90834 PSYCHOTHERAPY 45 MIN PATIENT 3 0.333 14 67 1 2 0 NA NA 5906 5906 Carrier C 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90868 TRANSCRANIAL MAG STIMJ TX DLVR & MGMT 228 0.009 63.7 0 228 0 NA NA 5907 5907 Carrier C 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0601 CPAP DEVICE 3097 0.9655 13.5 31 603 2494 0 NA NA 5908 5908 Carrier C 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0603 DME ELECTRIC BREAST PUMP KIT PURCHASE 1721 0.9971 11.6 27.7 1301 420 0 NA NA 5909 5909 Carrier C 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT A7027 COMB ORAL/NASAL MASK USED W/CPAP DEVICE EA 1323 0.997 14.4 21.2 311 1012 0 NA NA 5910 5910 Carrier C 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT A7034 NASAL APPLICATION DEVICE 1317 0.9924 13.7 0 1317 0 NA NA 5911 5911 Carrier C 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0604 DME ELECTRIC BREAST PUMP KIT RENTAL 887 0.982 12.7 27.8 571 316 0 NA NA 5912 5912 Carrier C 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0143 WALKER, FOLDING, WHEELED, ADJUSTABLE OR FIXED HEIGHT 576 0.9878 6 24.4 276 300 0 NA NA 5913 5913 Carrier C 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L4361 PNEUMATIC, WALKING BOOT 555 0.9982 5.5 18.6 2 553 0 NA NA 5914 5914 Carrier C 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0114 CRUTCHES METAL UNDERARM PAIR 552 0.9964 12.9 14 20 532 0 NA NA 5915 5915 Carrier C 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E1390 OXYGEN CONCENTRATOR 401 0.9701 4.9 26.1 93 308 0 NA NA 5916 5916 Carrier C 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L3908 WRIST SPLINT W/WO COCK-UP 386 1 12 16.1 4 382 0 NA NA 5917 5917 Carrier C 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L3908 WRIST SPLINT W/WO COCK-UP 386 1 12 16.1 4 382 0 NA NA 5918 5918 Carrier C 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L3660 SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND 352 1 15 0 352 0 NA NA 5919 5919 Carrier C 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L4205 REPAIR ORTHOTIC DEV LABOR PER 15 MIN 300 1 15.1 32.5 28 272 0 NA NA 5920 5920 Carrier C 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L3809 WRIST THUMB SPICA 283 1 9.8 14.6 4 279 0 NA NA 5921 5921 Carrier C 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L3670 SHLDER IMMOB W/ABDUCTION PILLOW 216 1 21 15.6 3 213 0 NA NA 5922 5922 Carrier C 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4388 DRAINABLE PCH W EX WEAR BARR 196 1 13.8 16.2 123 73 0 NA NA 5923 5923 Carrier C 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L1833 WARRIOR WRAP WITH HINGES/FLEX STOP 162 1 16 0.7 1 161 0 NA NA 5924 5924 Carrier C 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4670 AUTOMATIC BP MONITOR DIAL 149 1 13 0.8 25 124 0 NA NA 5925 5925 Carrier C 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L8000 BREAST PROSTHESIS MASTECTOMY BRA 149 1 14 32 3 146 0 NA NA 5926 5926 Carrier C 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L1830 KO IMMOBILIZER CANVAS LONGIT 141 1 14.9 0 141 0 NA NA 5927 5927 Carrier C 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E8000 GAIT TRAINER, PEDIATRIC SIZE, POSTERIOR SUPPORT INCL ALL ACCESSORIES & COMP 2 0.5 98 0 2 0 NA NA 5928 5928 Carrier C 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L5331 HIP DISART CANADIAN SACH FT 2 0.5 78.5 0 2 0 NA NA 5929 5929 Carrier C 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L5920 ADDN KNEE-SHIN ALIGNABLE 2 0.5 66.5 0 2 0 NA NA 5930 5930 Carrier C 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L5321 AK OPEN END SACH 2 0.5 144.5 0 2 0 NA NA 5931 5931 Carrier C 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0483 HIGH FREQ CHEST WALL OCSILLATION SYSTEM, INCL ALL ACCESSORIES/SUPPLIES, EA 6 0.167 87.3 0 6 0 NA NA 5932 5932 Carrier C 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT K0005 ULTRALIGHTWEIGHT WHEELCHAIR 11 0.091 123.9 0 11 0 NA NA 5933 5933 Carrier C 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT B4153 ENTERAL FORMULAE CATEGORYIII 13 0.077 16 108 1 12 0 NA NA 5934 5934 Carrier C 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A5500 DIAB ONLY FIT CSTM PREP&SPL SHOE MX DNSITY INSRT PER SHOE 25 0.04 30 21 1 24 0 NA NA 5935 5935 Carrier C 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E2103 NONADJUNCTIVE NONIMPLANTED CGM/RECEIVER 25 0.04 30 81.4 4 21 0 NA NA 5936 5936 Carrier C 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT B4160 ENTERAL FORMULA, PEDS, NUTRITIONALLY COMP CALORIE DENSE, 100 CAL = 1 UNIT 49 0.02 105.4 0 49 0 NA NA 5937 5937 Carrier C 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 OFFICE VISIT E&M EST PT, MODERATE MDM, 30-39 MINS 1406 0.9651 14.8 24.9 77 1329 0 NA NA 5938 5938 Carrier C 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT E2103 NONADJUNCTIVE NONIMPLANTED CGM/RECEIVER 692 0.7254 15.1 66.1 68 624 0 NA NA 5939 5939 Carrier C 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A4239 SPLY ALW NONADJUNC NONIMPL CGM 1 MO SPLY= 1 UOS 586 0.9369 13.9 34.7 340 246 0 NA NA 5940 5940 Carrier C 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT 97802 MED NUTRIT THRPY INIT ASSESS 15 MIN 390 0.9897 11.9 20.1 23 367 0 NA NA 5941 5941 Carrier C 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A4224 SUPPLIES FOR MAINTENANCE OF INSULIN INFUSION CATH, PER WEEK 291 1 11.3 37.9 214 77 0 NA NA 5942 5942 Carrier C 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A5500 DIAB ONLY FIT CSTM PREP&SPL SHOE MX DNSITY INSRT PER SHOE 162 0.9753 7.4 30.5 5 157 0 NA NA 5943 5943 Carrier C 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A9276 SNSR;INVSV DISP USE NONDME INTRSTL CGM 1U=1D SPL 94 0.8511 11.4 60.7 31 63 0 NA NA 5944 5944 Carrier C 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT G0108 DIAB MGMT TRN PER INDIV 85 0.9765 11.5 45.6 2 83 0 NA NA 5945 5945 Carrier C 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT K0553 SUPPLY ALLOWANCE FOR THERAPEUTIC CONTINUOUS GLUCOSE MONITOR (CGM), INCLUDES ALL SUPPLIES AND ACCESSORIES 77 0.7792 12.3 59.7 20 57 0 NA NA 5946 5946 Carrier C 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A4221 WEEKLY SUPPLIES DRUG INFUS CATH 77 0.987 11 36.6 43 34 0 NA NA 5947 5947 Carrier C 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4224 SUPPLIES FOR MAINTENANCE OF INSULIN INFUSION CATH, PER WEEK 291 1 11.3 37.9 214 77 0 NA NA 5948 5948 Carrier C 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J9035 INJ BEVACIZUMAB 10 MG 58 1 17.5 31.4 16 42 0 NA NA 5949 5949 Carrier C 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 67228 DESTRUCT EXTENSIVE/PROG RETINOPATHY PHOTOCOAGULATN 23 1 10.3 47.8 8 15 0 NA NA 5950 5950 Carrier C 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97597 DEBRIDEMENT, OPEN WOUND, ASSESSMENT, ONGOING CARE, PER SESSION, FIRST 20 SQ CM OR LESS 21 1 14.4 25.8 5 16 0 NA NA 5951 5951 Carrier C 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A5513 FOR DIAB ONLY MX DNSITY INSRT CSTM MOLD CSTM EA 21 1 7 41.3 2 19 0 NA NA 5952 5952 Carrier C 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95250 GLUCOSE MONITORING 72 HRS MD OR OTH QUAL, EQUIP PROV, REC/STORAGE GL 20 1 13 28.8 2 18 0 NA NA 5953 5953 Carrier C 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4230 INFUS SET INSULIN PUMP NON NEEDLE 17 1 9.4 21.6 8 9 0 NA NA 5954 5954 Carrier C 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 92012 INTERMEDIATE EYE EXAM ESTABLISHED PATIENT 14 1 22.9 0 14 0 NA NA 5955 5955 Carrier C 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99204 OFFICE VISIT E&M NEW PT MODERATE MDM, 45-59 MINS 14 1 13.3 26.1 3 11 0 NA NA 5956 5956 Carrier C 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E2402 NEGATIVE PRESSURE WOUND THERAPY ELECT PUMP, STATIONARY OR PORTABLE 16 1 19.2 75.5 10 6 0 NA NA 5957 5957 Carrier C 2023 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E2103 NONADJUNCTIVE NONIMPLANTED CGM/RECEIVER 692 0.0029 15.1 66.1 68 624 0 NA NA 5958 5958 Carrier C 2023 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A4239 SPLY ALW NONADJUNC NONIMPL CGM 1 MO SPLY= 1 UOS 586 0.0017 13.9 34.7 340 246 0 NA NA 5959 5959 Carrier C 2023 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 99214 OFFICE VISIT E&M EST PT, MODERATE MDM, 30-39 MINS 1406 0.0014 14.8 24.9 77 1329 0 NA NA 5960 5960 Carrier C 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 2485 0.3172 11 78 43 2442 0 semaglutide Ozempic, Rybelsus 5961 5961 Carrier C 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 1247 0.4258 22 79 36 1211 0 lisdexamphetamine Vyvanse 5962 5962 Carrier C 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 736 0.7745 13 47 5 731 0 cyclosporine Restasis, Cequa 5963 5963 Carrier C 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 701 0.5991 23 54 15 686 0 BUDESONIDE-FORMOTEROL Symbicort 5964 5964 Carrier C 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 691 0.8292 8 36 70 621 0 rivaroxaba XARELTO 5965 5965 Carrier C 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 642 0.553 7 72 14 628 0 liraglutide VICTOZA 5966 5966 Carrier C 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 603 0.9436 20 81 8 595 0 empagliflozin Jardiance 5967 5967 Carrier C 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 580 0.4759 16 68 84 496 0 apixiban ELIQUIS 5968 5968 Carrier C 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 479 0.0313 0 92 3 476 0 tirzepatide MOUNJARO 5969 5969 Carrier C 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 348 0.8851 10 46 3 345 0 adalimumab-atto AMJEVITA 5970 5970 Carrier C 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 32 1 3 36 6 26 0 LENALIDOMIDE Revlamid 5971 5971 Carrier C 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 22 1 40 39 2 20 0 enzalutamide Xtandi 5972 5972 Carrier C 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 19 1 0 31 1 18 0 midazolam Nayzilam 5973 5973 Carrier C 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 18 1 2 24 3 15 0 dofetilide Tikosyn 5974 5974 Carrier C 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 18 1 33 34 2 16 0 ribociclib Kisqali 5975 5975 Carrier C 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 12 1 28 43 1 11 0 acalabrutinib Calquence 5976 5976 Carrier C 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 11 1 82 0 11 0 Epoetin Alfa Epogen, Procrit 5977 5977 Carrier C 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 11 1 23 52 2 9 0 pomalidomide Pomalyst 5978 5978 Carrier C 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 10 1 35 34 2 8 0 Posaconazole Noxafil 5979 5979 Carrier C 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 9 1 43 0 9 0 Pirfenidone Esbriet 5980 5980 Carrier C 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 21 1 0 0 pegfilgrastim-jmdb Fulphila 5981 5981 Carrier C 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 123 0 1 0 lonapegsomatropin-tcgd Skytrofa 5982 5982 Carrier C 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 76 0 1 0 darbepoetin Aranesp 5983 5983 Carrier C 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 4 0.5 94 0 4 0 sodium oxybate Xyrem 5984 5984 Carrier C 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 4 0.5 98 0 4 0 teriflunomide Aubagio 5985 5985 Carrier C 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 0.5 0 121 1 1 0 selinexor Xpovio 5986 5986 Carrier C 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 17 0.353 119 0 17 0 calcium/magnesium/potassium/sodium oxybates Xywav 5987 5987 Carrier C 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 0.333 93 0 3 0 peg-filgrastim Neulasta 5988 5988 Carrier C 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 0.333 49 42 1 2 0 ponatinib Iclusig 5989 5989 Carrier C 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 0.333 108 0 3 0 droxidopa Northera 5990 5990 Carrier D 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 59400 FULL ROUT OBSTE CARE,VAGINAL DELIV 17 1 7.2 0 17 0 NA NA 5991 5991 Carrier D 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 59510 FULL ROUT OBSTE CARE,CESAREAN DELIV 16 1 26.4 0 16 0 NA NA 5992 5992 Carrier D 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27447 TOTAL KNEE ARTHROPLASTY 12 0.3333 43 99.7 2 10 0 NA NA 5993 5993 Carrier D 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 ARTHRODESIS ANT INTERBODY W/ DISKECTOMY LU 8 0.875 92.1 0 8 0 NA NA 5994 5994 Carrier D 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44204 COLECTOMY LAP PARTIAL W/ ANAST 5 1 11.2 0 5 0 NA NA 5995 5995 Carrier D 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44205 COLECTOMY LAP PART W/ REM TERM ILEUM 5 1 13.5 41 2 3 0 NA NA 5996 5996 Carrier D 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 50360 TRANSPLANTATION OF KIDNEY 5 0.8 65.2 0 5 0 NA NA 5997 5997 Carrier D 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 19364 BREAST RECONSTRUCTION; WITH FREE FLAP 4 1 66.3 0 4 0 NA NA 5998 5998 Carrier D 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96413 CHEMO ADMIN IV INFUS SING/INITIAL SUB/DRUG UP TO * 4 1 21.7 41 3 1 0 NA NA 5999 5999 Carrier D 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43644 LAP GASTRIC BYPASS/ROUX-EN-Y 4 0.75 80.3 0 4 0 NA NA 6000 6000 Carrier D 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 59400 FULL ROUT OBSTE CARE,VAGINAL DELIV 17 1 7.2 0 17 0 NA NA 6001 6001 Carrier D 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 59510 FULL ROUT OBSTE CARE,CESAREAN DELIV 16 1 26.4 0 16 0 NA NA 6002 6002 Carrier D 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44204 COLECTOMY LAP PARTIAL W/ ANAST 5 1 11.2 0 5 0 NA NA 6003 6003 Carrier D 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44205 COLECTOMY LAP PART W/ REM TERM ILEUM 5 1 13.5 41 2 3 0 NA NA 6004 6004 Carrier D 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19364 BREAST RECONSTRUCTION; WITH FREE FLAP 4 1 66.3 0 4 0 NA NA 6005 6005 Carrier D 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96413 CHEMO ADMIN IV INFUS SING/INITIAL SUB/DRUG UP TO * 4 1 21.7 41 3 1 0 NA NA 6006 6006 Carrier D 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99404 PREV MED COUNSELING IND 53-67 MIN 4 1 37 0 4 0 NA NA 6007 6007 Carrier D 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93306 TTE (ECHO) WITH SPECTRAL & COLOR FLOW DOPPLER 4 1 57.5 0 4 0 NA NA 6008 6008 Carrier D 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22551 ARTHRODESIS ANT INTERBODY CERVICAL BELOW C2 3 1 35 86.5 1 2 0 NA NA 6009 6009 Carrier D 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96416 CHEMO ADMIN IV INFUS >8 HRS W/PORT/IMPLANTED PUMP 3 1 12 31 2 1 0 NA NA 6010 6010 Carrier D 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 OFFICE VISIT E&M EST PT, MODERATE MDM, 30-39 MINS 22813 0.989 18 28.4 1894 20919 0 NA NA 6011 6011 Carrier D 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97110 THERA PROC 1+ AREAS EA 15 MIN THERA EXERCISES 3145 0.9933 17.6 25.8 109 3036 0 NA NA 6012 6012 Carrier D 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97124 THERA PROC 1+ AREAS EA 15 MIN MASSAGE 1509 0.9934 15.3 22.3 23 1486 0 NA NA 6013 6013 Carrier D 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 COLONOSCOPY W/ BX SINGLE/MULT 1060 0.9962 13 20 62 998 0 NA NA 6014 6014 Carrier D 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 MRI BRAIN W/ & W/O CONTRAST, 988 0.7834 19.2 74.7 127 861 0 NA NA 6015 6015 Carrier D 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 TTE (ECHO) WITH SPECTRAL & COLOR FLOW DOPPLER 825 0.9963 12.8 34.9 94 731 0 NA NA 6016 6016 Carrier D 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 MRI ANY JOINT 787 0.7649 32.5 63.8 113 674 0 NA NA 6017 6017 Carrier D 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74178 CT ABD & PELVIS W/O CONTRST 1+ BODY REGNS 688 0.9157 14.7 28.4 202 486 0 NA NA 6018 6018 Carrier D 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73718 MRI LOWER EXTREMITY W/O CONTRAST 651 0.871 16.4 47.8 97 554 0 NA NA 6019 6019 Carrier D 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 71250 COMPUTED TOMOGRAPHY, THORAX, DIAGNOSTIC; W/O CONTRAST MATERIAL 599 0.8447 20.2 37.2 123 476 0 NA NA 6020 6020 Carrier D 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96040 GENETICS COUNSELING, EACH 30 MIN, W/ PT/FAMILY 390 1 14.1 23.2 56 334 0 NA NA 6021 6021 Carrier D 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99204 OFFICE VISIT E&M NEW PT MODERATE MDM, 45-59 MINS 207 1 15.3 33 24 183 0 NA NA 6022 6022 Carrier D 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 11102 TANGENTIAL BIOPSY OF SKIN; FIRST LESION 168 1 12.7 43.2 3 165 0 NA NA 6023 6023 Carrier D 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 52000 CYSTOURETHROSCOPY (SEP PROC) 155 1 11.9 29.1 22 133 0 NA NA 6024 6024 Carrier D 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95863 EMG NEEDLE 3 EXTREMITIES W/WO RELATED PARASPINAL 153 1 11.8 54.9 6 147 0 NA NA 6025 6025 Carrier D 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 17311 MOHS HD, NCK, HND, FEET, GEN 1ST STGE UP TO 5 BLCK 144 1 12.5 19 27 117 0 NA NA 6026 6026 Carrier D 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 17000 DESTRUCT 1ST AK PREMALIG LESION 141 1 12.3 21.4 34 107 0 NA NA 6027 6027 Carrier D 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 66984 EXTRACAPSULAR CAT REM W/ INSERT LENS PROSTHESIS; W/O ECP 115 1 15.2 31.2 11 104 0 NA NA 6028 6028 Carrier D 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 94010 SPIROMETRY W/GRAPHIC RECORD/VITAL CAPACITY/FLOW 112 1 12 35.8 5 107 0 NA NA 6029 6029 Carrier D 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64400 INJ(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRIGEMINAL NRV, EA BRANCH 106 1 10.7 25.1 21 85 0 NA NA 6030 6030 Carrier D 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43284 LAPAROSCOPY SURG, ESOPHAGEAL SPHINCTER AUGMNTATION W/DEV (IE MAGNETIC BAND) 1 1 129 0 1 0 NA NA 6031 6031 Carrier D 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 77385 INTENSITY MODULATED RADIATION TREATMENT DELIVERY (IMRT), SIMPLE 1 1 71 0 1 0 NA NA 6032 6032 Carrier D 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT B4154 ENTERAL FORMULAE CATEGORY IV 1 1 132 0 1 0 NA NA 6033 6033 Carrier D 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT J1559 INJECTION, IMMUNE GLOBULIN (HIZENTRA), 100 MG 1 1 38 0 1 0 NA NA 6034 6034 Carrier D 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 81204 AR GENE ANALYSIS; CHARACTERIZATION OF ALLELES 2 0.5 57 0 2 0 NA NA 6035 6035 Carrier D 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90868 TRANSCRANIAL MAG STIMJ TX DLVR & MGMT 3 0.333 113.7 0 3 0 NA NA 6036 6036 Carrier D 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64582 OPEN IMPLTJ HPGLSL NRV NSTIM RA PG&RESPIR SENSOR 4 0.25 111 0 4 0 NA NA 6037 6037 Carrier D 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 29916 ARTHROSCOPY HIP W/LABRAL REPAIR 9 0.222 5 65.1 1 8 0 NA NA 6038 6038 Carrier D 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 77522 PROTON TRMT, SIMPLE W/COMP 5 0.2 18 78.3 2 3 0 NA NA 6039 6039 Carrier D 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 81439 HEREDIT CARDIOMYOPTHY, GENOMIC ANALY PANEL MUST INCL 5 GENES 5 0.2 83.6 0 5 0 NA NA 6040 6040 Carrier D 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY 60 MIN PATIENT 860 0.9553 1.8 3.8 95 765 0 NA NA 6041 6041 Carrier D 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90836 PSYCHOTHERAPY 45 MIN PATIENT WITH MEDICAL SVCS 304 1 3.1 3.1 36 268 0 NA NA 6042 6042 Carrier D 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90791 PSYCHIATRIC DIAGNOSTIC EVAL W/O MEDICAL SERVICES 150 0.9933 19.3 24.2 4 146 0 NA NA 6043 6043 Carrier D 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 TRANSCRANIAL MAG STIMJ TX DLVR & MGMT 113 0.8053 65.9 0 113 0 NA NA 6044 6044 Carrier D 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 BEHAV IDENTIFICATION ASSESSMNT, ADM BY PHYS OR QUAL PROF, EA 15 MINS 70 0.9 39 157 1 69 0 NA NA 6045 6045 Carrier D 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96132 NEUROPSYCHOLOGICAL TEST EVAL BY PHYS OR QUAL PROF; FIRST HOUR 51 0.8824 15 42 2 49 0 NA NA 6046 6046 Carrier D 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90853 GROUP PSYCHOTHERAPY 45 1 25.8 0 45 0 NA NA 6047 6047 Carrier D 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96130 PSYCHOLOGICAL TESTING EVAL BY PHYS OR QUAL PROF; FIRST HOUR 43 0.9767 17.3 0 43 0 NA NA 6048 6048 Carrier D 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97153 ADAPTIVE BEHAV TX BY PROTOCOL, ADM BY TECH/SUP BY PHYS, EA 15 MINS 25 0.88 105.6 0 25 0 NA NA 6049 6049 Carrier D 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90792 PSYCHIATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES 22 0.9091 37 52.4 4 18 0 NA NA 6050 6050 Carrier D 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90836 PSYCHOTHERAPY 45 MIN PATIENT WITH MEDICAL SVCS 304 1 3.1 3.1 36 268 0 NA NA 6051 6051 Carrier D 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90853 GROUP PSYCHOTHERAPY 45 1 25.8 0 45 0 NA NA 6052 6052 Carrier D 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99214 OFFICE VISIT E&M EST PT, MODERATE MDM, 30-39 MINS 12 1 36 17.1 1 11 0 NA NA 6053 6053 Carrier D 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96136 PSYCHOLOGICAL OR NEUROPSYCHOLOGICAL TEST BY PHYS,2 OR MORE;FIRST 30 MINS 8 1 21 0 8 0 NA NA 6054 6054 Carrier D 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT G2082 VISIT FOR EVAL/MGMT EST PT REQ SUPERVISOIN MD, UP TO 56 MG OF ESKETAMINE NASAL, SELF ADMIM 6 1 33.5 0 6 0 NA NA 6055 6055 Carrier D 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96116 NEUROBEHAVIORAL STATUS EXAM, PHYS OR QUAL PROF, FIRST HOUR 3 1 31 0 3 0 NA NA 6056 6056 Carrier D 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96138 PSYCHOLOGICAL OR NEUROPSYCHOLOGICAL TEST BY TECH,2 OR MORE;FIRST 30 MINS 3 1 745 0 3 0 NA NA 6057 6057 Carrier D 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90833 PSYCHOTHERAPY 30 MIN PATIENT WITH MEDICAL SVCS 2 1 0 0 2 0 NA NA 6058 6058 Carrier D 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97155 ADAPTIVE BEHAV TX W/PROTOCOL MOD, ADM BY PHYS OR QUAL PROF, EA 15 MINS 1 1 141 0 1 0 NA NA 6059 6059 Carrier D 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT H0020 ALCOHOL AND/OR DRUG SERVICES 1 1 11 0 1 0 NA NA 6060 6060 Carrier D 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90792 PSYCHIATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES 22 0.045 37 52.4 4 18 0 NA NA 6061 6061 Carrier D 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90868 TRANSCRANIAL MAG STIMJ TX DLVR & MGMT 113 0.035 65.9 0 113 0 NA NA 6062 6062 Carrier D 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0601 CPAP DEVICE 1504 0.9561 12.6 26.4 149 1355 0 NA NA 6063 6063 Carrier D 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0603 DME ELECTRIC BREAST PUMP KIT PURCHASE 537 0.9981 11.5 21 475 62 0 NA NA 6064 6064 Carrier D 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT A7027 COMB ORAL/NASAL MASK USED W/CPAP DEVICE EA 470 1 12.3 16.2 92 378 0 NA NA 6065 6065 Carrier D 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT A7034 NASAL APPLICATION DEVICE 333 0.988 13.5 19.5 2 331 0 NA NA 6066 6066 Carrier D 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L4361 PNEUMATIC, WALKING BOOT 321 0.9969 16 18.4 2 319 0 NA NA 6067 6067 Carrier D 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0114 CRUTCHES METAL UNDERARM PAIR 286 1 15 17.5 1 285 0 NA NA 6068 6068 Carrier D 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0604 DME ELECTRIC BREAST PUMP KIT RENTAL 195 0.9846 12.6 24 115 80 0 NA NA 6069 6069 Carrier D 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L3908 WRIST SPLINT W/WO COCK-UP 191 1 17.6 0 191 0 NA NA 6070 6070 Carrier D 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L3809 WRIST THUMB SPICA 156 1 8 15.9 1 155 0 NA NA 6071 6071 Carrier D 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0143 WALKER, FOLDING, WHEELED, ADJUSTABLE OR FIXED HEIGHT 151 0.9934 5.3 30.1 56 95 0 NA NA 6072 6072 Carrier D 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A7027 COMB ORAL/NASAL MASK USED W/CPAP DEVICE EA 470 1 12.3 16.2 92 378 0 NA NA 6073 6073 Carrier D 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0114 CRUTCHES METAL UNDERARM PAIR 286 1 15 17.5 1 285 0 NA NA 6074 6074 Carrier D 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L3908 WRIST SPLINT W/WO COCK-UP 191 1 17.6 0 191 0 NA NA 6075 6075 Carrier D 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L3809 WRIST THUMB SPICA 156 1 8 15.9 1 155 0 NA NA 6076 6076 Carrier D 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L3660 SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND 149 1 19.2 0 149 0 NA NA 6077 6077 Carrier D 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L3670 SHLDER IMMOB W/ABDUCTION PILLOW 101 1 27 14.7 2 99 0 NA NA 6078 6078 Carrier D 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0118 CRUTCH SUBSTITUTE, LOWER LEG PLATFORM, WITH OR WITHOUT WHEELS, EACH 95 1 12.2 69 31 64 0 NA NA 6079 6079 Carrier D 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L1902 ANKLE LACE UP BRACE 89 1 17 0 89 0 NA NA 6080 6080 Carrier D 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0570 DME NEBULIZE HOME/PORTABLE 83 1 14.1 28.7 15 68 0 NA NA 6081 6081 Carrier D 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L4205 REPAIR ORTHOTIC DEV LABOR PER 15 MIN 75 1 34.7 33.2 3 72 0 NA NA 6082 6082 Carrier D 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L5321 AK OPEN END SACH 2 0.5 72.5 0 2 0 NA NA 6083 6083 Carrier D 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E1161 MANUAL ADULT SIZE WHEELCHAIR, INCLUDES TILT IN SPACE 5 0.2 95.2 0 5 0 NA NA 6084 6084 Carrier D 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT K0861 POWER WHEELCHAIR, GROUP 3 STD, MULT POWER OPTION, CAP UP TO 300 LBS 5 0.2 51.2 0 5 0 NA NA 6085 6085 Carrier D 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT K0005 ULTRALIGHTWEIGHT WHEELCHAIR 9 0.111 96.2 0 9 0 NA NA 6086 6086 Carrier D 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT B4149 ENTERAL FORMULA, MANUFACT, ADM VIA ENTERAL FEED TUBE, 100 CALORIES=1UN 10 0.1 8 111.3 2 8 0 NA NA 6087 6087 Carrier D 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E2402 NEGATIVE PRESSURE WOUND THERAPY ELECT PUMP, STATIONARY OR PORTABLE 73 0.014 40.3 77.8 49 24 0 NA NA 6088 6088 Carrier D 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0601 CPAP DEVICE 1504 0.001 12.6 26.4 149 1355 0 NA NA 6089 6089 Carrier D 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 OFFICE VISIT E&M EST PT, MODERATE MDM, 30-39 MINS 440 0.9909 17.9 27 36 404 0 NA NA 6090 6090 Carrier D 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT E2103 NONADJUNCTIVE NONIMPLANTED CGM/RECEIVER 223 0.713 22 70.5 26 197 0 NA NA 6091 6091 Carrier D 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A4239 SPLY ALW NONADJUNC NONIMPL CGM 1 MO SPLY= 1 UOS 208 0.8558 16.5 42.1 84 124 0 NA NA 6092 6092 Carrier D 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT 97802 MED NUTRIT THRPY INIT ASSESS 15 MIN 133 1 12.9 24.1 8 125 0 NA NA 6093 6093 Carrier D 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A4224 SUPPLIES FOR MAINTENANCE OF INSULIN INFUSION CATH, PER WEEK 87 0.977 11.8 35.1 60 27 0 NA NA 6094 6094 Carrier D 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT E0784 EXTERN AMBUL INSULIN INFUS PUMP 52 0.8462 10 80.6 2 50 0 NA NA 6095 6095 Carrier D 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT G0108 DIAB MGMT TRN PER INDIV 47 1 43.7 0 47 0 NA NA 6096 6096 Carrier D 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT J9035 INJ BEVACIZUMAB 10 MG 47 1 8.2 32.8 5 42 0 NA NA 6097 6097 Carrier D 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A9276 SNSR;INVSV DISP USE NONDME INTRSTL CGM 1U=1D SPL 40 0.95 18.3 45.9 7 33 0 NA NA 6098 6098 Carrier D 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT J0178 INJ AFLIBERCEPT (EYLEA) 1 MG 36 0.9444 17.8 77 6 30 0 NA NA 6099 6099 Carrier D 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97802 MED NUTRIT THRPY INIT ASSESS 15 MIN 133 1 12.9 24.1 8 125 0 NA NA 6100 6100 Carrier D 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT G0108 DIAB MGMT TRN PER INDIV 47 1 43.7 0 47 0 NA NA 6101 6101 Carrier D 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J9035 INJ BEVACIZUMAB 10 MG 47 1 8.2 32.8 5 42 0 NA NA 6102 6102 Carrier D 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A5500 DIAB ONLY FIT CSTM PREP&SPL SHOE MX DNSITY INSRT PER SHOE 34 1 36.3 0 34 0 NA NA 6103 6103 Carrier D 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4230 INFUS SET INSULIN PUMP NON NEEDLE 12 1 10 32.5 6 6 0 NA NA 6104 6104 Carrier D 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99202 OFFICE VISIT E&M NEW PT STRAIGHTFORWARD MDM, 15-29 MINS 11 1 41 39.5 1 10 0 NA NA 6105 6105 Carrier D 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 67228 DESTRUCT EXTENSIVE/PROG RETINOPATHY PHOTOCOAGULATN 10 1 10 39.8 1 9 0 NA NA 6106 6106 Carrier D 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A9274 EXTERNAL AMB INSULIN DEL SYSTEM DISPOSABLE EA 10 1 14 27.7 1 9 0 NA NA 6107 6107 Carrier D 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A5501 DIABETIC CUSTOM MOLDED SHOE 9 1 39.7 0 9 0 NA NA 6108 6108 Carrier D 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A5513 FOR DIAB ONLY MX DNSITY INSRT CSTM MOLD CSTM EA 7 1 38.1 0 7 0 NA NA 6109 6109 Carrier D 2023 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT K0739 REPAIR OR NONROUTN SVC DME OTHER THAN O2 EQUIP,REQ TECH SKILL,PER 15 MINS 1 1 138 0 1 0 NA NA 6110 6110 Carrier D 2023 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A4224 SUPPLIES FOR MAINTENANCE OF INSULIN INFUSION CATH, PER WEEK 87 0.011 11.8 35.1 60 27 0 NA NA 6111 6111 Carrier D 2023 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E2103 NONADJUNCTIVE NONIMPLANTED CGM/RECEIVER 223 0.004 22 70.5 26 197 0 NA NA 6112 6112 Carrier D 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 1510 0.3033 14 79 53 1457 0 semaglutide Ozempic, Rybelsus 6113 6113 Carrier D 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 745 0.4242 11 69 43 702 0 lisdexamphetamine Vyvanse 6114 6114 Carrier D 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 397 0.0353 18 85 22 375 0 tirzepatide MOUNJARO 6115 6115 Carrier D 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 358 0.5223 18 75 8 350 0 liraglutide VICTOZA 6116 6116 Carrier D 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 349 0.5473 19 59 10 339 0 BUDESONIDE-FORMOTEROL Symbicort 6117 6117 Carrier D 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 338 0.932 26 67 4 334 0 empagliflozin Jardiance 6118 6118 Carrier D 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 322 0.7826 13 41 41 281 0 rivaroxaban XARELTO 6119 6119 Carrier D 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 319 0.7837 8 56 8 311 0 cyclosporine Restasis, Cequa 6120 6120 Carrier D 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 275 0.44 15 72 40 235 0 apixiban ELIQUIS 6121 6121 Carrier D 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 220 0 71 220 0 semaglutide Wegovy 6122 6122 Carrier D 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 16 1 30 0 16 0 Diazempam Valtoco 6123 6123 Carrier D 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 14 1 2 45 1 13 0 midazolam Nayzilam 6124 6124 Carrier D 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 12 1 13 55 2 10 0 LENALIDOMIDE Revlamid 6125 6125 Carrier D 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 10 1 64 0 10 0 enzalutamide Xtandi 6126 6126 Carrier D 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 9 1 76 0 9 0 Pioglitazone Actos 6127 6127 Carrier D 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 2 80 1 7 0 Pirfenidone Esbriet 6128 6128 Carrier D 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 47 0 7 0 Dofetilide Tikosyn 6129 6129 Carrier D 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 0 71 1 6 0 cannabidiol Epidiolex 6130 6130 Carrier D 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 74 0 7 0 pomalidomide Pomalyst 6131 6131 Carrier D 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 2 63 1 6 0 Posaconazole Noxafil 6132 6132 Carrier D 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 4 0.25 109 0 4 anakinra Kineret 6133 6133 Carrier D 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 33 0.091 12 85 9 24 Buprenorphine Butrans 6134 6134 Carrier D 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 14 0.071 83 0 14 varenicline Tyrvaya Nasal Spray 6135 6135 Carrier D 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 57 0.035 1 90 4 53 upadacitinib Rinvoq 6136 6136 Carrier D 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 110 0.009 4 91 5 105 rimegepant Nurtec 6137 6137 Carrier D 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 163 0.006 14 70 21 142 Insuline Glargine Basaglar, Lantus, Toujeo, Semglee 6138 6138 Carrier D 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 745 0.004 11 69 43 702 LISDEXAMFETAMINE Vyvanse 6139 6139 Carrier D 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1510 0.001 14 79 53 1457 semaglutide Ozempic, Rybelsus 6140 6140 Carrier F 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 121 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Medical/Surgical/GYN 100 0.83 21 35 25 75 NA NA 6141 6141 Carrier F 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 12 1 10 32 2 10 NA NA 6142 6142 Carrier F 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20936 Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure) 8 1 13 24 3 5 NA NA 6143 6143 Carrier F 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44207 Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) 7 0.8571 1 42 1 6 NA NA 6144 6144 Carrier F 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure) 7 1 10 26 2 5 NA NA 6145 6145 Carrier F 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 7 1 3 26 1 6 NA NA 6146 6146 Carrier F 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar 6 1 3 28 1 5 NA NA 6147 6147 Carrier F 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 6 1 22 0 6 NA NA 6148 6148 Carrier F 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) 6 1 13 47 3 3 NA NA 6149 6149 Carrier F 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44204 Laparoscopy, surgical; colectomy, partial, with anastomosis 5 1 16 38 1 4 NA NA 6150 6150 Carrier F 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 12 1 10 32 2 10 NA NA 6151 6151 Carrier F 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 20936 Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure) 8 1 13 24 3 5 NA NA 6152 6152 Carrier F 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure) 7 1 10 26 2 5 NA NA 6153 6153 Carrier F 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 7 1 3 26 1 6 NA NA 6154 6154 Carrier F 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar 6 1 3 28 1 5 NA NA 6155 6155 Carrier F 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 6 1 22 0 6 NA NA 6156 6156 Carrier F 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) 6 1 13 47 3 3 NA NA 6157 6157 Carrier F 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44204 Laparoscopy, surgical; colectomy, partial, with anastomosis 5 1 16 38 1 4 NA NA 6158 6158 Carrier F 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63052 Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [eg, spinal or lateral recess stenosis]), during posterior interbody arthrodesis, lumbar; single vertebral segment (List separately in addition to code for primary procedure) 5 1 18 35 1 4 NA NA 6159 6159 Carrier F 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 69990 Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure) 5 1 56 0 5 NA NA 6160 6160 Carrier F 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22850 Removal of posterior nonsegmental instrumentation (eg, Harrington rod) 2 0.5 23 0 2 NA NA 6161 6161 Carrier F 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27446 Arthroplasty, knee, condyle and plateau; medial OR lateral compartment 3 0.33 21 0 3 NA NA 6162 6162 Carrier F 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22585 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); each additional interspace (List separately in addition to code for primary procedure) 4 0.25 3 21 1 3 NA NA 6163 6163 Carrier F 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22614 Arthrodesis, posterior or posterolateral technique, single interspace; each additional interspace (List separately in addition to code for primary procedure) 5 0.2 35 40 2 3 NA NA 6164 6164 Carrier F 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22612 Arthrodesis, posterior or posterolateral technique, single interspace; lumbar (with lateral transverse technique, when performed) 5 0.2 3 28 1 4 NA NA 6165 6165 Carrier F 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar 6 0.17 3 28 1 5 NA NA 6166 6166 Carrier F 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) 6 0.17 13 47 3 3 NA NA 6167 6167 Carrier F 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 7 0.14 3 26 1 6 NA NA 6168 6168 Carrier F 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure) 7 0.14 10 26 2 5 NA NA 6169 6169 Carrier F 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 12 0.08 10 32 2 10 NA NA 6170 6170 Carrier F 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 Mental health partial hospitalization, treatment, less than 24 hours 1 0 14 0 1 NA NA 6171 6171 Carrier F 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0017 Behavioral health; residential (hospital residential treatment program), without room and board, per diem 1 1 3 0 1 NA NA 6172 6172 Carrier F 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0010 Alcohol and/or drug services; subacute detoxification (residential addiction program inpatient) 1 1 91 0 1 NA NA 6173 6173 Carrier F 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 128 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Rehabilitation 1 1 91 0 1 NA NA 6174 6174 Carrier F 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Psychiatric 1 1 22 0 1 NA NA 6175 6175 Carrier F 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0017 Behavioral health; residential (hospital residential treatment program), without room and board, per diem 1 1 3 0 1 NA NA 6176 6176 Carrier F 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0010 Alcohol and/or drug services; subacute detoxification (residential addiction program inpatient) 1 1 91 0 1 NA NA 6177 6177 Carrier F 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 128 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Rehabilitation 1 1 91 0 1 NA NA 6178 6178 Carrier F 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Psychiatric 1 1 22 0 1 NA NA 6179 6179 Carrier F 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0035 Mental health partial hospitalization, treatment, less than 24 hours 1 0 14 0 1 NA NA 6180 6180 Carrier F 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple 381 0.9738 10 19 36 345 NA NA 6181 6181 Carrier F 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 353 0.9773 11 21 35 318 NA NA 6182 6182 Carrier F 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 124 0.8387 12 22 5 119 NA NA 6183 6183 Carrier F 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 Colonoscopy, flexible; with biopsy, single or multiple 124 0.8629 19 22 7 117 NA NA 6184 6184 Carrier F 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation 120 0.9 20 62 15 105 NA NA 6185 6185 Carrier F 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 95 0.8737 11 20 4 91 NA NA 6186 6186 Carrier F 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. 92 0.5435 25 88 26 66 NA NA 6187 6187 Carrier F 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64483 Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, single level 89 0.9213 29 75 5 84 NA NA 6188 6188 Carrier F 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99205 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. 80 0.3875 28 83 21 59 NA NA 6189 6189 Carrier F 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27447 Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) 79 0.8987 19 74 5 74 NA NA 6190 6190 Carrier F 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64493 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level 57 1 20 28 11 46 NA NA 6191 6191 Carrier F 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64494 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure) 39 1 12 28 4 35 NA NA 6192 6192 Carrier F 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64635 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint 22 1 16 77 2 20 NA NA 6193 6193 Carrier F 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64636 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure) 18 1 27 73 1 17 NA NA 6194 6194 Carrier F 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation 18 1 35 74 6 12 NA NA 6195 6195 Carrier F 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC J9035 Injection, bevacizumab, 10 mg 18 1 19 58 6 12 NA NA 6196 6196 Carrier F 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64634 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint (List separately in addition to code for primary procedure) 16 1 19 79 1 15 NA NA 6197 6197 Carrier F 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 45381 Colonoscopy, flexible; with directed submucosal injection(s), any substance 13 1 24 35 1 12 NA NA 6198 6198 Carrier F 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 91110 Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus through ileum, with interpretation and report 13 1 46 112 1 12 NA NA 6199 6199 Carrier F 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 66982 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; without endoscopic cyclophotocoagulation 12 1 27 46 2 10 NA NA 6200 6200 Carrier F 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 15822 Blepharoplasty, upper eyelid; 1 1 212 0 1 NA NA 6201 6201 Carrier F 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27496 Decompression fasciotomy, thigh and/or knee, 1 compartment (flexor or extensor or adductor); 1 1 23 1 0 NA NA 6202 6202 Carrier F 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 36592 Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified 1 1 29 1 0 NA NA 6203 6203 Carrier F 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 37248 Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein 1 1 102 0 1 NA NA 6204 6204 Carrier F 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 80069 Renal function panel This panel must include the following: Albumin (82040) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphorus inorganic (phosphate) (84100) Potassium (84132) Sodium (84295) Urea nitrogen (BUN) (84520) 1 1 29 1 0 NA NA 6205 6205 Carrier F 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 83615 Lactate dehydrogenase (LD), (LDH); 1 1 29 1 0 NA NA 6206 6206 Carrier F 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 84100 Phosphorus inorganic (phosphate); 1 1 29 1 0 NA NA 6207 6207 Carrier F 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 85730 Thromboplastin time, partial (PTT); plasma or whole blood 1 1 29 1 0 NA NA 6208 6208 Carrier F 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 87497 Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, quantification 1 1 29 1 0 NA NA 6209 6209 Carrier F 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 54520 Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach 3 0.6667 118 0 3 NA NA 6210 6210 Carrier F 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 Mental health partial hospitalization, treatment, less than 24 hours 161 0.8944 18 49 11 150 NA NA 6211 6211 Carrier F 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC S9480 Intensive outpatient psychiatric services, per diem 68 0.7941 21 47 7 61 NA NA 6212 6212 Carrier F 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 37 0.8649 34 63 6 31 NA NA 6213 6213 Carrier F 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0015 Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education 35 0.7143 22 75 2 33 NA NA 6214 6214 Carrier F 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 34 0.8529 34 63 6 28 NA NA 6215 6215 Carrier F 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 29 0.8621 31 67 5 24 NA NA 6216 6216 Carrier F 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan 23 0.8696 30 77 3 20 NA NA 6217 6217 Carrier F 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC S0201 Partial hospitalization services, less than 24 hours, per diem 21 0.8571 38 44 3 18 NA NA 6218 6218 Carrier F 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 Psychotherapy, 60 minutes with patient 16 0.375 33 64 7 9 NA NA 6219 6219 Carrier F 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97156 Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes 16 0.9375 30 42 3 13 NA NA 6220 6220 Carrier F 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC G2083 Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of greater than 56 mg esketamine nasal self administration, includes 2 hours post administration observation 10 1 25 56 6 4 NA NA 6221 6221 Carrier F 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC G2082 Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of up to 56 mg of esketamine nasal self administration, includes 2 hours post administration observation 8 1 30 70 5 3 NA NA 6222 6222 Carrier F 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0031 Mental health assessment, by nonphysician 5 1 99 0 5 NA NA 6223 6223 Carrier F 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S0013 Esketamine, nasal spray, 1 mg 5 1 26 117 4 1 NA NA 6224 6224 Carrier F 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97158 Group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, face-to-face with multiple patients, each 15 minutes 3 1 42 0 3 NA NA 6225 6225 Carrier F 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. 3 1 192 0 3 NA NA 6226 6226 Carrier F 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99215 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. 3 1 192 0 3 NA NA 6227 6227 Carrier F 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96116 Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; first hour 2 1 79 0 2 NA NA 6228 6228 Carrier F 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96121 Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; each additional hour (List separately in addition to code for primary procedure) 2 1 79 0 2 NA NA 6229 6229 Carrier F 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. 1 1 87 0 1 NA NA 6230 6230 Carrier F 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC G2082 Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of up to 56 mg of esketamine nasal self administration, includes 2 hours post administration observation 8 0.13 30 70 5 3 NA NA 6231 6231 Carrier F 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 Continuous positive airway pressure (CPAP) device 25 0.32 13 67 3 22 NA NA 6232 6232 Carrier F 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with nondurable medical equipment interstitial continuous glucose monitoring system (CGM), one unit = 1 day supply 24 0.5 100 0 24 NA NA 6233 6233 Carrier F 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2402 Negative pressure wound therapy electrical pump, stationary or portable 16 0.9375 41 101 1 15 NA NA 6234 6234 Carrier F 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A6550 Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories 15 0.9333 41 99 1 14 NA NA 6235 6235 Carrier F 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A7000 Canister, disposable, used with suction pump, each 15 0.9333 41 99 1 14 NA NA 6236 6236 Carrier F 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0562 Humidifier, heated, used with positive airway pressure device 14 0.1429 14 68 1 13 NA NA 6237 6237 Carrier F 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1390 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate 10 0.7 126 0 10 NA NA 6238 6238 Carrier F 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9277 Transmitter; external, for use with nondurable medical equipment interstitial continuous glucose monitoring system (CGM) 10 0.9 87 0 10 NA NA 6239 6239 Carrier F 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A7037 Tubing used with positive airway pressure device 8 0.125 93 0 8 NA NA 6240 6240 Carrier F 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0747 Osteogenesis stimulator, electrical, noninvasive, other than spinal applications 8 0.75 107 0 8 NA NA 6241 6241 Carrier F 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0108 Wheelchair component or accessory, not otherwise specified 7 1 82 0 7 NA NA 6242 6242 Carrier F 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L1852 Knee orthosis (KO), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf 7 1 73 0 7 NA NA 6243 6243 Carrier F 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0973 Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each 6 1 90 0 6 NA NA 6244 6244 Carrier F 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 External ambulatory infusion pump, insulin 6 1 93 0 6 NA NA 6245 6245 Carrier F 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC V2624 Polishing/resurfacing of ocular prosthesis 5 1 99 0 5 NA NA 6246 6246 Carrier F 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0739 Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes 4 1 67 0 4 NA NA 6247 6247 Carrier F 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC V2628 Fabrication and fitting of ocular conformer 4 1 74 0 4 NA NA 6248 6248 Carrier F 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC B4088 Gastrostomy/jejunostomy tube, low-profile, any material, any type, each 3 1 77 0 3 NA NA 6249 6249 Carrier F 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0465 Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) 3 1 28 68 1 2 NA NA 6250 6250 Carrier F 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0466 Home ventilator, any type, used with noninvasive interface, (e.g., mask, chest shell) 3 1 75 0 3 NA NA 6251 6251 Carrier F 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E1012 Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each 1 1 100 0 1 NA NA 6252 6252 Carrier F 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E1002 Wheelchair accessory, power seating system, tilt only 1 1 100 0 1 NA NA 6253 6253 Carrier F 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E2313 Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each 1 1 100 0 1 NA NA 6254 6254 Carrier F 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E2311 Power wheelchair accessory, electronic connection between wheelchair controller and 2 or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware 1 1 100 0 1 NA NA 6255 6255 Carrier F 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E1232 Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system 1 1 119 0 1 NA NA 6256 6256 Carrier F 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0966 Manual wheelchair accessory, headrest extension, each 1 1 119 0 1 NA NA 6257 6257 Carrier F 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0960 Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware 1 1 119 0 1 NA NA 6258 6258 Carrier F 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E2608 Skin protection and positioning wheelchair seat cushion, width 22 in or greater, any depth 1 1 100 0 1 NA NA 6259 6259 Carrier F 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC K0860 Power wheelchair, group 3 very heavy-duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds 1 1 100 0 1 NA NA 6260 6260 Carrier F 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0955 Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each 2 0.5 88 0 2 NA NA 6261 6261 Carrier F 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year NA NA Diabetes Supplies & Equip 47 0.7021 96 0 47 0 NA NA 6262 6262 Carrier F 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA Diabetes Supplies & Equip 47 0.7021 96 0 47 0 NA NA 6263 6263 Carrier F 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 198 0.4343 2.03 17.82 10 188 0 SEMAGLUTIDE OZEMPIC 6264 6264 Carrier F 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 58 0.5344 0.07 21.23 5 53 0 TIRZEPATIDE MOUNJARO 6265 6265 Carrier F 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 53 0.7547 1.92 47.87 8 45 0 RIMEGEPANT NURTEC 6266 6266 Carrier F 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 42 0.8095 30.64 68.95 10 32 0 DUPILUMAB DUPIXENT 6267 6267 Carrier F 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 39 0.8974 1.07 25.83 6 33 0 EVOLOCUMAB REPATHA 6268 6268 Carrier F 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 36 0.9722 1.84 9.75 3 33 0 EMPAGLIFLOZIN JARDIANCE 6269 6269 Carrier F 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 35 0.4857 0.97 21.1 4 31 0 LIRAGLUTIDE VICTOZA 6270 6270 Carrier F 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 32 0.3125 1.63 21.83 2 30 0 TIRZEPATIDE MOUNJARO 6271 6271 Carrier F 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 31 0.7419 1.69 16.99 3 28 0 EMPAGLIFLOZIN JARDIANCE 6272 6272 Carrier F 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 30 0.9 6.1 13.18 7 23 0 GALCANEZUMAB EMGALITY 6273 6273 Carrier F 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 18 1 1.24 20.17 4 14 0 ERENUMAB AIMOVIG 6274 6274 Carrier F 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 13 1 0.11 17.86 2 11 0 LISDEXAMFETAMINE VYVANSE 6275 6275 Carrier F 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 11 1 4.64 35 2 9 0 ETANERCEPT ENBREL 6276 6276 Carrier F 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 9 1 7.02 11.62 4 5 0 ONDANSETRON ONDANSETRON 6277 6277 Carrier F 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 7 1 3 35.39 5 2 0 CARIPRAZINE VRAYLAR 6278 6278 Carrier F 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 5 1 2.12 30.44 2 3 0 ACALABRUTINIB CALQUENCE 6279 6279 Carrier F 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 5 1 0.12 10.63 2 3 0 BREXPIPRAZOLE REXULTI 6280 6280 Carrier F 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 5 1 4.35 32.86 1 4 0 UBROGEPANT UBRELVY 6281 6281 Carrier F 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 4 1 2.04 47.14 2 2 0 BISMUTH-METRONIDAZOLE-TETRACYCLINE BISMUTH-METRONIDAZOLE-TETRACYCLINE 6282 6282 Carrier F 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 4 1 0.03 0.13 1 3 0 SACUBITRIL-VALSARTAN ENTRESTO 6283 6283 Carrier G 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22842 POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG 13 0.6923 27 82.8 78.5 1 12 13 NA NA 6284 6284 Carrier G 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96416 CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP 12 0.9167 5.3 59.5 29.9 7 5 12 NA NA 6285 6285 Carrier G 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 15734 MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK 9 0.7778 8.5 30.1 11.6 6 3 9 NA NA 6286 6286 Carrier G 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 69990 MICROSURG TQS REQ USE OPERATING MICROSCOPE 8 0.875 32.2 43.8 39.4 3 5 8 NA NA 6287 6287 Carrier G 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT J9000 INJECTION DOXORUBICIN HCL 10 MG 8 0.75 2.7 65.5 55 2 6 8 NA NA 6288 6288 Carrier G 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT J9370 VINCRISTINE SULFATE 1 MG 8 0.875 12.3 65.5 50.3 2 6 8 NA NA 6289 6289 Carrier G 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT J9070 CYCLOPHOSPHAMIDE 100 MG 7 0.8571 1.8 65.5 54.9 1 6 7 NA NA 6290 6290 Carrier G 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22614 ARTHRODESIS PST/PSTLAT TQ 1NTRSPC EA ADDL NTRSPC 7 0.5714 77 77 7 7 NA NA 6291 6291 Carrier G 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 32663 THORACOSCOPY W/LOBECTOMY SINGLE LOBE 7 0.8571 3 4 7 NA NA 6292 6292 Carrier G 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY 7 1 22.3 44.7 41.5 1 6 7 NA NA 6293 6293 Carrier G 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58150 TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY 7 1 22.3 44.7 41.5 1 6 7 NA NA 6294 6294 Carrier G 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44207 LAPS COLECTOMY PRTL W/COLOPXTSTMY LW ANAST 6 1 2.1 24.8 21 1 5 6 NA NA 6295 6295 Carrier G 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44213 LAPS MOBLJ SPLENIC FLXR PFRMD W/PRTL COLECTOMY 6 1 2.7 21.2 18.1 1 5 6 NA NA 6296 6296 Carrier G 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93355 ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN 6 1 23.2 23.2 6 6 NA NA 6297 6297 Carrier G 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19364 BREAST RECONSTRUCTION W/FREE FLAP 5 1 22.1 22.1 5 5 NA NA 6298 6298 Carrier G 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22633 ARTHRODESIS COMBINED TQ 1NTRSPC LUMBAR 5 1 37.8 37.8 5 5 NA NA 6299 6299 Carrier G 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33533 CABG W/ARTERIAL GRAFT SINGLE ARTERIAL GRAFT 5 1 159.8 159.8 5 5 NA NA 6300 6300 Carrier G 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44205 LAPS COLECTOMY PRTL W/RMVL TERMINAL ILEUM 5 1 25.6 25.6 5 5 NA NA 6301 6301 Carrier G 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J9100 INJECTION CYTARABINE 100 MG 5 1 1.4 47.3 19.8 3 2 5 NA NA 6302 6302 Carrier G 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27134 REVJ TOT HIP ARTHRP BTH W/WO AGRFT/ALGRFT 4 1 1 28.7 21.8 1 3 4 NA NA 6303 6303 Carrier G 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 20937 AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION 1 1 244.1 244.1 1 1 NA NA 6304 6304 Carrier G 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22630 ARTHRODESIS POSTERIOR INTERBODY 1 NTRSPC LUMBAR 1 1 244.1 244.1 1 1 NA NA 6305 6305 Carrier G 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27299 UNLISTED PROCEDURE PELVIS/HIP JOINT 1 1 24.1 24.1 1 1 NA NA 6306 6306 Carrier G 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43645 LAPS GSTR RSTCV PX W/BYP and SM INT RCNSTJ 1 1 5.6 5.6 1 1 NA NA 6307 6307 Carrier G 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 50546 LAPAROSCOPY NEPHRECTOMY W/PARTIAL URETERECT 1 1 78.4 78.4 1 1 NA NA 6308 6308 Carrier G 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 47135 LVR ALTRNSPLJ ORTHOTOPIC PRTL/WHL DON ANY AGE 2 0.5 35.1 35.1 2 2 NA NA 6309 6309 Carrier G 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27134 REVJ TOT HIP ARTHRP BTH W/WO AGRFT/ALGRFT 4 0.25 1 28.7 21.8 1 3 4 NA NA 6310 6310 Carrier G 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63047 LAM FACETECTOMY and FORAMOTOMY 1 VRT SGM LUMBAR 7 0.143 26.4 72.4 64.7 1 6 7 NA NA 6311 6311 Carrier G 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22853 INSJ BIOMCHN DEV INTERVERTEBRAL DSC SPC W/ARTHRD 17 0.118 26.4 63 60.9 1 16 17 NA NA 6312 6312 Carrier G 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22558 ARTHRD ANT INTERBODY MIN DSC LUMBAR 10 0.1 26.4 59 55.7 1 9 10 NA NA 6313 6313 Carrier G 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC and COLR D 1311 0.9268 17.3 14.1 14.8 31 1280 1311 NA NA 6314 6314 Carrier G 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93015 CV STRS TST XERS and /OR RX CONT ECG W/SI and R 244 0.9385 10.5 10.5 244 244 NA NA 6315 6315 Carrier G 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 78452 MYOCARDIAL SPECT MULTIPLE STUDIES 227 0.9339 17 17 2 225 227 NA NA 6316 6316 Carrier G 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93971 DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY 209 0.933 12.8 12.8 24 185 209 NA NA 6317 6317 Carrier G 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT J0585 BOTULINUM TOXIN TYPE A PER UNIT 188 0.7819 31.5 95.7 90.8 13 175 188 NA NA 6318 6318 Carrier G 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93248 EXTERNAL ECG REC GT 7D LT 15D REVIEW and INTERPRETATION 161 0.9503 11.8 11.8 2 159 161 NA NA 6319 6319 Carrier G 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 77334 TX DEVICES DESIGN AND CONSTRUCTION COMPLEX 152 0.9013 8.3 155.3 57.3 31 121 152 NA NA 6320 6320 Carrier G 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 77336 CONTINUING MEDICAL PHYSICS CONSLTJ PR WK 147 0.8912 10.8 92.7 59.9 26 121 147 NA NA 6321 6321 Carrier G 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93246 EXTERNAL ECG REC GT 7D LT 15D RECORDING 146 0.9658 16 16 2 144 146 NA NA 6322 6322 Carrier G 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 77263 THERAPEUTIC RADIOLOGY TX PLANNING COMPLEX 145 0.8966 17.5 107.2 81.6 26 119 145 NA NA 6323 6323 Carrier G 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 36471 INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS 42 1 42 42 NA NA 6324 6324 Carrier G 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 36475 ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN 33 1 1 32 33 NA NA 6325 6325 Carrier G 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93290 INTERROG DEV EVAL ICPMS PHYS/QHP IN PERSON 29 1 29 29 NA NA 6326 6326 Carrier G 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93280 PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER 21 1 21 21 NA NA 6327 6327 Carrier G 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93296 REM INTERROG PM/LDLS PM/IDS LT 90 D TECH REVIEW 21 1 17.8 32.2 28.6 1 20 21 NA NA 6328 6328 Carrier G 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93283 PRGRMG EVAL IMPLANTABLE IN PRSN DUAL LEAD DFB 19 1 19 19 NA NA 6329 6329 Carrier G 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93279 PRGRMG DEV EVAL 1 LEAD PM/LDLS PM 1 CAR CHMBR IP 17 1 17 17 NA NA 6330 6330 Carrier G 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93289 INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB 17 1 17 17 NA NA 6331 6331 Carrier G 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93284 PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB 16 1 16 16 NA NA 6332 6332 Carrier G 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93288 INTERROG DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON 16 1 16 16 NA NA 6333 6333 Carrier G 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 13151 REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM 1 1 0 98 0 1 1 NA NA 6334 6334 Carrier G 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 14061 ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM 1 1 0 98 0 1 1 NA NA 6335 6335 Carrier G 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 28306 OSTEOT W/WO LNGTH SHRT/CORRJ 1ST METAR 1 1 0 20 0 1 1 NA NA 6336 6336 Carrier G 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 47001 BX LVR NDL DONE PURPOSE TM OTH MAJOR PX 1 1 0 67 0 1 1 NA NA 6337 6337 Carrier G 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 55880 TRANSRECTAL ABLTJ MAL PRST8 TISSUE HIFU W/US 1 1 0 29 0 1 1 NA NA 6338 6338 Carrier G 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 59400 OB CARE ANTEPARTUM VAG DLVR AND POSTPARTUM 1 1 0 863 0 1 1 NA NA 6339 6339 Carrier G 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 59409 VAGINAL DELIVERY ONLY 1 1 0 863 0 1 1 NA NA 6340 6340 Carrier G 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 62321 NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN 1 1 0 91 0 1 1 NA NA 6341 6341 Carrier G 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64625 RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN 1 1 0 23 0 1 1 NA NA 6342 6342 Carrier G 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97129 THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES 1 1 0 5 0 1 1 NA NA 6343 6343 Carrier G 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96132 NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR 34 0.5588 61 112.5 110.9 1 33 34 NA NA 6344 6344 Carrier G 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96133 NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR 34 0.5588 115 115 34 34 NA NA 6345 6345 Carrier G 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96116 NEUROBEHAVIORAL STATUS XM PHYS/QHP 1ST HOUR 28 0.5357 61 120.7 118.6 1 27 28 NA NA 6346 6346 Carrier G 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96137 PSYCL/NRPSYCL TST PHYS/QHP 2 Plus TST EA ADDL 30 MIN 21 0.5238 61 110.7 108.3 1 20 21 NA NA 6347 6347 Carrier G 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96139 PSYCL/NRPSYCL TST TECH 2 Plus TST EA ADDL 30 MIN 21 0.619 113 113 21 21 NA NA 6348 6348 Carrier G 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96138 PSYCL/NRPSYCL TST TECH 2 Plus TST 1ST 30 MIN 20 0.6 118.1 118.1 20 20 NA NA 6349 6349 Carrier G 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES 20 0.7 84.5 67.8 70.1 2 18 20 NA NA 6350 6350 Carrier G 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96136 PSYL/NRPSYCL TST PHYS/QHP 2 Plus TST 1ST 30 MIN 20 0.55 61 106 103.8 1 19 20 NA NA 6351 6351 Carrier G 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION 18 0.6111 67.5 82.7 80.9 2 16 18 NA NA 6352 6352 Carrier G 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 THERAP REPETITIVE TMS TX SUBSEQ DELIVERY AND MNG 13 0.8462 88.1 88.1 13 13 NA NA 6353 6353 Carrier G 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT S9480 INTENSIVE OP PSYCHIATRIC SERVICES PER DIEM 5 1 64.5 45.67 53.2 2 3 5 NA NA 6354 6354 Carrier G 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT H0020 ALCOHL AND OR RX SRVC; METHADONE ADMIN AND OR SERVICE 3 1 103 103 3 3 NA NA 6355 6355 Carrier G 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90870 ELECTROCONVULSIVE THERAPY 2 1 68.5 68.5 2 2 NA NA 6356 6356 Carrier G 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97153 ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN 1 1 1 1 NA NA 6357 6357 Carrier G 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97156 FAMILY ADAPT BHV TX GDN PHYS/QHP EA 15 MIN 1 1 1 1 NA NA 6358 6358 Carrier G 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4239 SPLY ALW NONADJUNC NONIMPL CGM 1 MO SPLY Equal to 1 UOS 1 1 121 121 1 1 NA NA 6359 6359 Carrier G 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT G0480 DRUG TEST DEFINITV DR ID METH P DAY 1-7 DRUG CL 1 1 45 45 1 1 2 NA NA 6360 6360 Carrier G 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT H0011 ALCOHOL and / DRUG SERVICES; ACUTE DTOX RES PROG IP 1 1 12 12 NA NA 6361 6361 Carrier G 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT H0019 BHVAL HEALTH; LONG-TERM RES W/O ROOM and BOARD-DIEM 1 1 25 25 1 1 NA NA 6362 6362 Carrier G 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90867 REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL and M 12 0.9167 92.4 92.4 12 12 NA NA 6363 6363 Carrier G 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90792 PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES 2 0.5 7.7 7.7 2 2 NA NA 6364 6364 Carrier G 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90870 ELECTROCONVULSIVE THERAPY 2 0.5 74 74 2 2 NA NA 6365 6365 Carrier G 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90869 REPET TMS TX SUBSEQ MOTR THRESHLD W/DELIV and MN 9 0.33 100.4 100.4 9 9 NA NA 6366 6366 Carrier G 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90867 REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL and M 12 0.25 99.2 99.2 12 12 NA NA 6367 6367 Carrier G 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90868 THERAP REPETITIVE TMS TX SUBSEQ DELIVERY AND MNG 13 0.23 95.2 95.2 13 13 NA NA 6368 6368 Carrier G 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 80307 DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE 6 0.17 30.8 30.8 6 6 NA NA 6369 6369 Carrier G 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 96130 PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR 6 0.17 80.9 80.9 6 6 NA NA 6370 6370 Carrier G 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 96138 PSYCL/NRPSYCL TST TECH 2 Plus TST 1ST 30 MIN 20 0.15 124 124 20 20 NA NA 6371 6371 Carrier G 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 96139 PSYCL/NRPSYCL TST TECH 2 Plus TST EA ADDL 30 MIN 21 0.14 119.2 119.2 21 21 NA NA 6372 6372 Carrier G 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 96131 PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR 7 0.14 59.5 80.9 77.9 1 6 7 NA NA 6373 6373 Carrier G 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E1390 O2 CONC 1 DEL PORT 85 PCT OR GT 02 CONC AT PRSC FLW RATE 64 0.7656 18.4 65.6 48.5 21 43 64 NA NA 6374 6374 Carrier G 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E2402 NEG PRESS WOUND THERAPY ELEC PUMP STATION/PRTBLE 18 0.5556 31.5 62.7 55.4 5 13 18 NA NA 6375 6375 Carrier G 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0470 RESP ASST DEVC BI-LEVL PRSS CAPABILITY W/O BACKU 17 0.7647 4 76.6 71.4 1 16 17 NA NA 6376 6376 Carrier G 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT A7000 CANISTER DISPOSABLE USED WITH SUCTION PUMP EACH 15 0.4667 41.7 59.2 55.4 4 11 15 NA NA 6377 6377 Carrier G 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT A6550 WND CARE SET NEG PRSS WND TX ELEC PUMP SPL 14 0.4286 41.7 63.4 58.4 4 10 14 NA NA 6378 6378 Carrier G 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT V2624 POLISHING/RESURFACING OF OCULAR PROSTHESIS 13 0.9231 8.5 8.5 13 13 NA NA 6379 6379 Carrier G 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L1960 AFO POSTERIOR SOLID ANK PLASTIC CUSTOM FAB 12 0.8333 22.1 22.1 12 12 NA NA 6380 6380 Carrier G 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E1399 DURABLE MEDICAL EQUIPMENT MISCELLANEOUS 9 0.4444 46 46 9 9 NA NA 6381 6381 Carrier G 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT V2625 ENLARGEMENT OF OCULAR PROSTHESIS 8 1 -160.9 -160.9 8 8 NA NA 6382 6382 Carrier G 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L1970 AFO PLASTIC WITH ANKLE JOINT CUSTOM FABRICATED 8 0.875 30.4 30.4 8 8 NA NA 6383 6383 Carrier G 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4649 SURGICAL SUPPLY; MISCELLANEOUS 1 1 17.8 17.8 1 1 NA NA 6384 6384 Carrier G 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A7524 TRACHEOSTOMA STENT/STUD/BUTTON EACH 1 1 45.2 45.2 1 1 NA NA 6385 6385 Carrier G 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A9513 LUTETIUM LU 177 DOTATATE THERAPEUTIC 1 MCI 1 1 21.6 21.6 1 1 NA NA 6386 6386 Carrier G 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0261 HOS BED SEMI-ELEC ANY TYPE SIDE RAIL W/O MATTRSS 1 1 70.7 70.7 1 1 NA NA 6387 6387 Carrier G 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0635 PATIENT LIFT ELECTRIC WITH SEAT OR SLING 1 1 3.3 3.3 1 1 NA NA 6388 6388 Carrier G 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0652 PNEUMAT COMPRS SEG HOM MDL W/CALBRTD GRADNT PRSS 1 1 119.8 119.8 1 1 NA NA 6389 6389 Carrier G 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0656 SEG PNEUMAT APPLIANCE USE W/PNEUMAT COMPRS TRUNK 1 1 119.8 119.8 1 1 NA NA 6390 6390 Carrier G 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0667 SEG PNEUMAT APPLINC W/PNEUMAT COMPRS FULL LEG 1 1 119.8 119.8 1 1 NA NA 6391 6391 Carrier G 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0748 OSTOGNS STIMULATOR ELEC NONINVASV SPINAL APPLIC 1 1 40.1 40.1 1 1 NA NA 6392 6392 Carrier G 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E1226 WHLCHAIR ACCESS MANUAL FULL RECLINING BACK EACH 1 1 3 3 1 1 NA NA 6393 6393 Carrier G 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0652 PNEUMAT COMPRS SEG HOM MDL W/CALBRTD GRADNT PRSS 1 1 120 120 1 1 NA NA 6394 6394 Carrier G 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0656 SEG PNEUMAT APPLIANCE USE W/PNEUMAT COMPRS TRUNK 1 1 120 120 1 1 NA NA 6395 6395 Carrier G 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0667 SEG PNEUMAT APPLINC W/PNEUMAT COMPRS FULL LEG 1 1 120 120 1 1 NA NA 6396 6396 Carrier G 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT V2624 POLISHING/RESURFACING OF OCULAR PROSTHESIS 13 0.08 8.5 8.5 13 13 NA NA 6397 6397 Carrier G 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A6550 WND CARE SET NEG PRSS WND TX ELEC PUMP SPL 14 0.07 41.7 63.4 58.4 4 10 14 NA NA 6398 6398 Carrier G 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A7000 CANISTER DISPOSABLE USED WITH SUCTION PUMP EACH 15 0.07 41.7 59.2 55.4 4 11 15 NA NA 6399 6399 Carrier G 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E2402 NEG PRESS WOUND THERAPY ELEC PUMP STATION/PRTBLE 18 0.06 31.5 62.7 55.4 5 13 18 NA NA 6400 6400 Carrier G 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E1390 O2 CONC 1 DEL PORT 85 PCT OR GT 02 CONC AT PRSC FLW RATE 64 0.02 18.4 65.6 48.5 21 43 64 NA NA 6401 6401 Carrier G 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 11056 PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4 1 0 1 1 NA NA 6402 6402 Carrier G 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 11721 DEBRIDEMENT NAIL ANY METHOD 6 OR GT 1 0 1 1 NA NA 6403 6403 Carrier G 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT E0784 EXTERNAL AMBULATORY INFUSION PUMP INSULIN 16 1 19.2 60.2 42.6 9 14 23 NA NA 6404 6404 Carrier G 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT K0553 SUPPLY ALLOW FOR TX CGM1 MO SPL Equal to 1 U OF SERVICE 1 1 NA NA 6405 6405 Carrier G 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A9277 TRANSMITTER; EXT USE WITH NONDME INTRSTL CGM 1 0 NA NA 6406 6406 Carrier G 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A9277 TRANSMITTER; EXT USE WITH NONDME INTRSTL CGM 1 0 NA NA 6407 6407 Carrier G 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0784 EXTERNAL AMBULATORY INFUSION PUMP INSULIN 16 1 19.2 60.16 42.6 9 14 23 NA NA 6408 6408 Carrier G 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT K0553 SUPPLY ALLOW FOR TX CGM1 MO SPL Equal to 1 U OF SERVICE 1 1 NA NA 6409 6409 Carrier G 2023 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0784 EXTERNAL AMBULATORY INFUSION PUMP INSULIN 23 60.8 43.1 9 14 23 NA NA 6410 6410 Carrier G 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 1393 0.849 13.3 52.3 425 968 AMPHETAMINE/DEXTROAMPHETAMINE ADDERALL 6411 6411 Carrier G 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 585 0.812 14.2 55.9 180 405 METHYLPHENIDATE HCL RITALIN 6412 6412 Carrier G 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 457 0.499 18.7 74.5 143 314 DEXCOM Receiver/Sensor/Transmiter DEXCOM 6413 6413 Carrier G 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 431 0.473 13.7 56.3 86 345 SEMAGLUTIDE OZEMPIC 6414 6414 Carrier G 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 383 0.564 22.1 73 133 250 LISDEXAMFETAMINE DIMESYLATE VYVANSE 6415 6415 Carrier G 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 278 0.522 19.9 79 95 183 PREGABALIN LYRICA 6416 6416 Carrier G 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 268 0.575 16.9 62.2 103 165 Hydrocodone/Acetaminophen NORCO 6417 6417 Carrier G 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 264 0.591 16.2 66.8 30 234 ADALIMUMAB HUMIRA 6418 6418 Carrier G 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 210 0.567 12.3 65.3 105 105 Oxycodone OXYCONTIN 6419 6419 Carrier G 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 188 0.739 16 62.1 66 122 ATOMOXETINE HYDROCHLORIDE STRATTERA 6420 6420 Carrier G 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 55 0.891 16.5 49.6 18 37 FILGRASTIM-SNDZ ZARXIO 6421 6421 Carrier G 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 1393 0.849 13.3 52.3 425 968 AMPHETAMINE-DEXTROAMPHETAMINE ADDERALL 6422 6422 Carrier G 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 85 0.835 11.3 60.9 22 63 INSULIN INFUSION DISPOSABLE PUMP OMNIPOD 10 PACK 6423 6423 Carrier G 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 54 0.815 12.4 65.6 16 38 ISOTRETINOIN ACCUTANE 6424 6424 Carrier G 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 585 0.812 14.2 55.9 180 405 METHYLPHENIDATE HCL RITALIN 6425 6425 Carrier G 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 143 0.811 11.7 48.3 48 95 EMPAGLIFLOZIN JARDIANCE 6426 6426 Carrier G 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 111 0.793 11.3 58.6 33 78 SACUBITRIL-VALSARTAN ENTRESTO 6427 6427 Carrier G 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 52 0.769 17 63.1 22 30 MODAFINIL PROVIGIL 6428 6428 Carrier G 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 79 0.759 9.6 66.9 13 66 GUANFACINE HCL (ADHD) INTUNIV 6429 6429 Carrier G 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 63 0.746 21.3 58.4 15 48 GALCANEZUMAB-GNLM EMGALITY 6430 6430 Carrier G 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 63 0.048 14.6 67.5 25 67 SECUKINUMAB COSENTYX 6431 6431 Carrier G 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 90 0.022 17.9 59.1 28 88 EVOLOCUMAB REPATHA 6432 6432 Carrier G 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 138 0.022 18.1 50.4 39 156 DUPILIMAB DUPIXENT 6433 6433 Carrier G 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 56 0.018 20.3 51.9 22 44 VILAZODONE VIIBRYD 6434 6434 Carrier G 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 59 0.017 19.4 40 32 74 DAPAGLIFLOZIN FARXIGA 6435 6435 Carrier G 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 60 0.017 12.3 67 7 49 ERENUMAB-AOOE AIMOVIG 6436 6436 Carrier G 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 60 0.017 16.9 52.3 16 51 ESCITALOPRAM LEXIPRO 6437 6437 Carrier G 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 62 0.016 20.5 58.2 24 63 RIFAXIMIN XIFAXAN 6438 6438 Carrier G 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 62 0.016 20.2 62.6 28 69 VENLAFAXINE EFFEXOR 6439 6439 Carrier G 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 62 0.016 17 43.9 4 54 RISANKIZUMAB-RZAA SKYRIZI 6440 6440 Carrier H 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 121 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Medical/Surgical/GYN 78 0.7949 24.2 39.7 19 59 NA NA 6441 6441 Carrier H 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43775 Laps Gstrc Rstrictiv Px Longitudinal Gastrectomy 53 0.8679 63.7 0 53 NA NA 6442 6442 Carrier H 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 Total Abdominal Hysterectomy (Corpus And Cervix), With Or Without Removal Of Tube(S), With 41 0.9512 4 56.9 6 35 NA NA 6443 6443 Carrier H 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43644 Laparoscopy, Surg, Gastric Restrictive Procedure; W Gastric Bypass And Roux-En-Y Gastroent 37 0.8649 52 0 37 NA NA 6444 6444 Carrier H 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22614 Arthrodesis, Posterior Or Posterolateral Technique, Single Interspace; Each Additional Int 31 0.871 48 73.7 2 29 NA NA 6445 6445 Carrier H 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22552 Arthrodesis, Anterior Interbody, Incl Disc Space Prep, Discectomy, Osteophytectomy & Decom 22 0.8636 24 84 2 20 NA NA 6446 6446 Carrier H 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22585 Arthrodesis, Anterior/-Lateral,Ea Add.In 18 0.7222 97.3 0 18 NA NA 6447 6447 Carrier H 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64999 Unlisted Procedure,Nervous System 13 0.9231 24 82.9 1 12 NA NA 6448 6448 Carrier H 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22634 Arthrodesis, Combined Posterior Or Posterolateral Technique With Posterior Interbody Techn 12 0.9167 48 82.9 1 11 NA NA 6449 6449 Carrier H 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure) 9 0.6667 28 51.3 3 6 NA NA 6450 6450 Carrier H 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33361 Transcatheter Aortic Valve Replacement (Tavr/Tavi) With Prosthetic Valve; Percutaneous Fem 8 1 75 0 8 NA NA 6451 6451 Carrier H 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 11971 Removal Of Tissue Expander Without Insertion Of Implant 8 1 52 0 8 NA NA 6452 6452 Carrier H 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19371 Peri-Implant Capsulectomy, Breast, Complete, Including Removal Of All Intracapsular Conten 7 1 28.8 0 7 NA NA 6453 6453 Carrier H 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27447 Replacement Knee Total 7 1 75 0 7 NA NA 6454 6454 Carrier H 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19370 Revision Of Peri-Implant Capsule, Breast, Including Capsulotomy, Capsulorrhaphy, And/Or Pa 5 1 28.8 0 5 NA NA 6455 6455 Carrier H 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 760 Ancillary Services - Specialty Services-General Classification 5 1 42.3 45.8 1 4 NA NA 6456 6456 Carrier H 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43235 Esophagogastroduodenoscopy Flexible, Transoral; Diagnostic, Including Collection Of Specim 4 1 72 0 4 NA NA 6457 6457 Carrier H 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33340 Percutaneous Transcatheter Closure Of The Left Atrial Appendage With Endocardial Implant, 4 1 54 0 4 NA NA 6458 6458 Carrier H 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33477 Transcatheter Pulmonary Valve Implantation, Percutaneous Approach, Including Pre-Stenting 4 1 48 0 4 NA NA 6459 6459 Carrier H 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19303 Mastectomy Simple Complete 4 1 54 0 4 NA NA 6460 6460 Carrier H 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43775 Laps Gstrc Rstrictiv Px Longitudinal Gastrectomy 53 1 63.7 0 53 NA NA 6461 6461 Carrier H 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 58150 Total Abdominal Hysterectomy (Corpus And Cervix), With Or Without Removal Of Tube(S), With 41 1 4 56.9 6 35 NA NA 6462 6462 Carrier H 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22552 Arthrodesis, Anterior Interbody, Incl Disc Space Prep, Discectomy, Osteophytectomy & Decom 22 1 24 84 2 20 NA NA 6463 6463 Carrier H 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 33361 Transcatheter Aortic Valve Replacement (Tavr/Tavi) With Prosthetic Valve; Percutaneous Fem 8 1 75 0 8 NA NA 6464 6464 Carrier H 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43235 Esophagogastroduodenoscopy Flexible, Transoral; Diagnostic, Including Collection Of Specim 4 1 72 0 4 NA NA 6465 6465 Carrier H 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 33418 Transcatheter Mitral Valve Repair, Percutaneous Approach, Including Transseptal Puncture W 4 1 54 0 4 NA NA 6466 6466 Carrier H 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63053 Laminectomy, Facetectomy, Or Foraminotomy During Posterior Interbody Arthrodesis, Lumbar; 4 1 78 0 4 NA NA 6467 6467 Carrier H 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63048 Laminectomy, Facetectomy & Foraminotomy (Unilateral Or Bilateral W/ Decompression Of Spina 2 1 84 0 2 NA NA 6468 6468 Carrier H 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 33419 Transcatheter Mitral Valve Repair, Percutaneous Approach, Including Transseptal Puncture W 2 1 48 0 2 NA NA 6469 6469 Carrier H 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 58999 Unlisted Procedure Female Genital System Nonobstetrical 1 1 24 0 1 NA NA 6470 6470 Carrier H 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 128 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Rehabilitation 7 0.2857 15.4 55.7 4 3 NA NA 6471 6471 Carrier H 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0017 Behavioral health; residential (hospital residential treatment program), without room and board, per diem 2 0 17.6 1.3 1 1 NA NA 6472 6472 Carrier H 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Psychiatric 1 1 49.5 0 1 NA NA 6473 6473 Carrier H 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Psychiatric 1 1 49.5 0 1 NA NA 6474 6474 Carrier H 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 128 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Rehabilitation 7 0.2857 15.4 55.7 4 3 NA NA 6475 6475 Carrier H 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0017 Behavioral health; residential (hospital residential treatment program), without room and board, per diem 2 0 17.6 1.3 1 1 NA NA 6476 6476 Carrier H 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 Echo, Transthoracic W/Doppler, Complete 36002 0.9176 1.3 5.3 18 35984 NA NA 6477 6477 Carrier H 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 Continuous Airway Pressure (Cpap) Device [May Be Used For Either Cpap Or Apap] 32416 0.9632 0 2.4 1 32415 NA NA 6478 6478 Carrier H 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 Mri, Lower Extremity Any Joint; Wo Contr 26621 0.8688 3.5 7.1 55 26566 NA NA 6479 6479 Carrier H 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT MSMPT Physical Therapy 21069 0.69 4 11 NA NA 6480 6480 Carrier H 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72148 Mri Of Lumbar Spine 18789 0.8605 3.6 7.4 20 18769 NA NA 6481 6481 Carrier H 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 Mri Of Brain And Further Sequences 16630 0.9196 13.8 4.9 33 16597 NA NA 6482 6482 Carrier H 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74177 Ct Abd & Pelv W Contrast 16107 0.909 2.6 5.6 82 16025 NA NA 6483 6483 Carrier H 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73221 Mri, Any Joint Of Upper Extremity; Wo Co 13081 0.8606 3 7.6 16 13065 NA NA 6484 6484 Carrier H 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72141 Mri Of Cervical Spine 11142 0.8577 5.3 7.7 18 11124 NA NA 6485 6485 Carrier H 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70551 Mri Of Brain 9629 0.8909 4.5 6.5 16 9613 NA NA 6486 6486 Carrier H 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15772 Grafting Of Autologous Fat Harvested By Liposuction Technique To Trunk, Breasts, Scalp, Ar 57 1 63.8 0 57 NA NA 6487 6487 Carrier H 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 92250 Fundus photography with interpretation and report 29 1 22 13.2 1 28 NA NA 6488 6488 Carrier H 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29870 Arthroscopy,Knee,Dx,W/Wo Syn.Bx 22 1 24 62.9 1 21 NA NA 6489 6489 Carrier H 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64590 I & Plcmt. Peripheral Generator/Rec 17 1 181.5 0 17 NA NA 6490 6490 Carrier H 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64479 Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), cervical or thoracic, single level 14 1 22 71.7 2 12 NA NA 6491 6491 Carrier H 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64491 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; second level (List separately in addition to code for primary procedure) 14 1 20.6 75.9 1 13 NA NA 6492 6492 Carrier H 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 31267 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus 14 1 17.9 83.2 1 13 NA NA 6493 6493 Carrier H 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64484 Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, each additional level (List separately in addition to code for primary procedure) 13 1 68.6 0 13 NA NA 6494 6494 Carrier H 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15771 Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; 50 cc or less injectate 10 1 82.6 0 10 NA NA 6495 6495 Carrier H 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63030 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar 9 1 45.3 80.3 1 8 NA NA 6496 6496 Carrier H 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27447 Replacement Knee Total 160 1 0 64.3 1 159 NA NA 6497 6497 Carrier H 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27130 Replacement Hip Total Simple 116 1 8 63 3 113 NA NA 6498 6498 Carrier H 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 36482 Endovenous Ablation Therapy Of Incompetent Vein, Extremity, By Transcatheter Delivery Of A 78 1 71.1 0 78 NA NA 6499 6499 Carrier H 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 36470 Injection Of Sclerosant; Single Incompetent Vein (Other Than Telangiectasia) 39 1 69.7 0 39 NA NA 6500 6500 Carrier H 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 19303 Mastectomy Simple Complete 38 1 0 45.9 2 36 NA NA 6501 6501 Carrier H 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64615 Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial, Trigeminal, Cervical Spinal 33 1 14.9 0 33 NA NA 6502 6502 Carrier H 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 17106 Dest Cut Vasc Proliferative Les To 10 Sq 20 1 75.6 0 20 NA NA 6503 6503 Carrier H 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 19350 Reconstruct Nipple/Areolar Unil 17 1 46.4 0 17 NA NA 6504 6504 Carrier H 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64590 I & Plcmt. Peripheral Generator/Rec 17 1 181.5 0 17 NA NA 6505 6505 Carrier H 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22614 Arthrodesis, Posterior Or Posterolateral Technique, Single Interspace; Each Additional Int 9 1 88 0 9 NA NA 6506 6506 Carrier H 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Therapeutic Repetitive Transcranial Magnetic Simulation (Tms) Treatment; Initial, Includin 264 0.88 14.2 510.1 25 239 NA NA 6507 6507 Carrier H 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 Therapeutic Repetitive Transcranial Magnetic Stimulation (Tms) Treatment; Subsequent Motor 168 0.9107 10.3 48.2 14 154 NA NA 6508 6508 Carrier H 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 Therapeutic Repetitive Transcranial Magnetic Simulation (Tms) Treatment; Including Cortica 165 0.8848 10 43.1 12 153 NA NA 6509 6509 Carrier H 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 Mental health partial hospitalization, treatment, less than 24 hours 135 0.8593 28.2 50.1 12 123 NA NA 6510 6510 Carrier H 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan 102 0.8137 32.6 67.9 8 94 NA NA 6511 6511 Carrier H 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97155 Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes 90 0.8333 23.7 68.4 8 82 NA NA 6512 6512 Carrier H 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97156 Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes 87 0.8736 24.2 69.1 8 79 NA NA 6513 6513 Carrier H 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97153 Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes 79 0.8354 17.8 70 7 72 NA NA 6514 6514 Carrier H 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC S9480 Intensive outpatient psychiatric services, per diem 73 0.8356 18.5 56.3 9 64 NA NA 6515 6515 Carrier H 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0032 Mental health service plan development by nonphysician 58 0.8103 43 53 2 56 NA NA 6516 6516 Carrier H 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S9480 Intensive Outpatient Psychiatric Services Per Diem 15 1 41.6 0 15 NA NA 6517 6517 Carrier H 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97151 Behavior Identification Assessment, Administered By A Physician Or Other Qualified Health 6 1 4 0 6 NA NA 6518 6518 Carrier H 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97156 Family Adptve Bhvr Trtmnt Guidance, Admnstrd By Phys Or Other Qualified Hlth Care Profess 5 1 4.8 0 5 NA NA 6519 6519 Carrier H 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97153 Adaptive Behavior Treatment By Protocol, Admnstrd By Tech Under The Direction Of A Phys Or 5 1 4.8 0 5 NA NA 6520 6520 Carrier H 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97155 Adptve Bhvr Trtmnt W/ Protocol Modifictn, Admnstrd By Phys Or Other Qualified Hlth Care Pr 5 1 4.8 0 5 NA NA 6521 6521 Carrier H 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0035 Mental Health Partial Hospitalization, Treatment, Less Than 24 Hours 3 1 48 96 1 2 NA NA 6522 6522 Carrier H 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97152 Behavior identification-supporting assessment, administered by one technician under the direction of a physician or other qualified health care professional, face-to-face with the patient, each 15 minutes 2 1 16 0 2 NA NA 6523 6523 Carrier H 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90870 Electroconvulsive therapy (includes necessary monitoring) 2 1 3.2 90.7 1 1 NA NA 6524 6524 Carrier H 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC G0283 Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care 2 1 45.3 2 0 NA NA 6525 6525 Carrier H 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97154 Grp Adptve Bhvior Trtmnt By Protocol, Admnstrd By Tech Under The Drction Of A Phys Or Othe 1 1 0 0 1 NA NA 6526 6526 Carrier H 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90868 Therapeutic Repetitive Transcranial Magnetic Simulation (Tms) Treatment; Initial, Includin 203 1 11.3 47.6 17 186 NA NA 6527 6527 Carrier H 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90869 Therapeutic Repetitive Transcranial Magnetic Stimulation (Tms) Treatment; Subsequent Motor 168 1 10.3 48.2 14 154 NA NA 6528 6528 Carrier H 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90867 Therapeutic Repetitive Transcranial Magnetic Simulation (Tms) Treatment; Including Cortica 165 1 10 43.1 12 153 NA NA 6529 6529 Carrier H 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT S0013 Esketamine, Nasal Spray, 1 Mg 31 1 16.8 60.6 10 21 NA NA 6530 6530 Carrier H 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90837 Psychotherapy, 60 minutes with patient 11 0.091 41.5 107.1 2 9 NA NA 6531 6531 Carrier H 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97151 Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan 102 0.01 32.6 67.9 8 94 NA NA 6532 6532 Carrier H 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0486 Adjustable, Custom Fabricated, Includes Fitting And Adjustment 258 0.938 21.8 9 3 1587 NA NA 6533 6533 Carrier H 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0108 Wheelchair Component Or Accessory, Not Otherwise Specified 110 0.8182 66.9 0 110 NA NA 6534 6534 Carrier H 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC S1040 Cranial Remolding Orthosis, Rigid, With Soft Interface Material, Custom Fabricated, Includ 63 0.9365 58.6 0 63 NA NA 6535 6535 Carrier H 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L8680 Implantable Neurostimulator Electrode Each 46 0.913 105.7 1 45 NA NA 6536 6536 Carrier H 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0005 Ultralightweight Wheelchair 37 0.8919 74.9 0 37 NA NA 6537 6537 Carrier H 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0748 Osteogenic Stimulator, Noninvasive, Spinal Applications 32 0.3125 150 0 32 NA NA 6538 6538 Carrier H 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0739 Pneumatic Compressor, Segmental Home Model With Calibrated Gradient Pr 29 0.8621 107.6 0 29 NA NA 6539 6539 Carrier H 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0652 Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes 29 0.6207 70.3 1 28 NA NA 6540 6540 Carrier H 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L1846 Ko, Double Upright, Thigh And Calf, With Adjustable Flexion And Extens 28 0.5357 74.6 0 28 NA NA 6541 6541 Carrier H 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L2755 Addition To Lower Extremity Orthosis Carbon Graphite Lamination 27 0.8889 69.3 0 27 NA NA 6542 6542 Carrier H 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0766 Electrical Stimulation Device Used For Cancer Treatment, Includes All Accessories, Any Typ 14 1 0 51.7 1 13 NA NA 6543 6543 Carrier H 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2607 Skin Protection And Positioning Wheelchair Seat Cushion, Width Less Than 22 7 1 96 0 7 NA NA 6544 6544 Carrier H 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0260 Hospital Bed, Seimi-Electric (Head And Foot Adjustment), With Any Type 7 1 80 0 7 NA NA 6545 6545 Carrier H 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0973 Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each 6 1 106.1 0 6 NA NA 6546 6546 Carrier H 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0040 Adjustable angle footplate, each 5 1 101 0 5 NA NA 6547 6547 Carrier H 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0978 Wheelchair accessory, positioning belt/safety belt/pelvic strap, each 5 1 117.3 0 5 NA NA 6548 6548 Carrier H 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2613 Positioning Wheelchair Back Cushion, Posterior, Width Less Than 22 Inches, Any 5 1 52.8 0 5 NA NA 6549 6549 Carrier H 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8690 Aud Osseo Dev, Int/Ext Comp 5 1 144 0 5 NA NA 6550 6550 Carrier H 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0261 Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type 5 1 57.6 0 5 NA NA 6551 6551 Carrier H 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5856 Addition To Lower Extremity Prosthesis, Endoskeletal Knee-Shin System, 5 1 110.4 0 5 NA NA 6552 6552 Carrier H 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0486 Adjustable, Custom Fabricated, Includes Fitting And Adjustment 250 1 0 0 250 NA NA 6553 6553 Carrier H 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC K0005 Ultralightweight Wheelchair 37 1 74.9 0 37 NA NA 6554 6554 Carrier H 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L2755 Addition To Lower Extremity Orthosis Carbon Graphite Lamination 27 1 69.3 0 27 NA NA 6555 6555 Carrier H 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0766 Electrical Stimulation Device Used For Cancer Treatment, Includes All Accessories, Any Typ 14 1 51.7 1 13 NA NA 6556 6556 Carrier H 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E2622 Skin Protection Wheelchair Seat Cushion, Adjustable, Width Less Than 22 Inches, Any Depth 10 1 61.3 1 9 NA NA 6557 6557 Carrier H 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E2613 Positioning Wheelchair Back Cushion, Posterior, Width Less Than 22 Inches, Any 5 1 52.8 0 5 NA NA 6558 6558 Carrier H 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L5856 Addition To Lower Extremity Prosthesis, Endoskeletal Knee-Shin System, 5 1 110.4 0 5 NA NA 6559 6559 Carrier H 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L5973 Endoskeletal Ankle Foot System, Microprocessor Controlled Feature, Dorsiflexion 3 1 112 0 3 NA NA 6560 6560 Carrier H 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC K0825 Pwc Gp 2 Hd Cap Chair 1 1 48 0 1 NA NA 6561 6561 Carrier H 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0483 High Frequency Chest Wall Oscillation System, With Full Anterior And/Or Posterior Thoracic 16 0.5 48 60 1 15 NA NA 6562 6562 Carrier H 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year NA NA Diabetes Supplies & Equip 71 0.6619 1.6 22.2 14 57 0 NA NA 6563 6563 Carrier H 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA Diabetes Supplies & Equip 71 0.6619 1.6 22.2 14 57 0 NA NA 6564 6564 Carrier H 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 2150 0.4632 1.7 16.53 258 1892 0 SEMAGLUTIDE OZEMPIC 6565 6565 Carrier H 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 1144 0.4274 2.79 19.4 141 1003 0 TIRZEPATIDE MOUNJARO 6566 6566 Carrier H 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 861 0.3217 2.62 29.53 76 785 0 SEMAGLUTIDE OZEMPIC 6567 6567 Carrier H 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 850 0.6529 4.48 45.24 166 684 0 RIMEGEPANT NURTEC ODT 6568 6568 Carrier H 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 596 0.7399 14.48 56.57 99 497 0 DUPILUMAB DUPIXENT 6569 6569 Carrier H 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 460 0.737 6.9 45.24 113 347 0 UBROGEPANT UBRELVY 6570 6570 Carrier H 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 455 0.6615 3.51 20.49 48 407 0 SEMAGLUTIDE WEGOVY 6571 6571 Carrier H 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 451 0.8448 1.42 13.66 80 371 0 EMPAGLIFLOZIN JARDIANCE 6572 6572 Carrier H 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 412 0.4879 3.7 15.51 53 359 0 TIRZEPATIDE MOUNJARO 6573 6573 Carrier H 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 411 0.5401 1.7 17.03 57 354 0 SEMAGLUTIDE OZEMPIC 6574 6574 Carrier H 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 24 1 7.85 5.19 20 4 0 ONDANSETRON HCL ZOFRAN 6575 6575 Carrier H 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 13 1 6.28 22.35 4 9 0 METHYLPHENIDATE CONCERTA 6576 6576 Carrier H 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 11 1 0.01 0.01 3 8 0 DESVENLAFAXINE SUCCINATE DESVENLAFAXINE ER 6577 6577 Carrier H 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 11 1 0.01 21.41 2 9 0 EMPAGLIFLOZIN AND METFORMIN SYNJARDY 6578 6578 Carrier H 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 11 1 2.33 17.18 5 6 0 NALTREXONE VIVITROL 6579 6579 Carrier H 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 11 1 1.12 33.31 8 3 0 ENZALUTAMIDE XTANDI 6580 6580 Carrier H 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 10 1 0.02 12.62 1 9 0 LURASIDONE HYDROCHLORIDE LATUDA 6581 6581 Carrier H 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 9 1 5.38 14.75 7 2 0 LENVATINIB LENVIMA 6582 6582 Carrier H 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 8 1 10.35 13.35 2 6 0 DEXLANSOPRAZOLE DEXILANT 6583 6583 Carrier H 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 8 1 12.03 0.01 2 6 0 CARIPRAZINE VRAYLAR 6584 6584 Carrier H 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 2 1 4.03 25.49 1 1 0 ADALIMUMAB HUMIRA 6585 6585 Carrier H 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 1 1 69.77 0 1 0 TRAMETINIB MEKINIST 6586 6586 Carrier H 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 1 1 20.47 1 0 0 ALPELISIB PIQRAY 6587 6587 Carrier H 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 1 1 3 1 0 0 SECUKINUMAB COSENTYX 6588 6588 Carrier H 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 1 1 1.33 1 0 0 ABIRATERONE ACETATE ZYTIGA 6589 6589 Carrier H 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 1 1 91.66 0 1 0 NEBIVOLOL HYDROCHLORIDE BYSTOLIC 6590 6590 Carrier H 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 1 1 3.19 1 0 0 AMBRISENTAN LETAIRIS 6591 6591 Carrier H 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 1 1 20.99 1 0 0 TOPIRAMATE TROKENDI 6592 6592 Carrier H 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 1 1 67.42 0 1 0 DROXIDOPA NORTHERA 6593 6593 Carrier H 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 1 1 73.6 0 1 0 MARAVIROC SELZENTRY 6594 6594 Carrier I 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 6 0.8333 48.46 6 NA NA 6595 6595 Carrier I 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 69990 Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure) 5 0 0.09 12.5 1 4 NA NA 6596 6596 Carrier I 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 5 0.8 30.97 5 NA NA 6597 6597 Carrier I 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 61781 Stereotactic computer-assisted (navigational) procedure; cranial, intradural (List separately in addition to code for primary procedure) 4 0 0.09 16.66 1 3 NA NA 6598 6598 Carrier I 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44207 Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) 4 0 1.41 4 NA NA 6599 6599 Carrier I 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44205 Laparoscopy, surgical; colectomy, partial, with removal of terminal ileum with ileocolostomy 4 0 1.41 4 NA NA 6600 6600 Carrier I 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 38562 Limited lymphadenectomy for staging (separate procedure); pelvic and para-aortic 4 0 0.6 0.47 3 1 NA NA 6601 6601 Carrier I 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44204 Laparoscopy, surgical; colectomy, partial, with anastomosis 4 0 1.39 4 NA NA 6602 6602 Carrier I 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) 3 0.6667 65.03 3 NA NA 6603 6603 Carrier I 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45330 Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 3 0 0.09 3 NA NA 6604 6604 Carrier I 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44206 Laparoscopy, surgical; colectomy, partial, with end colostomy and closure of distal segment (Hartmann type procedure) 3 0 1.85 3 NA NA 6605 6605 Carrier I 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar 2 1 72.21 2 NA NA 6606 6606 Carrier I 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar 2 1 26.16 2 NA NA 6607 6607 Carrier I 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27447 Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) 1 1 0.22 1 NA NA 6608 6608 Carrier I 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27487 Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component 1 1 0.04 1 NA NA 6609 6609 Carrier I 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22808 Arthrodesis, anterior, for spinal deformity, with or without cast; 2 to 3 vertebral segments 1 1 2.41 1 NA NA 6610 6610 Carrier I 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63048 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; each additional segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure) 1 1 88.71 1 NA NA 6611 6611 Carrier I 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 31299 Unlisted procedure, accessory sinuses 1 1 77.77 1 NA NA 6612 6612 Carrier I 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63046 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; thoracic 1 1 0.05 1 NA NA 6613 6613 Carrier I 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64999 Unlisted procedure, nervous system 1 1 77.77 1 NA NA 6614 6614 Carrier I 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 38206 Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; autologous 1 1 45.21 1 NA NA 6615 6615 Carrier I 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 38241 Hematopoietic progenitor cell (HPC); autologous transplantation 1 1 45.21 1 NA NA 6616 6616 Carrier I 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15769 Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia) 1 1 77.77 1 NA NA 6617 6617 Carrier I 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27134 Revision of total hip arthroplasty; both components, with or without autograft or allograft 1 1 0.38 1 NA NA 6618 6618 Carrier I 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 61736 Laser interstitial thermal therapy of a simple single intracranial lesion 1 1 52.42 1 NA NA 6619 6619 Carrier I 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27137 Revision of total hip arthroplasty; acetabular component only, with or without autograft or allograft 1 1 0.38 1 NA NA 6620 6620 Carrier I 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63200 Laminectomy, with release of tethered spinal cord, lumbar 1 1 0.01 1 NA NA 6621 6621 Carrier I 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22630 Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar 1 1 41.27 1 NA NA 6622 6622 Carrier I 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 47379 Unlisted laparoscopic procedure, liver 1 1 66.71 1 NA NA 6623 6623 Carrier I 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22850 Removal of posterior nonsegmental instrumentation (eg, Harrington rod) 1 1 0.02 1 NA NA 6624 6624 Carrier I 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 ECHO, transthoracic w/doppler, complete 241 0.9295 3.65 241 NA NA 6625 6625 Carrier I 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 MRI of brain and further sequences 180 0.9333 5.65 180 NA NA 6626 6626 Carrier I 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74177 CT abd & pelv w contrast 162 0.9198 4.16 162 NA NA 6627 6627 Carrier I 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 MRI, lower extremity any joint; wo contr 137 0.854 6.32 137 NA NA 6628 6628 Carrier I 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72148 MRI of lumbar spine 135 0.8 15.32 135 NA NA 6629 6629 Carrier I 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 Colonoscopy, flexible; with biopsy, single or multiple 100 0.93 0.01 3.54 1 99 NA NA 6630 6630 Carrier I 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 99 0.9293 3.57 468 99 2 NA NA 6631 6631 Carrier I 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 71250 DIAGNOSTIC CT THORAX W/O CNTRST 95 0.8842 3.9 95 NA NA 6632 6632 Carrier I 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73221 MRI, any joint of upper extremity; wo co 90 0.7444 0.14 12.65 1 89 NA NA 6633 6633 Carrier I 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 89 0.9326 0.01 2.62 1 88 NA NA 6634 6634 Carrier I 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 71271 CT THORAX LW DOSE LNG CA SCR C- 63 1 0 63 NA NA 6635 6635 Carrier I 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93303 ECHO, transthoracic, complete cng 42 1 3.74 42 NA NA 6636 6636 Carrier I 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72158 MRI of lumbar spine 15 1 9.2 15 NA NA 6637 6637 Carrier I 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93308 ECHO, transthoracic, heart, limited 12 1 2.55 12 NA NA 6638 6638 Carrier I 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 75574 CTA heart w/3d image 12 1 0.36 12 NA NA 6639 6639 Carrier I 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 71275 CTA chest (noncoronary) 12 1 0.35 12 NA NA 6640 6640 Carrier I 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 45381 Colonoscopy, flexible; with directed submucosal injection(s), any substance 11 1 0.52 11 NA NA 6641 6641 Carrier I 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 74181 MRI, abdomen; wo contrast material(s) 10 1 5.54 10 NA NA 6642 6642 Carrier I 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93312 ECHO, transesophageal, heart, compl 10 1 0 10 NA NA 6643 6643 Carrier I 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 62323 Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT) 10 1 0.19 8.1 216 1 9 1 NA NA 6644 6644 Carrier I 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 73220 MRI, upper extremity, other than joint; 11 0.0909 13.99 11 NA NA 6645 6645 Carrier I 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 73700 CT, lower extremity wo contrast 22 0.0455 24.34 22 NA NA 6646 6646 Carrier I 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 78815 Imaging PET/CT skul-thigh 47 0.0213 9.65 47 NA NA 6647 6647 Carrier I 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 73721 MRI, lower extremity any joint; wo contr 137 0.0146 6.32 137 NA NA 6648 6648 Carrier I 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 74177 CT abd & pelv w contrast 162 0.0123 4.16 162 NA NA 6649 6649 Carrier I 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 71260 DIAGNOSTIC CT THORAX W/CONTRAST 88 0.0114 4.72 88 NA NA 6650 6650 Carrier I 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 70553 MRI of brain and further sequences 180 0.0056 5.65 180 NA NA 6651 6651 Carrier I 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1002 Residential treatment, Substance Use Disorder 4 1 19.11 42.93 2 2 NA NA 6652 6652 Carrier I 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1001 Residential treatment, Psychiatric 2 1 6.84 2 NA NA 6653 6653 Carrier I 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 Room and board, Semi-Private, Psychiatric 1 1 66.66 1 NA NA 6654 6654 Carrier I 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1002 Residential treatment, Substance Use Disorder 4 1 19.11 42.93 2 2 NA NA 6655 6655 Carrier I 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1001 Residential treatment, Psychiatric 2 1 6.84 2 NA NA 6656 6656 Carrier I 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 Room and board, Semi-Private, Psychiatric 1 1 66.66 1 NA NA 6657 6657 Carrier I 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 9 1 9.08 9 NA NA 6658 6658 Carrier I 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 9 1 9.08 9 NA NA 6659 6659 Carrier I 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 19350 Nipple/areola reconstruction 9 1 36.39 9 NA NA 6660 6660 Carrier I 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 9 1 9.08 9 NA NA 6661 6661 Carrier I 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 Mental Health Partial Hospitalization, Treatment, Less Than 24 Hours 8 1 39.85 32.01 1 7 NA NA 6662 6662 Carrier I 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H2036 Alcohol and/or other drug treatment program, per diem 6 1 29.68 6 NA NA 6663 6663 Carrier I 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 6 1 13.53 10.53 2 4 NA NA 6664 6664 Carrier I 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 19303 Mastectomy, simple, complete 6 1 35.17 6 NA NA 6665 6665 Carrier I 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 19318 Breast reduction 5 1 28.3 5 NA NA 6666 6666 Carrier I 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 71271 CT THORAX LW DOSE LNG CA SCR C- 3 0.6667 0 3 NA NA 6667 6667 Carrier I 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 9 1 9.08 9 NA NA 6668 6668 Carrier I 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 9 1 9.08 9 NA NA 6669 6669 Carrier I 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19350 Nipple/areola reconstruction 9 1 36.39 9 NA NA 6670 6670 Carrier I 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 9 1 9.08 9 NA NA 6671 6671 Carrier I 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0035 Mental Health Partial Hospitalization, Treatment, Less Than 24 Hours 8 1 39.85 32.01 1 7 NA NA 6672 6672 Carrier I 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H2036 Alcohol and/or other drug treatment program, per diem 6 1 29.68 6 NA NA 6673 6673 Carrier I 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 6 1 13.53 10.53 2 4 NA NA 6674 6674 Carrier I 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19303 Mastectomy, simple, complete 6 1 35.17 6 NA NA 6675 6675 Carrier I 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19318 Breast reduction 5 1 28.3 5 NA NA 6676 6676 Carrier I 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70551 MRI of brain 2 1 0 2 NA NA 6677 6677 Carrier I 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 Continuous airway pressure (CPAP) device [may be used for either CPAP or APAP] 278 0.964 1.68 278 NA NA 6678 6678 Carrier I 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 8 0.875 3.2 8 NA NA 6679 6679 Carrier I 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 3 1 0 3 NA NA 6680 6680 Carrier I 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0108 W/C Component-Accessory Nos 3 0.3333 23.72 3 NA NA 6681 6681 Carrier I 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0739 Repair/svc DME non-oxygen eq 1 0 0.09 1 NA NA 6682 6682 Carrier I 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 3 1 0 3 NA NA 6683 6683 Carrier I 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0601 Continuous airway pressure (CPAP) device [may be used for either CPAP or APAP] 278 0.964 1.68 278 NA NA 6684 6684 Carrier I 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 8 0.875 3.2 8 NA NA 6685 6685 Carrier I 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0108 W/C Component-Accessory Nos 3 0.3333 23.72 3 NA NA 6686 6686 Carrier I 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0739 Repair/svc DME non-oxygen eq 1 0 0.09 1 NA NA 6687 6687 Carrier I 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 2 1 35.69 2 NA NA 6688 6688 Carrier I 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4216 Sterile water/saline, 10 ml 1 0 0.09 1 NA NA 6689 6689 Carrier I 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 2 1 35.69 2 NA NA 6690 6690 Carrier I 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4216 Sterile water/saline, 10 ml 1 0 0.09 1 NA NA 6691 6691 Carrier I 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 43 0.2326 5.41 1.51 4 39 SEMAGLUTIDE OZEMPIC, RYBELSUS 6692 6692 Carrier I 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 36 0.8056 1.32 66.59 4 32 CYCLOSPORINE (OPHTH) CEQUA, CYCLOSPORINE, RESTASIS 6693 6693 Carrier I 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 35 1 5.24 39.93 6 29 ADALIMUMAB HUMIRA 6694 6694 Carrier I 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 31 0.5484 29.41 116.08 8 23 HYDROCODONE-ACETAMINOPHEN HYDROCODONE-ACETAMINOPHEN 6695 6695 Carrier I 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 29 0.8276 4.5 22.42 11 18 OXYCODONE HCL OXYCODONE HCL, OXYCONTIN 6696 6696 Carrier I 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 26 1 6.8 31.85 7 19 RISANKIZUMAB-RZAA SKYRIZI 6697 6697 Carrier I 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 22 0.8182 16.77 127.82 1 21 DUPILUMAB DUPIXENT, DUPIXENT DUPILUMAB 6698 6698 Carrier I 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 20 0 5.18 12.71 5 15 SEMAGLUTIDE (WEIGHT MANAGEMENT) WEGOVY 6699 6699 Carrier I 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 19 0.2632 13.81 36.55 1 18 TIRZEPATIDE MOUNJARO 6700 6700 Carrier I 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 14 1 48.43 126.02 3 11 FREMANEZUMAB-VFRM AJOVY 6701 6701 Carrier I 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 35 1 5.24 39.93 6 29 ADALIMUMAB HUMIRA 6702 6702 Carrier I 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 26 1 6.8 31.85 7 19 RISANKIZUMAB-RZAA SKYRIZI 6703 6703 Carrier I 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 14 1 48.43 126.02 3 11 FREMANEZUMAB-VFRM AJOVY 6704 6704 Carrier I 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 18.19 0 8 LIFITEGRAST XIIDRA 6705 6705 Carrier I 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 36.38 0 7 GUSELKUMAB TREMFYA 6706 6706 Carrier I 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 5 1 1.82 17.05 3 2 HYDROMORPHONE HCL HYDROMORPHONE HCL 6707 6707 Carrier I 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 5 1 1.77 39.93 1 4 RUXOLITINIB PHOSPHATE (TOPICAL) OPZELURA 6708 6708 Carrier I 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 4 1 31.25 0 4 APREMILAST OTEZLA 6709 6709 Carrier I 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 4 1 7.86 0 4 FEZOLINETANT VEOZAH 6710 6710 Carrier I 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 4 1 3.58 39.14 2 2 ABEMACICLIB VERZENIO 6711 6711 Carrier I 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 44.17 1 0 IVABRADINE HCL CORLANOR 6712 6712 Carrier I 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 5.72 1 0 RIMEGEPANT SULFATE NURTEC 6713 6713 Carrier I 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 92.92 0 1 UPADACITINIB RINVOQ ER 6714 6714 Carrier I 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 19.67 1 0 RIBOCICLIB SUCCINATE KISQALI 6715 6715 Carrier I 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 81.75 0 1 ERENUMAB-AOOE AIMOVIG 6716 6716 Carrier I 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 15.68 1 0 ELAGOLIX SODIUM ORILISSA 6717 6717 Carrier I 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 0.5 87.67 0 2 DUPILUMAB DUPIXENT, DUPIXENT DUPILUMAB 6718 6718 Carrier I 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 0.5 27.45 1 0 AXITINIB INLYTA 6719 6719 Carrier I 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 0.25 22.95 1 0 EVOLOCUMAB REPATHA SURECLICK 6720 6720 Carrier I 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 0.125 283.82 0 1 RIFAXIMIN XIFAXAN 6721 6721 Carrier J 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 54 0.7778 4.67 64.65 6 48 11 NA NA 6722 6722 Carrier J 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96416 Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump 36 0 1 5.73 20 16 NA NA 6723 6723 Carrier J 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) 32 0.75 1.2 64.05 2 30 6 NA NA 6724 6724 Carrier J 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 32 0.7813 29.65 67.06 3 29 10 NA NA 6725 6725 Carrier J 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar 28 0.8214 22.26 75.23 4 24 5 NA NA 6726 6726 Carrier J 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44204 Laparoscopy, surgical; colectomy, partial, with anastomosis 28 0 0.63 6.3 4 24 NA NA 6727 6727 Carrier J 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44207 Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) 27 0 2.43 5.85 5 22 NA NA 6728 6728 Carrier J 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 27 0.8519 55.22 27 4 NA NA 6729 6729 Carrier J 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); 26 0.0385 0.76 4.83 5 21 NA NA 6730 6730 Carrier J 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) 25 0.84 0.1 46.46 1 24 8 NA NA 6731 6731 Carrier J 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22552 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2, each additional interspace (List separately in addition to code for separate procedure) 8 1 0.74 102.13 3 5 NA NA 6732 6732 Carrier J 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33340 Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, when performed, and radiological supervision and interpretation 7 1 1.21 60.72 1 6 NA NA 6733 6733 Carrier J 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27447 Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) 7 1 45.89 7 NA NA 6734 6734 Carrier J 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 47379 Unlisted laparoscopic procedure, liver 5 1 82.33 5 NA NA 6735 6735 Carrier J 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22325 Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; lumbar 5 1 21.26 480 5 1 NA NA 6736 6736 Carrier J 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22843 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments (List separately in addition to code for primary procedure) 5 1 17.61 5 NA NA 6737 6737 Carrier J 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22848 Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum (List separately in addition to code for primary procedure) 5 1 0.1 33.79 1 4 NA NA 6738 6738 Carrier J 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 61867 Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array 3 1 37.84 3 NA NA 6739 6739 Carrier J 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63285 Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, cervical 3 1 21.67 3 NA NA 6740 6740 Carrier J 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63052 Laminectomy, facetectomy, or foraminotomy with lumbar decompression of spinal cord, cauda equina and/or nerve root during posterior interbody arthrodesis, single segment 3 1 100.03 3 5 NA NA 6741 6741 Carrier J 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15734 Muscle, myocutaneous, or fasciocutaneous flap; trunk 3 1 100.65 3 NA NA 6742 6742 Carrier J 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27487 Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component 3 1 54.07 3 NA NA 6743 6743 Carrier J 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22632 Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; each additional interspace (List separately in addition to code for primary procedure) 1 1 115.39 1 NA NA 6744 6744 Carrier J 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43644 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less) 1 1 1 NA NA 6745 6745 Carrier J 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63267 Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; lumbar 1 1 115.39 192 1 1 NA NA 6746 6746 Carrier J 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63081 Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression of spinal cord and/or nerve root(s); cervical, single segment 2 0.5 61.1 720 2 2 NA NA 6747 6747 Carrier J 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63042 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar 3 0.3333 45.11 3 NA NA 6748 6748 Carrier J 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22216 Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; each additional vertebral segment (List separately in addition to primary procedure) 3 0.3333 51.12 720 3 2 NA NA 6749 6749 Carrier J 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22214 Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; lumbar 3 0.3333 57.08 3 NA NA 6750 6750 Carrier J 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22630 Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar 7 0.2857 54.87 7 NA NA 6751 6751 Carrier J 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22848 Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum (List separately in addition to code for primary procedure) 5 0.2 0.1 33.79 1 4 NA NA 6752 6752 Carrier J 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22325 Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; lumbar 5 0.2 21.26 480 5 1 NA NA 6753 6753 Carrier J 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 5468 0.6831 24.91 29.84 908.8 8 5460 10 NA NA 6754 6754 Carrier J 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 5182 0.682 18.09 29.51 10 5172 6 NA NA 6755 6755 Carrier J 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97112 Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities 4521 0.6713 35.49 29.66 931.2 6 4515 5 NA NA 6756 6756 Carrier J 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97140 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes 4282 0.6747 9.83 30.4 8 4274 6 NA NA 6757 6757 Carrier J 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 ECHO, transthoracic w/doppler, complete 3435 0.9613 0.2 3.88 320 2 3433 3 NA NA 6758 6758 Carrier J 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 Colonoscopy, flexible; with biopsy, single or multiple 2909 0.9636 3.82 5.94 857.6 125 2784 15 NA NA 6759 6759 Carrier J 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 MRI, lower extremity any joint; wo contr 2831 0.8859 1.13 8.13 444 2 2829 2 NA NA 6760 6760 Carrier J 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 2599 0.9604 4.38 7.1 884 117 2482 6 NA NA 6761 6761 Carrier J 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 2481 0.973 3.46 5.57 712.5 98 2383 16 NA NA 6762 6762 Carrier J 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74177 CT abd & pelv w contrast 2315 0.9525 2.63 4.07 604.8 14 2301 5 NA NA 6763 6763 Carrier J 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70460 Contrast CAT scan of head/brain 30 1 3.93 30 NA NA 6764 6764 Carrier J 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29898 Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, extensive 24 1 0.16 0.05 1 23 3 NA NA 6765 6765 Carrier J 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93924 Physiologic Arterial Extremity 22 1 0.76 22 NA NA 6766 6766 Carrier J 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63042 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar 20 1 0.15 74.99 3 17 2 NA NA 6767 6767 Carrier J 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 38222 Diagnostic bone marrow; biopsy(ies) and aspiration(s) 20 1 2.38 18.46 3 17 NA NA 6768 6768 Carrier J 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43250 Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps 20 1 1.41 20 NA NA 6769 6769 Carrier J 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43242 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis) 19 1 0.02 7.52 3 16 NA NA 6770 6770 Carrier J 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43254 Esophagogastroduodenoscopy, flexible, transoral; with endoscopic mucosal resection 19 1 0.01 8.25 1 18 NA NA 6771 6771 Carrier J 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72196 MRI, pelvis; with contrast material(s) 18 1 7.36 18 NA NA 6772 6772 Carrier J 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 76391 MR elastography 18 1 0.01 18 NA NA 6773 6773 Carrier J 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 72295 Discography, lumbar, radiological supervision and interpretation 8 0.25 0.26 100.09 1 7 NA NA 6774 6774 Carrier J 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 29873 Arthroscopy, knee, surgical; with lateral release 4 0.25 9.25 4 NA NA 6775 6775 Carrier J 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 29825 Arthroscopy, shoulder, surgical; with lysis and resection of adhesions, with or without manipulation 5 0.2 143.81 5 NA NA 6776 6776 Carrier J 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 62290 Injection procedure for discography, each level; lumbar 11 0.1818 0.26 77 1 10 NA NA 6777 6777 Carrier J 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63685 Insertion or replacement of spinal neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver 13 0.1538 21.72 13 NA NA 6778 6778 Carrier J 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 28297 Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method 8 0.125 8.99 8 NA NA 6779 6779 Carrier J 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63045 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; cervical 13 0.0769 75.42 13 4 NA NA 6780 6780 Carrier J 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63650 Percutaneous implantation of neurostimulator electrode array, epidural 30 0.0667 31.27 30 NA NA 6781 6781 Carrier J 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT G0260 Injection Procedure For Sacroiliac Joint; Provision Of Anesthetic, Ste 52 0.0577 58.34 52 21 NA NA 6782 6782 Carrier J 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64405 Injection(s), anesthetic agent(s) and/or steroid; greater occipital nerve 123 0.0569 1.42 58.43 1 122 NA NA 6783 6783 Carrier J 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1002 Residential treatment, Substance Use Disorder 110 0.9727 14.43 36.12 3 107 NA NA 6784 6784 Carrier J 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1001 Residential treatment, Psychiatric 24 0.625 16.99 29.22 3 21 3 NA NA 6785 6785 Carrier J 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 Room and board, Semi-Private, Psychiatric 17 0.9412 84.53 17 NA NA 6786 6786 Carrier J 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 54125 Amputation of penis; complete 3 1 85.26 3 NA NA 6787 6787 Carrier J 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 56805 Clitoroplasty for intersex state 3 1 85.26 3 NA NA 6788 6788 Carrier J 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 57335 Vaginoplasty for intersex state 3 1 85.26 3 NA NA 6789 6789 Carrier J 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 53430 Urethroplasty, reconstruction of female urethra 3 1 85.26 3 NA NA 6790 6790 Carrier J 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 54520 Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach 3 1 85.26 3 NA NA 6791 6791 Carrier J 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 55175 Scrotoplasty; simple 2 1 84.38 2 NA NA 6792 6792 Carrier J 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 99223 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded. 1 0 0.09 1 NA NA 6793 6793 Carrier J 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 15750 Flap; neurovascular pedicle 1 0 1.63 1 NA NA 6794 6794 Carrier J 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0019 Alcohol And/Or Drug Services 1 0 0 1 NA NA 6795 6795 Carrier J 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 64400 Injection(s), anesthetic agent(s) and/or steroid; trigeminal nerve, each branch (ie, ophthalmic, maxillary, mandibular) 1 0 10.89 1 NA NA 6796 6796 Carrier J 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 64505 Injection, anesthetic agent; sphenopalatine ganglion 1 0 10.89 1 NA NA 6797 6797 Carrier J 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97605 Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters 1 1 22.43 1 NA NA 6798 6798 Carrier J 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 55970 Intersex surgery; male to female 1 1 23.1 1 NA NA 6799 6799 Carrier J 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0009 Alcohol And/Or Drug Services 1 0 3.73 1 NA NA 6800 6800 Carrier J 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 31899 Unlisted procedure, trachea, bronchi 1 1 23.1 1 NA NA 6801 6801 Carrier J 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 14302 Adjacent tissue transfer or rearrangement, any area; each additional 30.0 sq cm, or part thereof (List separately in addition to code for primary procedure) 1 0 1.63 1 NA NA 6802 6802 Carrier J 2023 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 14301 Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm 1 0 1.63 1 NA NA 6803 6803 Carrier J 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 54125 Amputation of penis; complete 3 1 85.26 3 NA NA 6804 6804 Carrier J 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 56805 Clitoroplasty for intersex state 3 1 85.26 3 NA NA 6805 6805 Carrier J 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 57335 Vaginoplasty for intersex state 3 1 85.26 3 NA NA 6806 6806 Carrier J 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 53430 Urethroplasty, reconstruction of female urethra 3 1 85.26 3 NA NA 6807 6807 Carrier J 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 54520 Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach 3 1 85.26 3 NA NA 6808 6808 Carrier J 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 55175 Scrotoplasty; simple 2 1 84.38 2 NA NA 6809 6809 Carrier J 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97605 Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters 1 1 22.43 1 NA NA 6810 6810 Carrier J 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 55970 Intersex surgery; male to female 1 1 23.1 1 NA NA 6811 6811 Carrier J 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 31899 Unlisted procedure, trachea, bronchi 1 1 23.1 1 NA NA 6812 6812 Carrier J 2023 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1002 Residential treatment, Substance Use Disorder 110 0.9727 14.43 36.12 3 107 NA NA 6813 6813 Carrier J 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 71271 CT THORAX LW DOSE LNG CA SCR C- 304 0.9539 3.13 304 NA NA 6814 6814 Carrier J 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual 249 0.743 41.89 249 NA NA 6815 6815 Carrier J 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue H0015 Alcohol And/Or Drug Services 223 1 2.77 13.02 9 214 NA NA 6816 6816 Carrier J 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue H0035 Mental Health Partial Hospitalization, Treatment, Less Than 24 Hours 161 0.8758 22.5 38.85 2 159 NA NA 6817 6817 Carrier J 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 136 0.9044 10.4 24.63 9 127 NA NA 6818 6818 Carrier J 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 132 0.9015 11.47 24.57 8 124 NA NA 6819 6819 Carrier J 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 101 0.8911 10.4 23.41 9 92 NA NA 6820 6820 Carrier J 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue H2036 Alcohol and/or other drug treatment program, per diem 81 0.9383 34.8 81 NA NA 6821 6821 Carrier J 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 19350 Nipple/areola reconstruction 45 0.9556 16.64 37.63 1 44 NA NA 6822 6822 Carrier J 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 19303 Mastectomy, simple, complete 43 0.9535 16.64 39.84 1 42 NA NA 6823 6823 Carrier J 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 223 1 2.77 13.02 9 214 NA NA 6824 6824 Carrier J 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70551 MRI of brain 30 1 0.62 30 NA NA 6825 6825 Carrier J 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70553 MRI of brain and further sequences 12 1 4.52 12 NA NA 6826 6826 Carrier J 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81229 Cytogenomic constitutional (genome-wide) microarray analysis; interrogation of genomic regions for copy number and single nucleotide polymorphism (SNP) variants for chromosomal abnormalities 10 1 3.22 24.02 1 9 NA NA 6827 6827 Carrier J 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81243 FMR1 (fragile X messenger ribonucleoprotein 1) (eg, fragile X syndrome, X-linked intellectual disability [XLID]) gene analysis; evaluation to detect abnormal (eg, expanded) alleles 10 1 3.22 21.29 1 9 NA NA 6828 6828 Carrier J 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 17380 Electrolysis epilation, each 30 minutes 6 1 46.88 6 NA NA 6829 6829 Carrier J 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19325 Breast augmentation with implant 5 1 41.11 5 NA NA 6830 6830 Carrier J 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 41899 Unlisted procedure, dentoalveolar structures 4 1 2.7 49.17 1 3 NA NA 6831 6831 Carrier J 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70450 CT, head or brain wo contrast 3 1 1.02 3 NA NA 6832 6832 Carrier J 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 78608 Brain imaging, PET, metabolic eval 3 1 16.21 3 NA NA 6833 6833 Carrier J 2023 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 78608 Brain imaging, PET, metabolic eval 3 0.3333 16.21 3 NA NA 6834 6834 Carrier J 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 Continuous airway pressure (CPAP) device [may be used for either CPAP or APAP] 4242 0.943 2.52 252 4242 2 NA NA 6835 6835 Carrier J 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 204 0.9755 1.63 204 NA NA 6836 6836 Carrier J 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 95 0.9263 2.93 384 95 1 NA NA 6837 6837 Carrier J 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0108 W/C Component-Accessory Nos 26 0.3846 68.58 26 NA NA 6838 6838 Carrier J 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2402 Negative pressure wound therapy electrical pump, stationary or portable 26 0.2308 45.76 102.4 2 24 NA NA 6839 6839 Carrier J 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0739 Repair/svc DME non-oxygen eq 14 0 0.09 5.47 1 13 NA NA 6840 6840 Carrier J 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0748 Elec Osteogen Stim Spinal 12 0.4167 86.02 12 NA NA 6841 6841 Carrier J 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0861 PWC gp 3 std mult pow opt s/b 7 1 32.2 7 NA NA 6842 6842 Carrier J 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0005 Ultralightweight Wheelchair 6 0 5.83 6 NA NA 6843 6843 Carrier J 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0040 Adjustable Angle Footplate 6 0 29.68 6 NA NA 6844 6844 Carrier J 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2620 WC planar back cush wd <22in 6 0 3.91 6 NA NA 6845 6845 Carrier J 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0861 PWC gp 3 std mult pow opt s/b 7 1 32.2 7 NA NA 6846 6846 Carrier J 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 204 0.9755 1.63 204 NA NA 6847 6847 Carrier J 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0601 Continuous airway pressure (CPAP) device [may be used for either CPAP or APAP] 4242 0.943 2.52 252 4242 2 NA NA 6848 6848 Carrier J 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 95 0.9263 2.93 384 95 1 NA NA 6849 6849 Carrier J 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0748 Elec Osteogen Stim Spinal 12 0.4167 86.02 12 NA NA 6850 6850 Carrier J 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0108 W/C Component-Accessory Nos 26 0.3846 68.58 26 NA NA 6851 6851 Carrier J 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2402 Negative pressure wound therapy electrical pump, stationary or portable 26 0.2308 45.76 102.4 2 24 NA NA 6852 6852 Carrier J 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0739 Repair/svc DME non-oxygen eq 14 0 0.09 5.47 1 13 NA NA 6853 6853 Carrier J 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0005 Ultralightweight Wheelchair 6 0 5.83 6 NA NA 6854 6854 Carrier J 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0040 Adjustable Angle Footplate 6 0 29.68 6 NA NA 6855 6855 Carrier J 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2620 WC planar back cush wd <22in 6 0 3.91 6 NA NA 6856 6856 Carrier J 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 16 0.9375 9.3 16 NA NA 6857 6857 Carrier J 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4216 Sterile water/saline, 10 ml 14 0 1.1 2.36 3 11 NA NA 6858 6858 Carrier J 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A5513 For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each 2 0 6.14 2 NA NA 6859 6859 Carrier J 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A5500 Diab Shoe For Density Insert 2 0 6.14 2 NA NA 6860 6860 Carrier J 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4217 Sterile water/saline, 500 ml 1 0 0.09 1 NA NA 6861 6861 Carrier J 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply 1 0 29.1 1 NA NA 6862 6862 Carrier J 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 16 0.9375 9.3 16 NA NA 6863 6863 Carrier J 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4216 Sterile water/saline, 10 ml 14 0 1.1 2.36 3 11 NA NA 6864 6864 Carrier J 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A5513 For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each 2 0 6.14 2 NA NA 6865 6865 Carrier J 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A5500 Diab Shoe For Density Insert 2 0 6.14 2 NA NA 6866 6866 Carrier J 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4217 Sterile water/saline, 500 ml 1 0 0.09 1 NA NA 6867 6867 Carrier J 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply 1 0 29.1 1 NA NA 6868 6868 Carrier J 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 769 0.3121 22.04 43.29 104 665 SEMAGLUTIDE OZEMPIC, RYBELSUS 6869 6869 Carrier J 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 515 0.9359 8.72 46.22 128 387 ADALIMUMAB HUMIRA 6870 6870 Carrier J 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 506 0.332 15.03 37.9 70 436 TIRZEPATIDE MOUNJARO 6871 6871 Carrier J 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 356 0.6854 15.77 67.87 112 244 HYDROCODONE-ACETAMINOPHEN HYDROCODONE-ACETAMINOPHEN 6872 6872 Carrier J 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 335 0.006 6.03 14.93 33 302 SEMAGLUTIDE (WEIGHT MANAGEMENT) WEGOVY 6873 6873 Carrier J 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 325 0.8554 9.08 40.39 36 289 CYCLOSPORINE (OPHTH) CEQUA, CYCLOSPORINE, RESTASIS, VEVYE 6874 6874 Carrier J 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 303 0.8482 48.93 77.6 63 240 DUPILUMAB DUPIXENT, DUPIXENT DUPILUMAB 6875 6875 Carrier J 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 289 0.7163 13.68 47.47 111 178 OXYCODONE HCL OXYCODONE HCL, OXYCONTIN 6876 6876 Carrier J 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 222 0.2928 15.16 86.28 49 173 RIFAXIMIN XIFAXAN 6877 6877 Carrier J 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 218 0.867 42.99 90.41 83 135 GALCANEZUMAB-GNLM EMGALITY 6878 6878 Carrier J 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 28 1 25.06 33.74 9 19 ABATACEPT ORENCIA 6879 6879 Carrier J 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 24 1 3.53 35.41 10 14 LEVALBUTEROL TARTRATE LEVALBUTEROL TARTRATE, XOPENEX 6880 6880 Carrier J 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 24 1 10.77 54.22 6 18 LISDEXAMFETAMINE DIMESYLATE LISDEXAMFETAMINE DIMESYLATE, VYVANSE 6881 6881 Carrier J 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 12 1 8.41 86.97 3 9 NALOXEGOL OXALATE MOVANTIK 6882 6882 Carrier J 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 10 1 2.31 13.82 3 7 FLUOXETINE HCL FLUOXETINE HCL 6883 6883 Carrier J 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 3.76 275.74 4 4 ELAGOLIX SODIUM ORILISSA 6884 6884 Carrier J 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 8.12 9.21 6 2 CARBIDOPA-LEVODOPA RYTARY 6885 6885 Carrier J 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 2.55 1.52 6 1 ACALABRUTINIB MALEATE CALQUENCE 6886 6886 Carrier J 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 7.01 1.26 2 5 BIMEKIZUMAB-BKZX BIMZELX 6887 6887 Carrier J 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 1.46 7.45 1 6 CONTINUOUS GLUCOSE SYSTEM SENSOR DEXCOM, FREESTYLE LIBRE 6888 6888 Carrier J 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 4.05 1 0 LUMATEPERONE TOSYLATE CAPLYTA 6889 6889 Carrier J 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 30.07 1 0 METYROSINE METYROSINE 6890 6890 Carrier J 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 238.58 0 1 SARILUMAB KEVZARA 6891 6891 Carrier J 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 13.36 1 0 CANNABIDIOL EPIDIOLEX 6892 6892 Carrier J 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 1.79 1 0 GOLIMUMAB SIMPONI 6893 6893 Carrier J 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 160.78 0 1 RITLECITINIB TOSYLATE LITFULO 6894 6894 Carrier J 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 0.6667 9.45 2 0 LENVATINIB MESYLATE LENVIMA 6895 6895 Carrier J 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 0.6667 2.3 280.94 1 1 ABEMACICLIB VERZENIO 6896 6896 Carrier J 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 0.6 24.45 165.45 2 1 RISANKIZUMAB-RZAA (CROHN'S) SKYRIZI 6897 6897 Carrier J 2023 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 0.5 59.96 0 2 DIROXIMEL FUMARATE VUMERITY 6898 6898 Carrier L 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43775 LAPS GSTRC RSTRICTIV PX LONGITUDINAL GASTRECTOMY 5 1 35.9 0 5 NA NA 6899 6899 Carrier L 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY 5 1 20.3 62.3 3 2 NA NA 6900 6900 Carrier L 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 55866 LAPS SURG PRST8ECT RPBIC RAD W/NRV SPARING ROBOT 3 0.6667 87.7 0 3 NA NA 6901 6901 Carrier L 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44145 COLECTOMY PRTL W/COLOPROCTOSTOMY 2 1 19.9 40.5 1 1 NA NA 6902 6902 Carrier L 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 49255 OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX 2 1 19.9 40.5 1 1 NA NA 6903 6903 Carrier L 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58720 SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX 2 1 40.7 0 2 NA NA 6904 6904 Carrier L 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99223 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES 2 1 103.1 0 2 NA NA 6905 6905 Carrier L 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 11043 DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/< 1 1 40.5 1 0 NA NA 6906 6906 Carrier L 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 11046 DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM 1 1 40.5 1 0 NA NA 6907 6907 Carrier L 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 14301 ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM 1 1 35.9 0 5 NA NA 6908 6908 Carrier L 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43775 LAPS GSTRC RSTRICTIV PX LONGITUDINAL GASTRECTOMY 5 1 20.3 62.3 3 2 NA NA 6909 6909 Carrier L 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58150 TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY 5 1 19.9 40.5 1 1 NA NA 6910 6910 Carrier L 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44145 COLECTOMY PRTL W/COLOPROCTOSTOMY 2 1 19.9 40.5 1 1 NA NA 6911 6911 Carrier L 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 49255 OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX 2 1 40.7 0 2 NA NA 6912 6912 Carrier L 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58720 SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX 2 1 103.1 0 2 NA NA 6913 6913 Carrier L 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99223 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES 2 1 40.5 1 0 NA NA 6914 6914 Carrier L 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 11043 DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/< 1 1 40.5 1 0 NA NA 6915 6915 Carrier L 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 11046 DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM 1 1 3.5 0 1 NA NA 6916 6916 Carrier L 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 14301 ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM 1 1 3.5 0 1 NA NA 6917 6917 Carrier L 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15756 FREE MUSCLE/MYOCUTANEOUS FLAP W/MVASC ANAST 1 1 NA NA 6918 6918 Carrier L 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21085 IMPRESSION & PREPARATION ORAL SURGICAL SPLINT 1 68 0 1 NA NA 6919 6919 Carrier L 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21196 RCNSTJ MNDBLR RAMI&/BDY SGTL SPLT W/INT RGD FI 1 68 0 1 NA NA 6920 6920 Carrier L 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 26210 EXCISION/CURETTAGE CYST/TUMOR PHALANX FINGER 1 50.2 1 0 NA NA 6921 6921 Carrier L 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 32555 THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING 1 46 1 0 NA NA 6922 6922 Carrier L 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 55970 INTERSEX SURG MALE FEMALE 1 1 139.4 0 1 NA NA 6923 6923 Carrier L 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 61885 INSJ/RPLCMT CRANIAL NEUROSTIM PULSE GENERATOR 1 40.6 0 1 NA NA 6924 6924 Carrier L 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64568 OPEN IMPLANTATION CRANIAL NERVE NEA & PULSE GEN 1 40.6 0 1 NA NA 6925 6925 Carrier L 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 95976 ELEC ALYS IMPLT SMPL CN NPGT PRGRMG 1 40.6 0 1 NA NA 6926 6926 Carrier L 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 95977 ELEC ALYS IMPLT CPLX CN NPGT PRGRMG 1 40.6 0 1 NA NA 6927 6927 Carrier L 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT C1767 GENERATOR NEUROSTIMULATOR NONRECHARGEABLE 1 40.6 0 1 NA NA 6928 6928 Carrier L 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 81479 Unlisted molecular pathology procedure 156 0.8846 20.6 0 156 NA NA 6929 6929 Carrier L 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 Colonoscopy, flexible; with biopsy, single or multiple 144 0.9167 0.1 8.4 1 143 NA NA 6930 6930 Carrier L 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 120 0.9083 0.1 9.1 1 119 NA NA 6931 6931 Carrier L 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 113 0.9292 0.1 8 2 111 NA NA 6932 6932 Carrier L 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95810 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist 89 0.6404 17.8 47.3 4 85 NA NA 6933 6933 Carrier L 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 81420 Fetal chromosomal aneuploidy (eg, trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18, and 21 67 0.9552 23.9 0 67 NA NA 6934 6934 Carrier L 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95811 POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND 61 0.6557 24.5 48.4 3 58 NA NA 6935 6935 Carrier L 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk 57 0.8596 11.9 0 57 NA NA 6936 6936 Carrier L 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple 51 1 2 0 51 NA NA 6937 6937 Carrier L 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 49 1 2.6 0 49 NA NA 6938 6938 Carrier L 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple 51 1 2 0 51 NA NA 6939 6939 Carrier L 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 49 1 2.6 0 49 NA NA 6940 6940 Carrier L 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 87799 IADNA NOS QUANTIFICATION EACH ORGANISM 31 1 21.8 0 31 NA NA 6941 6941 Carrier L 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81374 HLA I LOW RESOLUTION ONE ANTIGEN EQUIVALENT EACH 29 1 2 0 29 NA NA 6942 6942 Carrier L 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58558 HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C 27 1 0.2 4.5 1 26 NA NA 6943 6943 Carrier L 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81256 HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS 21 1 15.3 0 21 NA NA 6944 6944 Carrier L 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 52356 CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT 20 1 0.1 2 5 15 NA NA 6945 6945 Carrier L 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43249 EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM 18 1 0.2 0 18 NA NA 6946 6946 Carrier L 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93656 COMPRE EP EVAL ABLTJ ATR FIB PULM VEIN ISOLATION 17 1 7.7 61.4 4 13 NA NA 6947 6947 Carrier L 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 45390 COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION 13 1 6.8 0 13 NA NA 6948 6948 Carrier L 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 95810 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist 89 0.01 17.8 47.3 4 85 NA NA 6949 6949 Carrier L 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 95811 POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND 61 24.5 48.4 3 58 NA NA 6950 6950 Carrier L 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 81479 Unlisted molecular pathology procedure 156 20.6 0 156 NA NA 6951 6951 Carrier L 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 36475 ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN 38 64.5 0 38 NA NA 6952 6952 Carrier L 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 45380 Colonoscopy, flexible; with biopsy, single or multiple 144 0.1 8.4 1 143 NA NA 6953 6953 Carrier L 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 120 0.1 9.1 1 119 NA NA 6954 6954 Carrier L 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 31267 NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS 22 0.0004 76.6 0 22 NA NA 6955 6955 Carrier L 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 30465 REPAIR NASAL VESTIBULAR STENOSIS 12 0.08 116.3 0 12 NA NA 6956 6956 Carrier L 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 31256 NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY 21 89.9 0 21 NA NA 6957 6957 Carrier L 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk 57 11.9 0 57 NA NA 6958 6958 Carrier L 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1399 DURABLE MEDICAL EQUIPMENT MISCELLANEOUS 13 0 46.7 0 13 NA NA 6959 6959 Carrier L 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1028 WC ACCSS MANL SWINGAWAY OTH CNTRL INTRFCE/PSTN 11 0.4545 40.7 108.4 2 9 NA NA 6960 6960 Carrier L 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0108 OTHER ACCESSORIES 5 0 98 0 5 NA NA 6961 6961 Carrier L 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0955 WC ACSS HEADREST CUSHNED FIX MOUNT HARDWARE EA 4 0.5 40.7 108.4 1 3 NA NA 6962 6962 Carrier L 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0956 WC ACSS LAT TRNK/HIP SUPP FIX MOUNT HARDWARE EA 4 0.5 105.7 0 4 NA NA 6963 6963 Carrier L 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0978 WHLCHAIR ACSS PSTN BELT/SFTY BELT/PELV STRAP EA 4 0.25 40.7 100.3 1 3 NA NA 6964 6964 Carrier L 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0562 HUMDIFIR HEATED USED W/POS ARWAY PRESSURE DEVICE 3 0.6667 36.3 0 3 NA NA 6965 6965 Carrier L 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0953 WHEELCHAIR AC LAT THIGH/KNEE SUPP ANY TYPE EA 3 0 97.7 0 3 NA NA 6966 6966 Carrier L 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0960 WC ACSS SHLDR HRNSS/STRAPS/CHST STRAP W/TYPE MOU 3 0.6667 40.7 105.7 1 2 NA NA 6967 6967 Carrier L 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2402 NEG PRESS WOUND THERAPY ELEC PUMP STATION/PRTBLE 3 0.6667 46 0 3 NA NA 6968 6968 Carrier L 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0040 ADJUSTABLE ANGLE FOOTPLATE EACH 3 0.6667 40.7 105.7 1 2 NA NA 6969 6969 Carrier L 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC S1040 CRANIAL REMOLDING ORTHOTIC PED RIGID CUSTOM FAB 3 1 39.5 0 3 NA NA 6970 6970 Carrier L 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S1040 CRANIAL REMOLDING ORTHOTIC PED RIGID CUSTOM FAB 3 1 39.5 0 3 NA NA 6971 6971 Carrier L 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0471 RAD BACKUP NON INV INTRFC NASAL/FACIAL MASK 2 1 33.6 0 2 NA NA 6972 6972 Carrier L 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0486 ORL DEVC/APPL RDUC UP AIRWAY COLLAPSIBILITY CSTM 2 1 15.3 0 2 NA NA 6973 6973 Carrier L 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L1852 KNEE ORTHOSIS DOUBLE UPRIGHT THIGH AND CALF 2 1 43.1 0 2 NA NA 6974 6974 Carrier L 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5301 BELOW KNEE MOLD SOCKET SHIN SACH FT ENDOSKEL SYS 2 1 69.2 0 2 NA NA 6975 6975 Carrier L 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5620 ADDITION LOWER EXTREMITY TEST SOCKET BELOW KNEE 2 1 68.9 0 2 NA NA 6976 6976 Carrier L 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5637 ADDITION LOWER EXTREMITY BELOW KNEE TOTAL CONTCT 2 1 68.9 0 2 NA NA 6977 6977 Carrier L 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5679 ADD LW EXT BK/AK CSTM MOLD/PRFAB NOT W/LOCK MECH 2 1 68.9 0 2 NA NA 6978 6978 Carrier L 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5685 ADD LOW EXT PROS BELW KNEE SUSP/SEAL SLEEVE EA 2 1 68.9 0 2 NA NA 6979 6979 Carrier L 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5910 ADD ENDOSKEL SYSTEM BELOW KNEE ALIGNABLE SYSTEM 2 1 68.9 0 2 NA NA 6980 6980 Carrier L 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8420 PROSTHETIC SOCK MULTIPLE PLY BELOW KNEE BK EACH 2 1 68.9 0 2 NA NA 6981 6981 Carrier L 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8470 PROSTHETIC SOCK SINGLE PLY FITTING BELOW KNEE EA 2 1 68.9 0 2 NA NA 6982 6982 Carrier L 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E1399 DURABLE MEDICAL EQUIPMENT MISCELLANEOUS 13 46.7 0 13 NA NA 6983 6983 Carrier L 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E1028 WC ACCSS MANL SWINGAWAY OTH CNTRL INTRFCE/PSTN 11 40.7 108.4 2 9 NA NA 6984 6984 Carrier L 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC K0108 OTHER ACCESSORIES 5 97.9 0 5 NA NA 6985 6985 Carrier L 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0953 WHEELCHAIR AC LAT THIGH/KNEE SUPP ANY TYPE EA 3 97.7 0 3 NA NA 6986 6986 Carrier L 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0978 WHLCHAIR ACSS PSTN BELT/SFTY BELT/PELV STRAP EA 4 40.7 100.3 1 3 NA NA 6987 6987 Carrier L 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0747 OSTOGNS STIM ELEC NONINVASV OTH THAN SP APPLIC 2 83.7 0 2 NA NA 6988 6988 Carrier L 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0950 WHEELCHAIR ACCESSORY TRAY EACH 2 105.6 0 2 NA NA 6989 6989 Carrier L 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0955 WC ACSS HEADREST CUSHNED FIX MOUNT HARDWARE EA 4 40.7 108.4 1 3 NA NA 6990 6990 Carrier L 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0956 WC ACSS LAT TRNK/HIP SUPP FIX MOUNT HARDWARE EA 4 105.7 0 4 NA NA 6991 6991 Carrier L 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0466 HOME VENTILATOR ANY TYPE USED W/NON-INVASV INTF 1 134 0 1 NA NA 6992 6992 Carrier L 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 External ambulatory infusion pump, insulin 11 1 1.7 4.7 1 10 NA NA 6993 6993 Carrier L 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4239 SPLY ALW NONADJUNC NONIMPL CGM 1 MO SPLY= 1 UOS 4 0.5 48.5 0 4 NA NA 6994 6994 Carrier L 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9274 External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories 1 1 0.1 0 1 NA NA 6995 6995 Carrier L 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9277 TRANSMITTER; EXT USE WITH NONDME INTRSTL CGM 1 1 20.9 0 1 NA NA 6996 6996 Carrier L 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9276 SNSR;INVSV DISP USE NONDME INTRSTL CGM 1U=1D SPL 1 1 20.9 0 1 NA NA 6997 6997 Carrier L 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2103 NONADJUNCTIVE NONIMPLANTED CGM/RECEIVER 1 0 72.3 0 1 NA NA 6998 6998 Carrier L 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 External ambulatory infusion pump, insulin 11 1 1.7 4.7 1 10 NA NA 6999 6999 Carrier L 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9274 External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories 1 1 0.1 0 1 NA NA 7000 7000 Carrier L 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9277 TRANSMITTER; EXT USE WITH NONDME INTRSTL CGM 1 1 20.9 0 1 NA NA 7001 7001 Carrier L 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9276 SNSR;INVSV DISP USE NONDME INTRSTL CGM 1U=1D SPL 1 1 20.9 0 1 NA NA 7002 7002 Carrier L 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4239 SPLY ALW NONADJUNC NONIMPL CGM 1 MO SPLY= 1 UOS 4 0.5 48.5 0 4 NA NA 7003 7003 Carrier L 2023 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC A4239 SPLY ALW NONADJUNC NONIMPL CGM 1 MO SPLY= 1 UOS 4 48.5 0 4 NA NA 7004 7004 Carrier L 2023 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E2103 NONADJUNCTIVE NONIMPLANTED CGM/RECEIVER 1 72.3 0 1 NA NA 7005 7005 Carrier L 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 46 0.5652 8 13 40 SEMAGLUTIDE OZEMPIC, RYBELSUS 7006 7006 Carrier L 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 32 0.75 0 4 29 CONTINUOUS GLUCOSE SYSTEM SENSOR FREESTYLE LIBRE 2/SENSOR/FLASH GLUCOSE MONITORING SYSTEM, DEXCOM G7 SENSOR, DEXCOM G6 SENSOR, FREESTYLE LIBRE 14 DAY/SENSOR/FLASH MONITORING SYSTEM, FREESTYLE LIBRE 3/SENSOR/GLUCOSE MONITORING SYSTEM 7007 7007 Carrier L 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 22 0.3182 0 18 21 TIRZEPATIDE MOUNJARO 7008 7008 Carrier L 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 13 0.6923 0 3 10 SACUBITRIL-VALSARTAN ENTRESTO 7009 7009 Carrier L 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 12 0.3333 1 2 10 VARENICLINE TARTRATE VARENICLINE STARTING MONTH BOX, VARENICLINE TARTRATE 7010 7010 Carrier L 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 12 0.9167 2 1 8 CYCLOSPORINE (OPHTH) RESTASIS, CEQUA, CYCLOSPORINE 7011 7011 Carrier L 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 11 0.4545 0 6 11 TESTOSTERONE TESTOSTERONE, ANDRODERM, TESTOSTERONE PUMP, TESTIM 7012 7012 Carrier L 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 11 0.7273 0 13 9 DULAGLUTIDE TRULICITY 7013 7013 Carrier L 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 11 0 0 0 11 SEMAGLUTIDE (WEIGHT MANAGEMENT) WEGOVY 7014 7014 Carrier L 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 9 1 2 8 5 ADALIMUMAB, ADALIMUMAB INJ KIT HUMIRA PEN, HUMIRA PEN-CD/UC/HS STARTER, HUMIRA 7015 7015 Carrier L 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 46 0.5652 8 13 40 SEMAGLUTIDE OZEMPIC, RYBELSUS 7016 7016 Carrier L 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 32 0.75 0 4 29 CONTINUOUS GLUCOSE SYSTEM SENSOR FREESTYLE LIBRE 2/SENSOR/FLASH GLUCOSE MONITORING SYSTEM, DEXCOM G7 SENSOR, DEXCOM G6 SENSOR, FREESTYLE LIBRE 14 DAY/SENSOR/FLASH MONITORING SYSTEM, FREESTYLE LIBRE 3/SENSOR/GLUCOSE MONITORING SYSTEM 7017 7017 Carrier L 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 12 0.9167 2 1 8 CYCLOSPORINE (OPHTH) RESTASIS, CEQUA, CYCLOSPORINE 7018 7018 Carrier L 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 9 1 2 8 5 ADALIMUMAB, ADALIMUMAB INJ KIT HUMIRA PEN, HUMIRA PEN-CD/UC/HS STARTER, HUMIRA 7019 7019 Carrier L 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 13 0.6923 0 3 10 SACUBITRIL-VALSARTAN ENTRESTO 7020 7020 Carrier L 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 11 0.7273 0 13 9 DULAGLUTIDE TRULICITY 7021 7021 Carrier L 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 22 0.3182 0 18 21 TIRZEPATIDE MOUNJARO 7022 7022 Carrier L 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 0.8571 0 3 5 MESALAMINE DELZICOL, MESALAMINE DR, MESALAMINE ER 7023 7023 Carrier L 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 0.75 1 4 4 LIRAGLUTIDE, LIRAGLUTIDE INJ VICTOZA 7024 7024 Carrier L 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 11 0.4545 0 6 11 TESTOSTERONE TESTOSTERONE, ANDRODERM, TESTOSTERONE PUMP, TESTIM 7025 7025 Carrier K 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 15740 FLAP ISLAND PEDICLE ANATOMIC NAMED AXIAL ARTERY 2 0.5 125.7 0 2 NA NA 7026 7026 Carrier K 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 15769 GRAFTING OF AUTOLOGOUS SOFT TISS BY DIRECT EXC 2 0.5 125.7 0 2 NA NA 7027 7027 Carrier K 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 21196 RCNSTJ MNDBLR RAMI&/BDY SGTL SPLT W/INT RGD FI 2 0 119.5 0 2 NA NA 7028 7028 Carrier K 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 30520 SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF 2 0 119.5 0 2 NA NA 7029 7029 Carrier K 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 30802 ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL 2 0 119.5 0 2 NA NA 7030 7030 Carrier K 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 61580 CRANIOFACIAL ANT CRANIAL FOSSA W/O ORBITAL EXNTJ 2 0.5 125.7 0 2 NA NA 7031 7031 Carrier K 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 61608 RESCJ/EXC LES PARASELLAR SINUS CLIVUS/MSB IDRL 2 0.5 125.7 0 2 NA NA 7032 7032 Carrier K 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 62272 THERAPEUTIC SPINAL PUNCTURE DRAINAGE CSF 2 0.5 125.7 0 2 NA NA 7033 7033 Carrier K 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64999 UNLISTED PROCEDURE NERVOUS SYSTEM 2 0 125.7 0 2 NA NA 7034 7034 Carrier K 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96416 CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP 2 1 23.5 2 0 NA NA 7035 7035 Carrier K 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT J9000 INJECTION DOXORUBICIN HCL 10 MG 2 1 23.5 2 0 NA NA 7036 7036 Carrier K 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT J9208 INJECTION IFOSFAMIDE 1 G 2 1 23.5 2 0 NA NA 7037 7037 Carrier K 2023 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT J9209 INJECTION MESNA 200 MG 2 1 23.5 2 0 NA NA 7038 7038 Carrier K 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96416 CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP 2 1 23.5 2 0 NA NA 7039 7039 Carrier K 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J9000 INJECTION DOXORUBICIN HCL 10 MG 2 1 23.5 2 0 NA NA 7040 7040 Carrier K 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J9208 INJECTION IFOSFAMIDE 1 G 2 1 23.5 2 0 NA NA 7041 7041 Carrier K 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J9209 INJECTION MESNA 200 MG 2 1 23.5 2 0 NA NA 7042 7042 Carrier K 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15860 Intravenous injection of agent (eg, fluorescein) to test vascular flow in flap or graft� 1 1 18 0 1 NA NA 7043 7043 Carrier K 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19364 Breast reconstruction; with free flap 1 1 18 0 1 NA NA 7044 7044 Carrier K 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33361 REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH 1 1 17.5 1 0 NA NA 7045 7045 Carrier K 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33427 VLVP MITRAL VALVE W/BYPASS RAD RCNSTJ W/WO RING 1 1 138.9 0 1 NA NA 7046 7046 Carrier K 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33477 TCAT PULMONARY VALVE IMPLANTATION PRQ APPROACH 1 1 94.6 0 1 NA NA 7047 7047 Carrier K 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58720 SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX 1 1 73.6 0 1 NA NA 7048 7048 Carrier K 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95714 Electroencephalogram with video (VEEG), review of data, technical description by EEG technologist, each increment of 12-26 hours; unmonitored� 1 1 215.6 0 1 NA NA 7049 7049 Carrier K 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95720 Electroencephalogram (EEG), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, each increment of greater than 12 hours, up to 26 hours of EEG recording, interpretation and report after each 24-hour period; with video (VEEG) 1 1 215.6 0 1 NA NA 7050 7050 Carrier K 2023 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99221 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. 1 1 215.6 0 1 NA NA 7051 7051 Carrier K 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21196 RCNSTJ MNDBLR RAMI&/BDY SGTL SPLT W/INT RGD FI 2 119.5 0 2 NA NA 7052 7052 Carrier K 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 30520 SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF 2 0.5 119.5 0 2 NA NA 7053 7053 Carrier K 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 30802 ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL 2 119.5 0 2 NA NA 7054 7054 Carrier K 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64999 UNLISTED PROCEDURE NERVOUS SYSTEM 2 125.7 0 2 NA NA 7055 7055 Carrier K 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21121 GENIOPLASTY SLIDING OSTEOTOMY SINGLE PIECE 1 141.6 0 1 NA NA 7056 7056 Carrier K 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21146 RCNSTJ MIDFACE LEFORT I 2 PIECES W/BONE GRAFTS 1 97.3 0 1 NA NA 7057 7057 Carrier K 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21147 RCNSTJ MIDFACE LEFORT I 3/> PIECE W/BONE GRAFTS 1 141.6 0 1 NA NA 7058 7058 Carrier K 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 38724 CERVICAL LYMPHADEC MODIFIED RADICAL NECK DSJ 1 47.3 1 0 NA NA 7059 7059 Carrier K 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 15740 FLAP ISLAND PEDICLE ANATOMIC NAMED AXIAL ARTERY 2 125.7 0 2 NA NA 7060 7060 Carrier K 2023 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 15769 GRAFTING OF AUTOLOGOUS SOFT TISS BY DIRECT EXC 2 125.7 0 2 NA NA 7061 7061 Carrier K 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 81479 Unlisted molecular pathology procedure 51 0.8039 20.5 0 51 NA NA 7062 7062 Carrier K 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 Colonoscopy, flexible; with biopsy, single or multiple 46 0.9348 27.5 6.3 1 45 NA NA 7063 7063 Carrier K 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 42 0.9286 6.9 0 42 NA NA 7064 7064 Carrier K 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 40 0.925 8.7 0 40 NA NA 7065 7065 Carrier K 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95810 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist 32 0.8438 0.1 20.7 1 31 NA NA 7066 7066 Carrier K 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 81420 Fetal chromosomal aneuploidy (eg, trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18, and 21 25 0.96 33.6 0 25 NA NA 7067 7067 Carrier K 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk 19 0.8421 14.1 0 19 NA NA 7068 7068 Carrier K 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64493 NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL 18 1 16.6 0 18 NA NA 7069 7069 Carrier K 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45384 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps 17 0.9412 3.5 0 17 NA NA 7070 7070 Carrier K 2023 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64483 NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL 16 1 83 0 16 NA NA 7071 7071 Carrier K 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64493 NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL 18 1 16.6 0 18 NA NA 7072 7072 Carrier K 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64483 NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL 16 1 83 0 16 NA NA 7073 7073 Carrier K 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 11 1 0.1 0 11 NA NA 7074 7074 Carrier K 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple 9 1 0.1 0 9 NA NA 7075 7075 Carrier K 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 52000 CYSTOURETHROSCOPY 9 1 25.4 0 9 NA NA 7076 7076 Carrier K 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58558 HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C 9 1 4.8 0 9 NA NA 7077 7077 Carrier K 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 38525 BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE 6 1 11.2 10.4 2 4 NA NA 7078 7078 Carrier K 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 52332 Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type) 6 1 0.2 0 6 NA NA 7079 7079 Carrier K 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 52356 CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT 6 1 0.1 0.1 1 5 NA NA 7080 7080 Carrier K 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58563 HYSTEROSCOPY ENDOMETRIAL ABLATION 6 1 11.8 0 6 NA NA 7081 7081 Carrier K 2023 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64484 NJX AA&/STRD TFRML EPI LUMBAR/SACRAL EA ADDL 6 1 40.9 0 6 NA NA 7082 7082 Carrier K 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 81479 Unlisted molecular pathology procedure 51 20.5 0 51 NA NA 7083 7083 Carrier K 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 95810 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist 32 0.03 0.1 20.7 1 31 NA NA 7084 7084 Carrier K 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 31276 NASAL/SINUS NDSC W/RMVL TISS FROM FRONTAL SINUS 4 132.2 0 4 NA NA 7085 7085 Carrier K 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 31257 NASAL/SINUS NDSC TOTAL WITH SPHENOIDOTOMY 6 131 0 6 NA NA 7086 7086 Carrier K 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 31256 NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY 7 112.3 0 7 NA NA 7087 7087 Carrier K 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 0340U ONC PAN CANCER ANALYSIS MRD FROM PLASMA 3 95.4 0 3 NA NA 7088 7088 Carrier K 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 30117 EXCISION/DESTRUCTION INTRANASAL LESION INT APPR 3 0.33 130.2 0 3 NA NA 7089 7089 Carrier K 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 14060 ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/< 5 101.6 0 5 NA NA 7090 7090 Carrier K 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21085 IMPRESSION & PREPARATION ORAL SURGICAL SPLINT 5 110.1 0 5 NA NA 7091 7091 Carrier K 2023 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 30465 REPAIR NASAL VESTIBULAR STENOSIS 6 99.3 0 6 NA NA 7092 7092 Carrier K 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 99499 Chiropractic Care 42 0.996 42 NA NA 7093 7093 Carrier K 2023 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 99499 Therapy Care 222 0.996 222 NA NA 7094 7094 Carrier K 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99499 Chiropractic Care 42 0.996 42 NA NA 7095 7095 Carrier K 2023 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99499 Therapy Care 222 0.996 222 NA NA 7096 7096 Carrier K 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC S1040 CRANIAL REMOLDING ORTHOTIC PED RIGID CUSTOM FAB 4 1 34.1 0 4 NA NA 7097 7097 Carrier K 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0766 Electrical stimulation device used for cancer treatment, includes all accessories, any type 3 1 48.3 0 3 NA NA 7098 7098 Carrier K 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0471 RAD BACKUP NON INV INTRFC NASAL/FACIAL MASK 2 0.5 1.7 95.7 1 1 NA NA 7099 7099 Carrier K 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0760 OSTOGNS STIM LOW INTENS ULTRASOUND NON-INVASV 2 1 10.8 0 2 NA NA 7100 7100 Carrier K 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0978 WHLCHAIR ACSS PSTN BELT/SFTY BELT/PELV STRAP EA 2 0.5 62.6 1 1 NA NA 7101 7101 Carrier K 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2402 NEG PRESS WOUND THERAPY ELEC PUMP STATION/PRTBLE 2 1 47 0 2 NA NA 7102 7102 Carrier K 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L1833 KNEE ORTHOSIS ADJUSTABLE JOINT RIGD SUPP PREFAB 2 0 104.5 0 2 NA NA 7103 7103 Carrier K 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC B4149 Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit 1 0 134.1 0 1 NA NA 7104 7104 Carrier K 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC B9998 NOC FOR ENTERAL SUPPLIES 1 0 134.1 0 1 NA NA 7105 7105 Carrier K 2023 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0748 OSTOGNS STIMULATOR ELEC NONINVASV SPINAL APPLIC 1 1 92.4 0 1 NA NA 7106 7106 Carrier K 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S1040 CRANIAL REMOLDING ORTHOTIC PED RIGID CUSTOM FAB 4 1 34.1 0 4 NA NA 7107 7107 Carrier K 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0766 Electrical stimulation device used for cancer treatment, includes all accessories, any type 3 1 48.3 0 3 NA NA 7108 7108 Carrier K 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0760 OSTOGNS STIM LOW INTENS ULTRASOUND NON-INVASV 2 1 10.8 0 2 NA NA 7109 7109 Carrier K 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2402 NEG PRESS WOUND THERAPY ELEC PUMP STATION/PRTBLE 2 1 47 0 2 NA NA 7110 7110 Carrier K 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0748 OSTOGNS STIMULATOR ELEC NONINVASV SPINAL APPLIC 1 1 92.4 0 1 NA NA 7111 7111 Carrier K 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2510 SPCH GEN DEVC SYNTHESIZD MX METH MESS&DEVC ACCSS 1 1 28.7 0 1 NA NA 7112 7112 Carrier K 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0108 OTHER ACCESSORIES 1 1 96.6 0 1 NA NA 7113 7113 Carrier K 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0739 REPR/SRVC DME NOT O2 RQR TECH CMPNT PER 15 MINS 1 1 96.6 0 1 NA NA 7114 7114 Carrier K 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L0457 TLSO FLX SC JUNC TERM INF TO SCAP SPINE PREFAB 1 1 38.9 0 1 NA NA 7115 7115 Carrier K 2023 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L1843 KNEE ORTHOSIS SINGLE UPRIGHT THIGH & CALF PREFAB 1 1 89.9 0 1 NA NA 7116 7116 Carrier K 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L1833 KNEE ORTHOSIS ADJUSTABLE JOINT RIGD SUPP PREFAB 2 104.5 0 2 NA NA 7117 7117 Carrier K 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0471 RAD BACKUP NON INV INTRFC NASAL/FACIAL MASK 2 1.7 95.7 1 1 NA NA 7118 7118 Carrier K 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0978 WHLCHAIR ACSS PSTN BELT/SFTY BELT/PELV STRAP EA 2 62.6 0 2 NA NA 7119 7119 Carrier K 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC B4149 Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit 1 134.1 0 1 NA NA 7120 7120 Carrier K 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC B9998 NOC FOR ENTERAL SUPPLIES 1 134.1 0 1 NA NA 7121 7121 Carrier K 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E1399 DURABLE MEDICAL EQUIPMENT MISCELLANEOUS 1 72.2 0 1 NA NA 7122 7122 Carrier K 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L1845 KNEE ORTHOSIS DOUBLE UPRIGHT THIGH & CALF PREFAB 1 150.4 0 1 NA NA 7123 7123 Carrier K 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L1960 AFO POSTERIOR SOLID ANK PLASTIC CUSTOM FAB 1 1 160.6 0 1 NA NA 7124 7124 Carrier K 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L2330 ADD LOW EXT LACER MOLD PT MDL CSTM ORTHOSIS ONLY 1 160.6 0 1 NA NA 7125 7125 Carrier K 2023 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L2350 ADD LOW EXTREM PROSTHETIC TYPE SOCKT MOLD PT MDL 1 160.6 0 1 NA NA 7126 7126 Carrier K 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 External ambulatory infusion pump, insulin 2 1 14.1 0 2 NA NA 7127 7127 Carrier K 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9276 SNSR;INVSV DISP USE NONDME INTRSTL CGM 1U=1D SPL 1 0 96.7 0 1 NA NA 7128 7128 Carrier K 2023 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9274 External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories 1 1 0.2 0 1 NA NA 7129 7129 Carrier K 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 External ambulatory infusion pump, insulin 2 1 14.1 0 2 NA NA 7130 7130 Carrier K 2023 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9274 External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories 1 1 0.2 0 1 NA NA 7131 7131 Carrier K 2023 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC A9276 SNSR;INVSV DISP USE NONDME INTRSTL CGM 1U=1D SPL 1 96.7 0 1 NA NA 7132 7132 Carrier K 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 75 0.3867 6 8 67 SEMAGLUTIDE OZEMPIC, RYBELSUS 7133 7133 Carrier K 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 36 0 0 3 36 SEMAGLUTIDE (WEIGHT MANAGEMENT) WEGOVY 7134 7134 Carrier K 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 29 0.7241 0 16 18 LISDEXAMFETAMINE DIMESYLATE VYVANSE, LISDEXAMFETAMINE DIMESYLATE 7135 7135 Carrier K 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 24 0.625 3 12 20 CONTINUOUS GLUCOSE SYSTEM SENSOR FREESTYLE LIBRE 2/SENSOR/FLASH GLUCOSE MONITORING SYSTEM, DEXCOM G7 SENSOR, DEXCOM G6 SENSOR, FREESTYLE LIBRE 14 DAY/SENSOR/FLASH MONITORING SYSTEM, FREESTYLE LIBRE 3/SENSOR/GLUCOSE MONITORING SYSTEM 7136 7136 Carrier K 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 20 0.15 27 8 19 TIRZEPATIDE MOUNJARO 7137 7137 Carrier K 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 19 0.5263 1 4 16 DULAGLUTIDE TRULICITY 7138 7138 Carrier K 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 17 0.7647 1 11 11 ADALIMUMAB INJ KIT, ADALIMUMAB HUMIRA PEN, HUMIRA PEN-PS/UV STARTER, HUMIRA 7139 7139 Carrier K 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 16 0.1875 1 15 15 VARENICLINE TARTRATE VARENICLINE STARTING MONTH BOX, VARENICLINE TARTRATE, CHANTIX STARTING MONTH PAK 7140 7140 Carrier K 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 13 0.4615 5 8 8 AMPHETAMINE-DEXTROAMPHETAMINE MYDAYIS, ADDERALL, AMPHETAMINE/DEXTROAMPHETAMINE 7141 7141 Carrier K 2023 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 11 0 0 2 11 LIRAGLUTIDE (WEIGHT MANAGEMENT) SAXENDA 7142 7142 Carrier K 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 75 0.3867 6 8 67 SEMAGLUTIDE OZEMPIC, RYBELSUS 7143 7143 Carrier K 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 29 0.7241 0 16 18 LISDEXAMFETAMINE DIMESYLATE VYVANSE, LISDEXAMFETAMINE DIMESYLATE 7144 7144 Carrier K 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 24 0.625 3 12 20 CONTINUOUS GLUCOSE SYSTEM SENSOR FREESTYLE LIBRE 2/SENSOR/FLASH GLUCOSE MONITORING SYSTEM, DEXCOM G7 SENSOR, DEXCOM G6 SENSOR, FREESTYLE LIBRE 14 DAY/SENSOR/FLASH MONITORING SYSTEM, FREESTYLE LIBRE 3/SENSOR/GLUCOSE MONITORING SYSTEM 7145 7145 Carrier K 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 17 0.7647 1 11 11 ADALIMUMAB, ADALIMUMAB INJ KIT HUMIRA PEN, HUMIRA PEN-PS/UV STARTER, HUMIRA 7146 7146 Carrier K 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 19 0.5263 1 4 16 DULAGLUTIDE TRULICITY 7147 7147 Carrier K 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 13 0.4615 5 8 8 AMPHETAMINE-DEXTROAMPHETAMINE MYDAYIS, ADDERALL, AMPHETAMINE/DEXTROAMPHETAMINE 7148 7148 Carrier K 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 0.8571 0 23 3 INSULIN INFUSION DISPOSABLE PUMP OMNIPOD DASH PODS (GEN 4), OMNIPOD 5 G6 INTRO KIT (GEN 5), OMNIPOD 5 G6 PODS (GEN 5) 7149 7149 Carrier K 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 5 1 1 7 3 MORPHINE SULFATE MORPHINE SULFATE ER 7150 7150 Carrier K 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 10 0.5 1 13 6 TESTOSTERONE TESTOSTERONE, TESTOSTERONE PUMP, TESTIM 7151 7151 Carrier K 2023 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 6 0.8333 0 7 6 LINACLOTIDE LINZESS 7152 7152 Carrier M 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20930 ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED 16 0.5 26.76278 100.4024 1 15 NA NA 7153 7153 Carrier M 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 INSJ BIOMCHN DEV INTERVERTEBRAL DSC SPC W/ARTHRD 15 0.3333 26.76278 107.1667 1 14 NA NA 7154 7154 Carrier M 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20936 AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION 13 0.7692 7.578055 113.4715 1 12 NA NA 7155 7155 Carrier M 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 ARTHRODESIS ANTERIOR INTERBODY LUMBAR 12 0.1667 26.76278 86.34995 1 11 NA NA 7156 7156 Carrier M 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22612 ARTHRD PST TQ 1NTRSPC LUMBAR 12 0.3333 26.76278 79.453 1 11 NA NA 7157 7157 Carrier M 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44204 LAPAROSCOPY COLECTOMY PARTIAL W/ANASTOMOSIS 11 1 10.25722 6.650667 1 10 NA NA 7158 7158 Carrier M 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22614 ARTHRD PST TQ 1NTRSPC EA ADD 11 0.3636 17.17778 100.8584 2 9 NA NA 7159 7159 Carrier M 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 61781 STRTCTC CPTR ASSTD PX CRANIAL INTRADURAL 11 1 0.355 25.17664 1 10 NA NA 7160 7160 Carrier M 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY 10 1 1.0975 4.566266 1 9 NA NA 7161 7161 Carrier M 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 69990 MICROSURG TQS REQ USE OPERATING MICROSCOPE 10 0.9 33.07558 0 10 NA NA 7162 7162 Carrier M 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44204 LAPAROSCOPY COLECTOMY PARTIAL W/ANASTOMOSIS 11 1 10.25722 6.650667 1 10 NA NA 7163 7163 Carrier M 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 61781 STRTCTC CPTR ASSTD PX CRANIAL INTRADURAL 11 1 0.355 25.17664 1 10 NA NA 7164 7164 Carrier M 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58150 TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY 10 1 1.0975 4.566266 1 9 NA NA 7165 7165 Carrier M 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44207 LAPS COLECTOMY PRTL W/COLOPXTSTMY LW ANAST 10 1 1.01 8.053858 1 9 NA NA 7166 7166 Carrier M 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95720 Electroencephalogram (EEG), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, each increment of greater than 12 hours, up to 26 hours of EEG recording, interpretation and report after each 24-hour period with video 10 1 13.22289 0 10 NA NA 7167 7167 Carrier M 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 61510 CRANIEC TREPHINE BONE FLP BRAIN TUMOR SUPRTENTOR 8 1 0.5844445 5.328849 1 7 NA NA 7168 7168 Carrier M 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43775 LAP SLEEVE GASTRECTOMY 8 1 57.6466 0 8 NA NA 7169 7169 Carrier M 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 50543 LAPAROSCOPY SURG PARTIAL NEPHRECTOMY 6 1 5.86463 0 6 NA NA 7170 7170 Carrier M 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96416 CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP 6 1 12.29333 39.62324 3 3 NA NA 7171 7171 Carrier M 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 61624 TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS 4 1 23.385 45.48653 2 2 NA NA 7172 7172 Carrier M 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 20939 BONE MARROW ASPIRATION BONE GRFG SPI SURG ONLY 4 0 26.76278 27.54981 1 3 NA NA 7173 7173 Carrier M 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63047 LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT LUMBAR 3 0.3333 26.76278 97.88 1 2 NA NA 7174 7174 Carrier M 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 20937 AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION 3 0 127.3089 0 3 NA NA 7175 7175 Carrier M 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 63053 LAM FACTC/FRMT ARTHRD LUM EA 2 0.5 93.22874 0 2 NA NA 7176 7176 Carrier M 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 53410 URETHROPLASTY 1 STG RECNST MALE ANTERIOR URETHRA 2 0.5 101.5028 0 2 NA NA 7177 7177 Carrier M 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27280 ARTHR SI JT OPN B1GRF INSTRM 2 0 23.48486 0 2 NA NA 7178 7178 Carrier M 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 23472 ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER 1 0 43.0525 0 1 NA NA 7179 7179 Carrier M 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22533 ARTHRODESIS LATERAL EXTRACAVITARY LUMBAR 1 1 51.40167 0 1 NA NA 7180 7180 Carrier M 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT S2900 ROBOTIC SURGICAL SYSTEM 1 0 75.52306 0 1 NA NA 7181 7181 Carrier M 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21497 INTERDENTAL WIRING OTHER THAN FRACTURE 1 0 168.3928 0 1 NA NA 7182 7182 Carrier M 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material 953 0.82 3 35 0 28 925 0 NA NA 7183 7183 Carrier M 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74177 Computed tomography, abdomen and pelvis; with contrast material(s) 803 0.86 5 46 0 74 729 0 NA NA 7184 7184 Carrier M 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences 704 0.89 0 28 0 17 687 0 NA NA 7185 7185 Carrier M 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72148 Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material 704 0.65 3 63 0 15 689 0 NA NA 7186 7186 Carrier M 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 71260 Computed tomography, thorax, diagnostic; with contrast material(s) 459 0.84 13 47 0 24 435 0 NA NA 7187 7187 Carrier M 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73221 Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s) 452 0.67 7 61 0 17 435 0 NA NA 7188 7188 Carrier M 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72141 Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material 419 0.6 73 94 0 14 405 0 NA NA 7189 7189 Carrier M 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70486 Computed tomography, maxillofacial area; without contrast material 389 0.85 20 30 0 5 384 0 NA NA 7190 7190 Carrier M 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 77049 Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; bilateral 365 0.76 10 66 0 7 358 0 NA NA 7191 7191 Carrier M 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 71250 Computed tomography, thorax, diagnostic; without contrast material 345 0.76 13 67 0 7 338 0 NA NA 7192 7192 Carrier M 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43239 UPPER NDSC BIOPSY SINGLE/MULTIPLE 172 1 31.55444 0 172 NA NA 7193 7193 Carrier M 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43235 UPPER GI NDSC DX W/WO COLLECTION SPECIMEN 162 1 6.066759 0 162 NA NA 7194 7194 Carrier M 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43251 UPR GI NDSC RMVL TUM POLYP/OTH LES SNARE TQ 30 1 8.463657 0 30 NA NA 7195 7195 Carrier M 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99417 PROLNG OP E/M EACH 15 MIN 30 1 18.04383 0 30 NA NA 7196 7196 Carrier M 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43248 UPR GI NDSC INSJ GUIDE WIRE DILAT ESOPHAGUS 29 1 7.726743 0 29 NA NA 7197 7197 Carrier M 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 52356 CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT 28 1 28.08507 0 28 NA NA 7198 7198 Carrier M 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43249 UPR GI NDSC BALLOON DILAT ESOPH <30 MM DIAM 28 1 12.11938 0 28 NA NA 7199 7199 Carrier M 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 69436 TYMPANOSTOMY GENERAL ANESTHESIA 26 1 12.2081 0 26 NA NA 7200 7200 Carrier M 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 37765 STAB PHLEBT VARICOSE VEINS 1 XTR 10-20 STAB INCS 24 1 17.09997 0 24 NA NA 7201 7201 Carrier M 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58322 ARTIFICIAL INSEMINATION INTRA-UTERINE 24 1 35.0264 0 24 NA NA 7202 7202 Carrier M 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 37227 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed 1 1 2 0 1 0 0 NA NA 7203 7203 Carrier M 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64495 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure) 2 0.5 5 0 0 1 0 NA NA 7204 7204 Carrier M 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 78814 Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; limited area (eg, chest, head/neck) 2 0.5 78 0 0 1 0 NA NA 7205 7205 Carrier M 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 77021 Magnetic resonance imaging guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation 2 0.5 141 0 0 1 0 NA NA 7206 7206 Carrier M 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 75635 Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s), including noncontrast images, if performed, and image postprocessing 3 0.33 79 0 0 1 0 NA NA 7207 7207 Carrier M 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 73719 Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) 3 0.33 49 0 0 1 0 NA NA 7208 7208 Carrier M 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 73225 Magnetic resonance angiography, upper extremity, with or without contrast material(s) 3 0.33 1087 0 0 1 0 NA NA 7209 7209 Carrier M 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 70481 Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) 4 0.25 1 0 0 1 0 NA NA 7210 7210 Carrier M 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 93454 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation 4 0.25 90 0 0 1 0 NA NA 7211 7211 Carrier M 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 89346 STORAGE PER YEAR OOCYTE 9 0.1111 74.2925 63.65142 1 8 NA NA 7212 7212 Carrier M 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year NA NA Chemical Dependency Residential Treatment Facility 22 1 22.508 10.25067 10 12 NA NA 7213 7213 Carrier M 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year NA NA Mental Health Inpatient 15 1 1.560833 2.576795 2 13 NA NA 7214 7214 Carrier M 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year NA NA Mental Health Residential Treatment Facility 4 0.5 60.47426 13.51194 3 1 NA NA 7215 7215 Carrier M 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year NA NA Detoxification 3 1 0.1572222 0 3 NA NA 7216 7216 Carrier M 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA Chemical Dependency Residential Treatment Facility 22 1 22.508 10.25067 10 12 NA NA 7217 7217 Carrier M 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA Mental Health Inpatient 15 1 1.560833 2.576795 2 13 NA NA 7218 7218 Carrier M 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA Detoxification 4 0.5 60.47426 13.51194 3 1 NA NA 7219 7219 Carrier M 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA Mental Health Residential Treatment Facility 3 1 0.1572222 0 3 NA NA 7220 7220 Carrier M 2024 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NA NA Mental Health Residential Treatment Facility 4 0.5 60.47426 13.51194 3 1 NA NA 7221 7221 Carrier M 2024 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NA NA Chemical Dependency Residential Treatment Facility 22 1 22.508 10.25067 10 12 NA NA 7222 7222 Carrier M 2024 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NA NA Mental Health Inpatient 15 1 1.560833 2.576795 2 13 NA NA 7223 7223 Carrier M 2024 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NA NA Detoxification 3 1 0.1572222 0 3 NA NA 7224 7224 Carrier M 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT H0035 MH PARTIAL HOSP TX UNDER 24H 89 0.9888 0.4312037 16.10623 3 86 NA NA 7225 7225 Carrier M 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN 65 0.9846 61.60067 0 65 NA NA 7226 7226 Carrier M 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY PATIENT &/ FAMILY 60 MINUTES 60 0.9833 43.69807 0 60 NA NA 7227 7227 Carrier M 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 THERAP REPETITIVE TMS TX SUBSEQ DELIVERY & MNG 54 0.4074 59.56004 0 54 NA NA 7228 7228 Carrier M 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97155 ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN 48 0.9167 82.30007 0 48 NA NA 7229 7229 Carrier M 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 REPET TMS TX SUBSEQ MOTR THRESHLD W/DELIV & MN 48 0.4167 91.12401 0 48 NA NA 7230 7230 Carrier M 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL&M 48 0.4375 58.95856 0 48 NA NA 7231 7231 Carrier M 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97156 FAMILY ADAPT BHV TX GDN PHYS/QHP EA 15 MIN 46 0.9783 80.21806 0 46 NA NA 7232 7232 Carrier M 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97153 ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN 44 0.9091 79.24001 0 44 NA NA 7233 7233 Carrier M 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT H2036 A/D TX PROGRAM, PER DIEM 41 1 0.3673055 10.12899 10 31 NA NA 7234 7234 Carrier M 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT H2036 A/D TX PROGRAM, PER DIEM 41 1 0.3673055 10.12899 10 31 NA NA 7235 7235 Carrier M 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90834 PSYCHOTHERAPY PATIENT &/ FAMILY 45 MINUTES 20 1 23.74197 0 20 NA NA 7236 7236 Carrier M 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION 16 1 36.42144 0 16 NA NA 7237 7237 Carrier M 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99214 OFFICE O/P EST MOD 30 MIN 10 1 38.19147 0 10 NA NA 7238 7238 Carrier M 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99215 OFFICE O/P EST HI 40 MIN 7 1 46.94278 0 7 NA NA 7239 7239 Carrier M 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90833 PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN 6 1 46.65949 0 6 NA NA 7240 7240 Carrier M 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99205 OFFICE O/P NEW HI 60 MIN 5 1 46.56316 0 5 NA NA 7241 7241 Carrier M 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96136 PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN 4 1 27.83681 0 4 NA NA 7242 7242 Carrier M 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96137 PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN 4 1 27.85792 0 4 NA NA 7243 7243 Carrier M 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96133 NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR 3 1 36.81065 0 3 NA NA 7244 7244 Carrier M 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97154 GROUP ADAPTIVE BHV TX BY PROTOCOL TECH EA 15 MIN 8 0.875 135.4883 0 8 NA NA 7245 7245 Carrier M 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97152 BEHAVIOR ID SUPPORT ASSMT BY 1 TECH EA 15 MIN 8 0.875 104.1307 0 8 NA NA 7246 7246 Carrier M 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97158 GRP ADAPT BHV PRTCL MODIFCAJ PHYS/QHP EA 15 MIN 6 0.8333 184.8687 0 6 NA NA 7247 7247 Carrier M 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90847 FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 6 0.8333 60.98616 0 6 NA NA 7248 7248 Carrier M 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97157 MULTIPLE FAM GROUP BHV TX GDN PHYS/QHP EA 15 MIN 5 0.8 161.0866 0 5 NA NA 7249 7249 Carrier M 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90867 REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL&M 48 0.4375 58.95856 0 48 NA NA 7250 7250 Carrier M 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90869 REPET TMS TX SUBSEQ MOTR THRESHLD W/DELIV & MN 48 0.4167 91.12401 0 48 NA NA 7251 7251 Carrier M 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90868 THERAP REPETITIVE TMS TX SUBSEQ DELIVERY & MNG 54 0.4074 59.56004 0 54 NA NA 7252 7252 Carrier M 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 0373T ADAPT BHV TX PRTCL MODIFICAJ EA 15 MIN TECH TIME 1 0 185.9483 0 1 NA NA 7253 7253 Carrier M 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 0362T BEHAVIOR ID SUPPORT ASSMT EA 15 MIN TECH TIME 1 0 185.9483 0 1 NA NA 7254 7254 Carrier M 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT V2623 PLASTIC EYE PROSTH CUSTOM 1 1 119.0292 0 1 NA NA 7255 7255 Carrier M 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0766 Elec stim cancer treatment 1 1 70.73473 0 1 NA NA 7256 7256 Carrier M 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E2365 U1 SEALED LEADACID BATTERY 1 1 9.833333 0 1 NA NA 7257 7257 Carrier M 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT K0831 PWC GP2 STD SEAT ELEVATE CAP 1 1 9.833333 0 1 NA NA 7258 7258 Carrier M 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0955 CUSHIONED HEADREST 1 1 16.56583 0 1 NA NA 7259 7259 Carrier M 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E1007 PWR SEAT COMBO W/SHEAR 1 1 20.69833 0 1 NA NA 7260 7260 Carrier M 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E2300 PWR SEAT ELEVATION SYS 1 1 16.54333 0 1 NA NA 7261 7261 Carrier M 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0973 W/CH ACCESS DET ADJ ARMREST 1 1 9.833333 0 1 NA NA 7262 7262 Carrier M 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT V2628 FABRICATION & FITTING 1 1 119.0442 0 1 NA NA 7263 7263 Carrier M 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E1028 W/C MANUAL SWINGAWAY 1 1 9.833333 0 1 NA NA 7264 7264 Carrier M 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT V2623 PLASTIC EYE PROSTH CUSTOM 1 1 119.0292 0 1 NA NA 7265 7265 Carrier M 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0766 Elec stim cancer treatment 1 1 70.73473 0 1 NA NA 7266 7266 Carrier M 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E2365 U1 SEALED LEADACID BATTERY 1 1 9.833333 0 1 NA NA 7267 7267 Carrier M 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT K0831 PWC GP2 STD SEAT ELEVATE CAP 1 1 9.833333 0 1 NA NA 7268 7268 Carrier M 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0955 CUSHIONED HEADREST 1 1 16.56583 0 1 NA NA 7269 7269 Carrier M 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E1007 PWR SEAT COMBO W/SHEAR 1 1 20.69833 0 1 NA NA 7270 7270 Carrier M 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E2300 PWR SEAT ELEVATION SYS 1 1 16.54333 0 1 NA NA 7271 7271 Carrier M 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0973 W/CH ACCESS DET ADJ ARMREST 1 1 9.833333 0 1 NA NA 7272 7272 Carrier M 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT V2628 FABRICATION & FITTING 1 1 119.0442 0 1 NA NA 7273 7273 Carrier M 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E1028 W/C MANUAL SWINGAWAY 1 1 9.833333 0 1 NA NA 7274 7274 Carrier M 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT V2623 PLASTIC EYE PROSTH CUSTOM 1 1 119.0292 0 1 NA NA 7275 7275 Carrier M 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0766 Elec stim cancer treatment 1 1 70.73473 0 1 NA NA 7276 7276 Carrier M 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E2365 U1 SEALED LEADACID BATTERY 1 1 9.833333 0 1 NA NA 7277 7277 Carrier M 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT K0831 PWC GP2 STD SEAT ELEVATE CAP 1 1 9.833333 0 1 NA NA 7278 7278 Carrier M 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0955 CUSHIONED HEADREST 1 1 16.56583 0 1 NA NA 7279 7279 Carrier M 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E1007 PWR SEAT COMBO W/SHEAR 1 1 20.69833 0 1 NA NA 7280 7280 Carrier M 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E2300 PWR SEAT ELEVATION SYS 1 1 16.54333 0 1 NA NA 7281 7281 Carrier M 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0973 W/CH ACCESS DET ADJ ARMREST 1 1 9.833333 0 1 NA NA 7282 7282 Carrier M 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT V2628 FABRICATION & FITTING 1 1 119.0442 0 1 NA NA 7283 7283 Carrier M 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E1028 W/C MANUAL SWINGAWAY 1 1 9.833333 0 1 NA NA 7284 7284 Carrier M 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 665 0.5985 5.52 4.81 0 126 539 0 Ozempic (0.25 or 0.5 MG/DOSE) 2MG/3ML SC SOPN OZEMPIC 7285 7285 Carrier M 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 625 0.3536 10.25 4.7 0 89 536 0 Wegovy (semaglutide injection) WEGOVY 7286 7286 Carrier M 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 493 0.3306 8.4 2.33 0 60 433 0 Zepbound Injection (tirzepatide) ZEPBOUND 7287 7287 Carrier M 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 417 0.5635 7.2 3.2 0 80 337 0 Mounjaro (tirzepatide) MOUNJARO 7288 7288 Carrier M 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 336 0.75 0.8 3.91 0 60 276 0 Testosterone Cypionate 200MG/ML IM SOLN TESTOSTERONE 7289 7289 Carrier M 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 236 0.8898 2.76 0 36 200 0 Omeprazole 20MG OR CPDR OMEPRAZOLE 7290 7290 Carrier M 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 219 0.7489 5.64 0 19 200 0 Tacrolimus 0.1% Ointment TACROLIMUS 7291 7291 Carrier M 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 214 0.7897 12.75 19.91 0 32 182 0 Dupixent Syn 300 DUPIXENT 7292 7292 Carrier M 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 189 0.8942 0.52 4.2 0 46 143 0 Jardiance 25MG OR TABS JARDIANCE 7293 7293 Carrier M 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 172 0.7035 9.41 8.13 0 51 121 0 Amphetamine-Dextroamphetamine 30mg AMPHETAMINE-DEXTROAMPHETAMINE 7294 7294 Carrier M 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 13 1 6 0 8 5 0 Buprenorphine 7.5MCG/HR TD PTWK BUPRENORPHINE 7295 7295 Carrier M 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 11 1 0 4 7 0 Synjardy XR 25-1000MG OR TB24 SYNJARDY 7296 7296 Carrier M 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 10 1 24 0 8 2 0 Spravato SPRAVATO 7297 7297 Carrier M 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 10 1 0 2 8 0 Kesimpta KESIMPTA 7298 7298 Carrier M 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 10 1 0 5 5 0 Acetaminophen-Codeine 300-30MG OR TABS ACETAMINOPHEN-CODEINE 7299 7299 Carrier M 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 10 1 0 10 0 Tazarotene 0.1% EX CREA TAZAROTENE 7300 7300 Carrier M 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 9 1 48 9 0 1 8 0 RABEprazole Sodium 20MG OR TBEC RABEPRAZOLE 7301 7301 Carrier M 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 9 1 0 3 6 0 Revlimid REVLIMID 7302 7302 Carrier M 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 3 0 8 0 Aklief 0.005% EX CREA AKLIEF 7303 7303 Carrier M 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 24 0 1 6 0 Hizentra HIZENTRA 7304 7304 Carrier M 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 101 1 25 24.62 0 24 77 0 Budesonide-Formoterol 160-4.5mcg/act Inhaler BUDESONIDE-FORMOTEROL 7305 7305 Carrier M 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 41 1 13.09 13.6 0 11 30 0 Epinephrine EPINEPHRINE 7306 7306 Carrier M 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 39 1 15.48 0 8 31 0 Stelara SQ 90mg STELARA 7307 7307 Carrier M 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 61 1 14 5.84 0 24 37 0 Fluticasone Propionate HFA FLUTICASONE 7308 7308 Carrier M 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 42 1 11.29 10.56 0 17 25 0 Vilazodone VILAZODONE 7309 7309 Carrier M 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 9 1 0 3 6 0 Methylphenidate Patch METHYLPHENIDATE 7310 7310 Carrier M 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 139 1 5.33 2.36 0 27 112 0 Nurtec ODT 75mg (rimegepant) NURTEC 7311 7311 Carrier M 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 17 1 0 2 15 0 Triamcinolone 0.1% Ointment TRIAMCINOLONE 7312 7312 Carrier M 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 1 48 0 1 1 0 Methotrexate 25mg/mL Injection METHOTREXATE 7313 7313 Carrier M 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 7 1 8 0 1 6 0 Bydureon BCise (exenatide) BYETTA 7314 7314 Carrier A 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 10 0.8 42.40066667 10 NA NA 7315 7315 Carrier A 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) 9 0.7778 39.85145062 9 NA NA 7316 7316 Carrier A 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 9 0.7778 39.85145062 9 NA NA 7317 7317 Carrier A 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 5 0.6 67.11994444 5 NA NA 7318 7318 Carrier A 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 61783 Stereotactic computer-assisted (navigational) procedure; spinal (List separately in addition to code for primary procedure) 5 0 0.729 5 NA NA 7319 7319 Carrier A 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure) 5 0 1.401 5 NA NA 7320 7320 Carrier A 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22585 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); each additional interspace (List separately in addition to code for primary procedure) 4 1 5.765833333 4 NA NA 7321 7321 Carrier A 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22614 Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure) 4 1 22.02895833 417.9693431 4 2 NA NA 7322 7322 Carrier A 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) 3 1 21.93685185 3 NA NA 7323 7323 Carrier A 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 50360 Renal allotransplantation, implantation of graft; without recipient nephrectomy 3 0 0.010092593 3 NA NA 7324 7324 Carrier A 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22830 Exploration of spinal fusion 3 1 21.96731481 3 NA NA 7325 7325 Carrier A 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar 3 1 36.49601852 3 NA NA 7326 7326 Carrier A 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22585 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); each additional interspace (List separately in addition to code for primary procedure) 4 1 5.765833333 4 NA NA 7327 7327 Carrier A 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22614 Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure) 4 1 22.02895833 417.9693431 4 2 NA NA 7328 7328 Carrier A 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) 3 1 21.93685185 3 NA NA 7329 7329 Carrier A 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22830 Exploration of spinal fusion 3 1 21.96731481 3 NA NA 7330 7330 Carrier A 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar 3 1 36.49601852 3 NA NA 7331 7331 Carrier A 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22848 Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum (List separately in addition to code for primary procedure) 2 1 11.29819444 2 NA NA 7332 7332 Carrier A 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22843 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments (List separately in addition to code for primary procedure) 2 1 20.51763889 417.9693431 2 2 NA NA 7333 7333 Carrier A 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27487 Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component 2 1 0.082361111 2 NA NA 7334 7334 Carrier A 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22212 Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; thoracic 1 1 18.73 1 NA NA 7335 7335 Carrier A 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63051 Laminoplasty, cervical, with decompression of the spinal cord, 2 or more vertebral segments; with reconstruction of the posterior bony elements (including the application of bridging bone graft and non-segmental fixation devices [eg, wire, suture, mini-plates], when performed) 1 1 31.18305556 319.6081722 1 1 NA NA 7336 7336 Carrier A 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27280 Arthrodesis, sacroiliac joint, open, includes obtaining bone graft, including instrumentation, when performed 1 1 22.30527778 1 NA NA 7337 7337 Carrier A 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22600 Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment 1 1 65.34361111 417.9693431 1 2 NA NA 7338 7338 Carrier A 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63001 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; cervical 1 1 31.18305556 319.6081722 1 1 NA NA 7339 7339 Carrier A 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22216 Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; each additional vertebral segment (List separately in addition to primary procedure) 1 1 18.73 1 NA NA 7340 7340 Carrier A 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22802 Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to 12 vertebral segments 1 1 18.73 1 NA NA 7341 7341 Carrier A 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22551 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2 1 1 65.34361111 1 NA NA 7342 7342 Carrier A 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 47379 Unlisted laparoscopic procedure, liver 1 1 4.545555556 1 NA NA 7343 7343 Carrier A 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27486 Revision of total knee arthroplasty, with or without allograft; 1 component 1 1 0.106388889 1 NA NA 7344 7344 Carrier A 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 355 0.969 0.313541667 5.408888889 311.6373792 12 343 4 NA NA 7345 7345 Carrier A 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography 341 0.9384 5.597543988 466.0545231 341 1 NA NA 7346 7346 Carrier A 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 Colonoscopy, flexible; with biopsy, single or multiple 339 0.9705 0.313634259 5.753335882 515.4680647 12 327 5 NA NA 7347 7347 Carrier A 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 250 0.876 6.649204444 248.3317229 250 15 NA NA 7348 7348 Carrier A 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 248 0.9758 0.413209877 28.78424802 423.6442907 9 239 5 NA NA 7349 7349 Carrier A 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97140 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes 228 0.8684 6.782820419 172.3699232 228 5 NA NA 7350 7350 Carrier A 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material 213 0.8545 2.693055556 7.836269654 1 212 NA NA 7351 7351 Carrier A 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 211 0.8626 6.724981569 163.5556299 211 8 NA NA 7352 7352 Carrier A 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74177 Computed tomography, abdomen and pelvis; with contrast material(s) 179 0.933 2.652892613 336.0130556 179 2 NA NA 7353 7353 Carrier A 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72148 Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material 176 0.7216 21.30910827 176 NA NA 7354 7354 Carrier A 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 78264 Gastric emptying imaging study (eg, solid, liquid, or both); 22 1 1.02540404 22 NA NA 7355 7355 Carrier A 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 45390 Colonoscopy, flexible; with endoscopic mucosal resection 19 1 3.879517544 292.0376564 19 1 NA NA 7356 7356 Carrier A 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft 16 1 6.2371875 16 NA NA 7357 7357 Carrier A 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93308 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study 10 1 0.113611111 0.000648148 658.0841758 1 9 1 NA NA 7358 7358 Carrier A 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70552 Magnetic resonance (eg, proton) imaging, brain (including brain stem); with contrast material(s) 10 1 0.117611111 10 NA NA 7359 7359 Carrier A 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 74174 Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing 10 1 0.012722222 10 NA NA 7360 7360 Carrier A 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 78306 Bone and/or joint imaging; whole body 10 1 0.000472222 10 NA NA 7361 7361 Carrier A 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 9 1 33.32033951 9 NA NA 7362 7362 Carrier A 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43248 Esophagogastroduodenoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) through esophagus over guide wire 9 1 0.01537037 9 NA NA 7363 7363 Carrier A 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 29828 Arthroscopy, shoulder, surgical; biceps tenodesis 9 1 47.03518519 437.4669158 9 1 NA NA 7364 7364 Carrier A 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64628 Thermal destruction of intraosseous basivertebral nerve, first 2 vertebral bodies 1 1 825.6608333 1 NA NA 7365 7365 Carrier A 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64629 Thermal destruction of intraosseous basivertebral nerve, each additional vertebral body 1 1 825.6608333 1 NA NA 7366 7366 Carrier A 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27446 Arthroplasty, knee, condyle and plateau; medial OR lateral compartment 4 0.25 72.39763889 4 NA NA 7367 7367 Carrier A 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 29822 Arthroscopy, shoulder, surgical; debridement, limited, 1 or 2 discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of 8 0.125 36.13864583 370.2510453 8 1 NA NA 7368 7368 Carrier A 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64636 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure) 25 0.04 28.6053 25 NA NA 7369 7369 Carrier A 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64635 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint 32 0.0313 23.03748264 32 NA NA 7370 7370 Carrier A 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 95811 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist 34 0.0294 17.2117402 34 NA NA 7371 7371 Carrier A 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 29826 Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) release, when performed (List separately in addition to code for primary procedure) 36 0.0278 1.000833333 65.06072222 502.1930412 1 31 2 NA NA 7372 7372 Carrier A 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 73221 Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s) 157 0.0064 0.196944445 22.63581909 1 155 NA NA 7373 7373 Carrier A 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1001 Residential treatment, Psychiatric 3 0.6667 62.94564815 3 NA NA 7374 7374 Carrier A 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 54520 Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach 1 1 42.96861111 1 NA NA 7375 7375 Carrier A 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 56805 Clitoroplasty for intersex state 1 1 42.96861111 1 NA NA 7376 7376 Carrier A 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 55175 Scrotoplasty; simple 1 1 42.96861111 1 NA NA 7377 7377 Carrier A 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 53430 Urethroplasty, reconstruction of female urethra 1 1 42.96861111 1 NA NA 7378 7378 Carrier A 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1002 Residential treatment, Substance Use Disorder 1 1 48.80472222 1 NA NA 7379 7379 Carrier A 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 57335 Vaginoplasty for intersex state 1 1 42.96861111 1 NA NA 7380 7380 Carrier A 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 54125 Amputation of penis; complete 1 1 42.96861111 1 NA NA 7381 7381 Carrier A 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 54520 Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach 1 1 42.96861111 1 NA NA 7382 7382 Carrier A 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 56805 Clitoroplasty for intersex state 1 1 42.96861111 1 NA NA 7383 7383 Carrier A 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 55175 Scrotoplasty; simple 1 1 42.96861111 1 NA NA 7384 7384 Carrier A 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 53430 Urethroplasty, reconstruction of female urethra 1 1 42.96861111 1 NA NA 7385 7385 Carrier A 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1002 Residential treatment, Substance Use Disorder 1 1 48.80472222 1 NA NA 7386 7386 Carrier A 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 57335 Vaginoplasty for intersex state 1 1 42.96861111 1 NA NA 7387 7387 Carrier A 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 54125 Amputation of penis; complete 1 1 42.96861111 1 NA NA 7388 7388 Carrier A 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1001 Residential treatment, Psychiatric 3 0.6667 62.94564815 3 NA NA 7389 7389 Carrier A 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 71271 Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s) 31 0.871 3.61561828 31 NA NA 7390 7390 Carrier A 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual 16 0.5625 38.65857639 16 NA NA 7391 7391 Carrier A 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 12 0.9167 19.79671717 12 NA NA 7392 7392 Carrier A 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 12 0.9167 19.79676768 12 NA NA 7393 7393 Carrier A 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 11 0.9091 21.77511111 11 NA NA 7394 7394 Carrier A 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 7 1 25.1915873 7 NA NA 7395 7395 Carrier A 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 Mental Health Partial Hospitalization, Treatment, Less Than 24 Hours 5 0.6 40.62916667 5 NA NA 7396 7396 Carrier A 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 17380 Electrolysis epilation, each 30 minutes 2 1 47.53888889 2 NA NA 7397 7397 Carrier A 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 17999 Unlisted procedure, skin, mucous membrane and subcutaneous tissue 2 1 47.53888889 2 NA NA 7398 7398 Carrier A 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 64999 Unlisted procedure, nervous system 2 1 47.53888889 2 NA NA 7399 7399 Carrier A 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 15877 Suction assisted lipectomy; trunk 2 1 22.12902778 2 NA NA 7400 7400 Carrier A 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 2 1 0.104722222 522 2 1 NA NA 7401 7401 Carrier A 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 19303 Mastectomy, simple, complete 2 1 19.79194444 2 NA NA 7402 7402 Carrier A 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 19350 Nipple/areola reconstruction 2 1 19.79194444 2 NA NA 7403 7403 Carrier A 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H2036 Alcohol and/or other drug treatment program, per diem 2 0.5 15.26625 2 NA NA 7404 7404 Carrier A 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 7 1 25.1915873 7 NA NA 7405 7405 Carrier A 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 17380 Electrolysis epilation, each 30 minutes 2 1 47.53888889 2 NA NA 7406 7406 Carrier A 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 17999 Unlisted procedure, skin, mucous membrane and subcutaneous tissue 2 1 47.53888889 2 NA NA 7407 7407 Carrier A 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64999 Unlisted procedure, nervous system 2 1 47.53888889 2 NA NA 7408 7408 Carrier A 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15877 Suction assisted lipectomy; trunk 2 1 22.12902778 2 NA NA 7409 7409 Carrier A 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 2 1 0.104722222 522 2 1 NA NA 7410 7410 Carrier A 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19303 Mastectomy, simple, complete 2 1 19.79194444 2 NA NA 7411 7411 Carrier A 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19350 Nipple/areola reconstruction 2 1 19.79194444 2 NA NA 7412 7412 Carrier A 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 92610 Evaluation of oral and pharyngeal swallowing function 1 1 16.84 1 NA NA 7413 7413 Carrier A 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 92523 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language) 1 1 16.84 1 NA NA 7414 7414 Carrier A 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 78608 Brain imaging, positron emission tomography (PET); metabolic evaluation 1 1 0.000277778 1 NA NA 7415 7415 Carrier A 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 30400 Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tip 1 1 165.5327778 1 NA NA 7416 7416 Carrier A 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 92526 Treatment of swallowing dysfunction and/or oral function for feeding 1 1 28.90222222 1 NA NA 7417 7417 Carrier A 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 47000 Biopsy of liver, needle; percutaneous 1 1 0.014722222 1 NA NA 7418 7418 Carrier A 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 67900 Repair of brow ptosis (supraciliary, mid-forehead or coronal approach) 1 1 165.5327778 1 NA NA 7419 7419 Carrier A 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0004 Alcohol And/Or Drug Services 1 1 45.68138889 1 NA NA 7420 7420 Carrier A 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 21209 Osteoplasty, facial bones; reduction 1 1 165.5327778 1 NA NA 7421 7421 Carrier A 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 Cont Airway Pressure Device 282 0.9504 1.814744878 282 NA NA 7422 7422 Carrier A 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without backup rate 21 0.9524 0.119510582 21 NA NA 7423 7423 Carrier A 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2402 Negative pressure wound therapy electrical pump, stationary or portable 7 0.4286 93.47083333 7 NA NA 7424 7424 Carrier A 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate 7 1 0.029087302 7 NA NA 7425 7425 Carrier A 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0748 Elec Osteogen Stim Spinal 6 0.5 78.90444444 6 NA NA 7426 7426 Carrier A 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1399 Durable Medical Equipment Mi 2 0 4.404722222 2 NA NA 7427 7427 Carrier A 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1012 Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each 2 0 4.861666667 2 NA NA 7428 7428 Carrier A 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1007 Wheelchair accessory, power seating system, combination tilt and recline, with manual shear reduction 2 0 4.862222222 2 NA NA 7429 7429 Carrier A 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2298 Complex rehabilitative power wheelchair accessory, power seat elevation system, any type 2 0 4.861944444 2 NA NA 7430 7430 Carrier A 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1028 Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other 2 0 4.862083333 2 NA NA 7431 7431 Carrier A 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2313 PWC harness, expand control 2 0 4.862222222 2 NA NA 7432 7432 Carrier A 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0486 Oral device/appliance cusfab 2 0 7.760833333 2 NA NA 7433 7433 Carrier A 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2311 Power wheelchair accessory, electronic connection between wheelchair controller 2 0 4.862361111 2 NA NA 7434 7434 Carrier A 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0760 Osteogen Ultrasound Stimltor 2 0.5 3.808055556 2 NA NA 7435 7435 Carrier A 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2377 Expandable controller, initl 2 0 4.862083333 2 NA NA 7436 7436 Carrier A 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0953 Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each 2 0 4.861805556 2 NA NA 7437 7437 Carrier A 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2624 Adj skin pro/pos cus<22in 2 0 4.861805556 2 NA NA 7438 7438 Carrier A 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0955 Wheelchair accessory, headrest, cushioned, prefabricated, including fixed mounting hardware, each 2 0 4.861666667 2 NA NA 7439 7439 Carrier A 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate 7 1 0.029087302 7 NA NA 7440 7440 Carrier A 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without backup rate 21 0.9524 0.119510582 21 NA NA 7441 7441 Carrier A 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0601 Cont Airway Pressure Device 282 0.9504 1.814744878 282 NA NA 7442 7442 Carrier A 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0748 Elec Osteogen Stim Spinal 6 0.5 78.90444444 6 NA NA 7443 7443 Carrier A 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0760 Osteogen Ultrasound Stimltor 2 0.5 3.808055556 2 NA NA 7444 7444 Carrier A 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2402 Negative pressure wound therapy electrical pump, stationary or portable 7 0.4286 93.47083333 7 NA NA 7445 7445 Carrier A 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4216 Sterile water/saline, 10 ml 1 0 0.008611111 1 NA NA 7446 7446 Carrier A 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 1 0 2.729444444 1 NA NA 7447 7447 Carrier A 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply 1 0 1.589722222 1 NA NA 7448 7448 Carrier A 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4216 Sterile water/saline, 10 ml 1 0 0.008611111 1 NA NA 7449 7449 Carrier A 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 1 0 2.729444444 1 NA NA 7450 7450 Carrier A 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply 1 0 1.589722222 1 NA NA 7451 7451 Carrier A 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 174 0.7586 8.73 43.14 76 98 HYDROCODONE-ACETAMINOPHEN HYDROCODONE-ACETAMINOPHEN 7452 7452 Carrier A 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 138 0.0362 10.84 15.17 17 121 SEMAGLUTIDE (WEIGHT MANAGEMENT) WEGOVY 7453 7453 Carrier A 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 86 0.6512 7.01 3.89 22 64 SEMAGLUTIDE OZEMPIC (0.25 OR 0.5 MG/DOSE), OZEMPIC (1 MG/DOSE), OZEMPIC (2 MG/DOSE), RYBELSUS 7454 7454 Carrier A 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 81 0.0123 1.89 4.73 7 74 TIRZEPATIDE (WEIGHT MANAGEMENT) ZEPBOUND 7455 7455 Carrier A 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 74 0.8108 7.93 8.41 33 41 OXYCODONE HCL OXYCODONE HCL, OXYCODONE HCL ER, OXYCONTIN 7456 7456 Carrier A 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 73 0.8219 3.02 7.85 4 69 CYCLOSPORINE (OPHTH) CEQUA, CYCLOSPORINE, RESTASIS 7457 7457 Carrier A 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 73 0.9041 6.34 23.38 21 52 ADALIMUMAB HUMIRA (2 PEN), HUMIRA (2 SYRINGE), HUMIRA-CD/UC/HS STARTER, HUMIRA-PSORIASIS/UVEIT STARTER 7458 7458 Carrier A 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 72 0.5694 4.83 5.28 13 59 TIRZEPATIDE MOUNJARO 7459 7459 Carrier A 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 65 0.7846 7.78 8.66 47 18 OXYCODONE W/ ACETAMINOPHEN OXYCODONE-ACETAMINOPHEN 7460 7460 Carrier A 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 43 0.8372 9.17 12.54 8 35 DUPILUMAB DUPIXENT 7461 7461 Carrier A 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 28 1 6.34 86.82 7 21 SECUKINUMAB COSENTYX, COSENTYX SENSOREADY (300 MG), COSENTYX SENSOREADY PEN, COSENTYX UNOREADY 7462 7462 Carrier A 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 17 1 5.15 4.53 5 12 GALCANEZUMAB-GNLM EMGALITY 7463 7463 Carrier A 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 15 1 8.38 7.52 9 6 ETANERCEPT ENBREL SURECLICK 7464 7464 Carrier A 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 10 1 4.95 283.87 4 6 BUPRENORPHINE HCL BELBUCA 7465 7465 Carrier A 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 13.84 4.71 3 5 CERTOLIZUMAB PEGOL CIMZIA, CIMZIA (2 SYRINGE) 7466 7466 Carrier A 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 7.75 6.58 5 3 FENTANYL FENTANYL 7467 7467 Carrier A 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 2.02 7.14 2 6 TOFACITINIB CITRATE XELJANZ, XELJANZ XR 7468 7468 Carrier A 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 5 1 15.48 3.87 1 4 LIFITEGRAST XIIDRA 7469 7469 Carrier A 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 4 1 6.07 0 4 NETARSUDIL DIMESYLATE-LATANOPROST ROCKLATAN 7470 7470 Carrier A 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 4 1 7.74 0 4 DIROXIMEL FUMARATE VUMERITY 7471 7471 Carrier A 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 4 1 24.78 29.18 3 1 EVOLOCUMAB REPATHA SURECLICK 7472 7472 Carrier A 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 1 12.24 2 0 ADALIMUMAB HUMIRA (2 PEN) 7473 7473 Carrier A 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 1 25.65 0 2 PENTOSAN POLYSULFATE SODIUM ELMIRON 7474 7474 Carrier A 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 1 16.54 46.99 1 1 OXYCODONE W/ ACETAMINOPHEN OXYCODONE-ACETAMINOPHEN 7475 7475 Carrier A 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 1 4.51 2 0 IVABRADINE HCL CORLANOR 7476 7476 Carrier A 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 1 47.28 0 2 ERENUMAB-AOOE AIMOVIG 7477 7477 Carrier A 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 21.81 0 1 RIBOCICLIB SUCCINATE KISQALI (600 MG DOSE) 7478 7478 Carrier A 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 15.7 1 0 SEMAGLUTIDE OZEMPIC (0.25 OR 0.5 MG/DOSE) 7479 7479 Carrier A 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 23.08 0 1 BUTORPHANOL TARTRATE BUTORPHANOL TARTRATE 7480 7480 Carrier A 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 5.42 1 0 BUPRENORPHINE BUPRENORPHINE 7481 7481 Carrier B 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99231 SUBSEQUENT HOSPITAL CARE 16 0.875 35.84 106.82 0 3 13 0 NA NA 7482 7482 Carrier B 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 TOTAL ABDOMINAL HYSTERECOMY WITH TUBES AND OVARIES 14 1 24.73 107.44 0 2 12 0 NA NA 7483 7483 Carrier B 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44207 LAP; COLECT PART W/COLOPROCTOST 10 1 38.72 68.74 0 5 5 0 NA NA 7484 7484 Carrier B 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 38724 CERV LYMPHADENECTOMY (MODIFIED RAD NECK DISECT) 10 0.9 41.84 70.7 0 5 5 0 NA NA 7485 7485 Carrier B 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22612 LUMBAR SPINE FUSION 9 1 18.78 0 0 9 0 NA NA 7486 7486 Carrier B 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 32663 SCOPE OF LUNGS WITH REMOVAL OF LOBE 8 1 28.45 72.52 0 4 4 0 NA NA 7487 7487 Carrier B 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 31622 BRANCHOSCOPY W/WOUT FLUOROSCOPIC GUIDANCE 7 0.8571 20.1 71.19 0 1 6 0 NA NA 7488 7488 Carrier B 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 69990 USE OPER MICROSCOPE 7 1 36.02 54.48 0 2 5 0 NA NA 7489 7489 Carrier B 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 33405 REPLACEMENT AORTIC VALVE OPN 7 1 39.71 59.82 0 3 4 0 NA NA 7490 7490 Carrier B 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 61781 SCAN PROC CRANIAL INTRA 6 1 35.67 65.02 0 2 4 0 NA NA 7491 7491 Carrier B 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 49255 OMENTECTOMY/EPIPLOECTOMY-RESEC OMENTUM (SEP PRO) 1 1 99.27 0 0 1 0 NA NA 7492 7492 Carrier B 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43621 GASTRECTOMY TOT; W/ROUX-EN-Y RECON 1 1 290.12 0 0 1 0 NA NA 7493 7493 Carrier B 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 61867 TWST DRL BURR CRANIOT W/REC 1 ARRAY 1 1 118.32 0 0 1 0 NA NA 7494 7494 Carrier B 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15769 HARVESTING OF SKIN WITH AUTOLOGOUS SOFT TISSUE 4 1 87.71 0 0 4 0 NA NA 7495 7495 Carrier B 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 61863 TWST DRL BURR CRANIOT NO REC 1 ARAY 2 1 42.26 0 0 2 0 NA NA 7496 7496 Carrier B 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15777 ACELLULAR DERM MATRIX IMPLT 2 1 117.18 163.35 0 1 1 0 NA NA 7497 7497 Carrier B 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 61700 SURGERICAL TREATMENT OF SIMPLE ANEURYSM THRU THE INTRACRANIAL CAROTID ARTERY 1 1 19.03 0 1 0 0 NA NA 7498 7498 Carrier B 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19370 OPEN PERIPROSTHETIC CAPSULOTOMY BREAST 2 1 118.3 163.35 0 1 1 0 NA NA 7499 7499 Carrier B 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33361 REPLACE AORTIC VALVE PERQ 3 1 140.28 119.21 0 1 2 0 NA NA 7500 7500 Carrier B 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19371 PERI-IMPLANT CAPSULECTOMY BREAST COMPLETE 2 1 118.28 163.35 0 1 1 0 NA NA 7501 7501 Carrier B 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0480 DEFINITIVE DRUG TEST OF CLASSES 1-7 216 0.6218 79.41 0 0 216 0 NA NA 7502 7502 Carrier B 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0481 DEFINITIVE DRUG TEST OF CLASSES 8-14 179 0.3519 88.25 0 0 179 0 NA NA 7503 7503 Carrier B 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0482 DEFINITIVE DRUG TEST OF CLASSES 15-22 176 0.0684 85.91 0 0 176 0 NA NA 7504 7504 Carrier B 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0483 DEFINITIVE DRUG TEST OF CLASSES 22+ 175 0.069 89.88 0 0 175 0 NA NA 7505 7505 Carrier B 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95810 SLEEP STUDY GREATER THAN 6 YRS OLD 243 0.4774 67.32 88.23 0 11 232 0 NA NA 7506 7506 Carrier B 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95811 SLEEP STUDY GREATER THAN 6 YRS OLD WITH CPAP MACHINE 183 0.5301 62.73 83.99 0 11 172 0 NA NA 7507 7507 Carrier B 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT J2469 INJECTION, PALONOSETRON HCL, 25 MCG 143 1 1 12 131 NA NA 7508 7508 Carrier B 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0299 DIRECT SKILLED NURSING SERVICES OF A REGISTERED NURSE IN HOME OR HOSPICE SETTING 102 0.9855 43.75 78.82 0 1 101 0 NA NA 7509 7509 Carrier B 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99212 OFFICE/OUTPATIENT ESTABLISHED MEMBER LASTING 10-19 MIN 127 0.5227 50.22 105.89 0 23 104 0 NA NA 7510 7510 Carrier B 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 30520 SEPTOPLASTY/SMR W/WO CARTIL SCORING/REPLAC W/GFT 106 0.9907 24.93 102.09 0 1 105 0 NA NA 7511 7511 Carrier B 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J2469 INJECTION, PALONOSETRON HCL, 25 MCG 143 1 1 12 131 0 NA NA 7512 7512 Carrier B 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J1453 INJECTION, FOSAPREPITANT, 1 MG 97 1 10 87 0 NA NA 7513 7513 Carrier B 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J1100 INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG 56 1 4 5 51 0 NA NA 7514 7514 Carrier B 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J9217 LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG 38 1 2 36 0 NA NA 7515 7515 Carrier B 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J3489 ZOLEDRONIC ACID 1MG (ZOMETA) 36 1 1 35 0 NA NA 7516 7516 Carrier B 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC Q5118 INJECTION BEVACIZUMAB-BVZR BIOSIMILAR 10 MG 29 1 5 2 27 0 NA NA 7517 7517 Carrier B 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J9171 INJECTION, DOCETAXEL, 1 MG 29 1 3 2 5 24 0 NA NA 7518 7518 Carrier B 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J9306 INJECTION, PERTUZUMAB, 1 MG 29 1 3 3 26 0 NA NA 7519 7519 Carrier B 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J2405 INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG 26 1 7 4 22 0 NA NA 7520 7520 Carrier B 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J9060 INJECTION, CISPLATIN, POWDER OR SOLUTION, 10 MG 24 1 0 24 0 NA NA 7521 7521 Carrier B 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21146 RECON MIDFACE LEFORT I; 2 PIECES REQ BONE GFT 1 1 75.48 0 0 1 0 NA NA 7522 7522 Carrier B 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 51999 UNLIS LAPS PX BLDR 1 1 501.75 0 1 0 0 NA NA 7523 7523 Carrier B 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21147 RECON MIDFACE LEFORT I; 3/MORE PIECES REQ GFT 2 1 76.5 0 0 2 0 NA NA 7524 7524 Carrier B 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 88323 CONS & REPORT REF MAT REQUIRING PREP SLIDES 1 1 88.12 0 0 1 0 NA NA 7525 7525 Carrier B 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 88321 CONS & REPORT REF SLIDES PREP ELSEWHERE 1 1 44.5 0 0 1 0 NA NA 7526 7526 Carrier B 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 29916 HIP ARTHRO W/LABRAL REPAIR 1 1 44.03 0 0 1 0 NA NA 7527 7527 Carrier B 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21196 RECONST LWR JAW W/ FIXATION 3 0.6667 91.45 0 0 3 0 NA NA 7528 7528 Carrier B 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21085 IMPRESS & CUST PREP; ORAL SURG SPLINT 4 0.5 77.94 0 0 4 0 NA NA 7529 7529 Carrier B 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27702 ARTHROPLASTY ANK; W/IMPLNT (TOT ANK) 2 0.5 48.63 0 0 2 0 NA NA 7530 7530 Carrier B 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43497 TRANSORAL LOWER ESOPHAGEAL MYOTOMY 2 0.5 158.39 0 0 2 0 NA NA 7531 7531 Carrier B 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 SEMI-PRIVATE PYSCHIATRIC INPATIENT STAY 189 0.9701 22.72 49.34 0 1 188 0 NA NA 7532 7532 Carrier B 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 126 DETOXIFICATION BED 55 0.9818 41.69 0 0 55 0 NA NA 7533 7533 Carrier B 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1002 BEHAVIORAL HEALTH ACCOMODATIONS-RELATED TO CHEMICAL DEPENDANCY 34 1 66.96 107.39 0 2 32 0 NA NA 7534 7534 Carrier B 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1001 BEHAVIORAL HEALTH ACCOMODATIONS-RESIDENTIAL TREATMENT PSYCHIATRIC 11 1 94.91 0 0 11 0 NA NA 7535 7535 Carrier B 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1001 BEHAVIORAL HEALTH ACCOMODATIONS-RESIDENTIAL TREATMENT PSYCHIATRIC 11 1 94.91 0 0 11 0 NA NA 7536 7536 Carrier B 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1002 BEHAVIORAL HEALTH ACCOMODATIONS-RELATED TO CHEMICAL DEPENDANCY 34 1 66.96 107.39 0 2 32 0 NA NA 7537 7537 Carrier B 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 126 DETOXIFICATION BED 55 0.9818 41.69 0 0 55 0 NA NA 7538 7538 Carrier B 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 SEMI-PRIVATE PYSCHIATRIC INPATIENT STAY 189 0.9701 22.72 49.34 0 1 188 0 NA NA 7539 7539 Carrier B 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC S9480 INTENSIVE OUTPATIENT PSYCHIATRIC SERVICES PER DIEM 55 0.9636 69.17 0 0 55 0 NA NA 7540 7540 Carrier B 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 906 PROFESSIONAL FEE FOR PSYCHOLOGY 37 0.9211 23.4 73.62 0 1 36 0 NA NA 7541 7541 Carrier B 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 905 INTENSIVE BEHAVIORAL HEALTH TREATMENT SERVICES 25 0.96 44.45 0 0 25 0 NA NA 7542 7542 Carrier B 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0015 IOP AL &/OR DRG SRV->=3HRS DA/3DAWK 22 0.7826 22.71 50.18 0 4 18 0 NA NA 7543 7543 Carrier B 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 912 PARTIAL HOSPITALIZATION PSYCHIATRIC PROGRAM 22 0.9545 181.07 0 0 22 0 NA NA 7544 7544 Carrier B 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96132 NEUROPSYCHOLOGICAL TEST EVALUATION BY A PHYSICIAN/QUALIFIED HEALTH PROFESSIONAL UP TO 1 HOUR. 16 1 70.89 0 0 16 0 NA NA 7545 7545 Carrier B 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 TCRANIAL MAGN STIM TX DELI 13 0.6154 96.83 178.19 0 1 12 0 NA NA 7546 7546 Carrier B 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 TRANSCRANIAL MAGNETIC STIMULATION USED TO IMPROVE DEPRESSION 12 0.5833 96.83 139.83 0 1 11 0 NA NA 7547 7547 Carrier B 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 TCRAN MAGN STIM REDETEMINE 12 0.5833 96.83 179.43 0 1 11 0 NA NA 7548 7548 Carrier B 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96130 PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR 10 1 46.47 0 0 10 0 NA NA 7549 7549 Carrier B 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96133 NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR 1 1 0.03 0 0 1 0 NA NA 7550 7550 Carrier B 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H2012 BEHAVIORAL HEALTH DAY TREATMENT, PER HOUR 2 1 96.28 0 0 2 0 NA NA 7551 7551 Carrier B 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99366 TEAM CONF W/PAT BY HC PRO 1 1 42.38 0 0 1 0 NA NA 7552 7552 Carrier B 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90837 PSYTX PT&/FAMILY 60 MINUTES 1 1 0.1 0 0 1 0 NA NA 7553 7553 Carrier B 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 901 BEHAVIORAL HEALTH TREATMENT SERVICES, ELECTROSHOCK 1 1 92.6 0 0 1 0 NA NA 7554 7554 Carrier B 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90870 ELECTRIC CONVULSIVE THERAPY 3 1 107.03 0 0 3 0 NA NA 7555 7555 Carrier B 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96139 PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN 1 1 0.03 0 0 1 0 NA NA 7556 7556 Carrier B 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96101 PSYCHOLOGICAL TESTING PER HOUR FACE TO FACE TIME WITH PATIENT 1 1 0 0 1 0 NA NA 7557 7557 Carrier B 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S0201 PART HOSPITALZTION SRVC <24 HR-DIEM 4 1 79.97 0 0 4 0 NA NA 7558 7558 Carrier B 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96116 NUBHVL STATUS XM PR HR F2F W/PT INTERPJ&PREPJ 1 1 0.17 0 0 1 0 NA NA 7559 7559 Carrier B 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE 913 0.949 40.96 103.95 0 26 887 0 NA NA 7560 7560 Carrier B 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1390 PORTABLE OXYGEN CONCENTRATOR 98 0.9636 23.99 113.36 0 10 88 0 NA NA 7561 7561 Carrier B 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4239 CONTINUOUS GLUCOSE MONITORING SUPPLIES BY MONTH 70 0.9718 35.95 112.15 0 2 68 0 NA NA 7562 7562 Carrier B 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0470 BI-PAP RESPIRATORY ASSIST DEVICE WITH OUT BACKUP 49 0.9388 58.21 124.15 0 3 46 0 NA NA 7563 7563 Carrier B 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2402 NEGATIVE PRESSURE WOUND PUMP 33 1 2.23 98.71 0 2 31 0 NA NA 7564 7564 Carrier B 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0471 BI-PAP RESPIRATORY ASSIST DEVICE WITH BACKUP 18 0.75 24.19 164.14 0 2 16 0 NA NA 7565 7565 Carrier B 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2103 NONADJUNCTIVE NONIMPLANTED CGM/RECEIVER 16 0.875 140.48 0 0 16 0 NA NA 7566 7566 Carrier B 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0935 PASSIVE MOTION EXERCISE DEVICE 12 0.5 25.86 101.77 0 2 10 0 NA NA 7567 7567 Carrier B 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0466 HOME VENTILATOR, USED WITH NON-INVASIVE INTERFACE (MASK, CHEST SHELL) 10 1 27.65 123.54 0 4 6 0 NA NA 7568 7568 Carrier B 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0483 HF CW OS SYS FULL THOR REG RECV SIM EXT OS EA 10 0.6 158.54 0 0 10 0 NA NA 7569 7569 Carrier B 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9273 COLD/HOT FL BTL ICE CAP/C HEAT AND/ COLD WRAP ANY 1 1 0 53.65 0 0 1 0 NA NA 7570 7570 Carrier B 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2300 POWER WHEELCHAIR ACCESSORY, POWER SEAT ELEVATION SYSTEM 1 1 0 119.35 0 0 1 0 NA NA 7571 7571 Carrier B 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1392 PORTABLE OXYGEN CONCENTRATOR 1 1 0 96.63333333 0 0 1 0 NA NA 7572 7572 Carrier B 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC B9002 ENTERAL NUTRITION INFUSION PUMP WITH ALARM 1 1 0 0.002777778 0 0 1 0 NA NA 7573 7573 Carrier B 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2609 CUSTOM FABRICATED WHEELCHAIR SEAT CUSHION SIZE 1 1 0 74.45 0 0 1 0 NA NA 7574 7574 Carrier B 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC B9004 PARENTERAL NUTRITION INFUSION PUMP PORTABLE 1 1 0 53.96666667 0 0 1 0 NA NA 7575 7575 Carrier B 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2343 PWER WHEELCHAIR ACC NONSTANDARD SEAT FRAME DEPTH, 20-25 INCHES 1 1 0 149.4666667 0 0 1 0 NA NA 7576 7576 Carrier B 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0261 HOSPITAL BED SEMI-ELECTRIC WITH ANY RAILS AND WITHOUT MATTRESS 1 1 0 46.55 0 0 1 0 NA NA 7577 7577 Carrier B 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0766 ELEC STIM CANCER TREATMENT 1 1 55.63333333 0 0 1 0 0 NA NA 7578 7578 Carrier B 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0277 POWERED PRESS-REDUCING AIR MATRESS 1 1 0 67.58333333 0 0 1 0 NA NA 7579 7579 Carrier B 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC K0606 AUTOMATIC EXTRNL DFBRLLTR, W INTGRTD ELECRDGRM ANALYSIS 3 0.3333 69.11666667 96.175 0 1 2 0 NA NA 7580 7580 Carrier B 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E2103 NONADJUNCTIVE NONIMPLANTED CGM/RECEIVER 16 0.125 0 140.4791667 0 0 16 0 NA NA 7581 7581 Carrier B 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E2402 NEGATIVE PRESSURE WOUND PUMP 33 0.0294 2.229861111 98.70549283 0 2 31 0 NA NA 7582 7582 Carrier B 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC A4239 CONTINUOUS GLUCOSE MONITORING SUPPLIES BY MONTH 70 0.0282 35.95 112.1450449 0 2 68 0 NA NA 7583 7583 Carrier B 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0470 BI-PAP RESPIRATORY ASSIST DEVICE WITH OUT BACKUP 49 0.0204 58.21111111 124.1508394 0 3 46 0 NA NA 7584 7584 Carrier B 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0601 CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE 913 0.017 40.96410256 103.9486343 0 26 887 0 NA NA 7585 7585 Carrier B 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E1390 PORTABLE OXYGEN CONCENTRATOR 98 0.0091 23.98666667 113.357178 0 10 88 0 NA NA 7586 7586 Carrier B 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 EXTERNAL AMBULATORY INFUSION PUMP, INSULIN 30 0.9667 0 111.81 0 0 30 0 NA NA 7587 7587 Carrier B 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9277 EXTERNAL TRANSMITTER CONTINOUS GLUCOSE MONITOR DAILY 28 1 0 120.48 0 0 28 0 NA NA 7588 7588 Carrier B 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9278 EXTERNAL RECEIVER FOR CONTINOUS GLUCOSE MONITORING 10 0.8333 0 101.92 0 0 10 0 NA NA 7589 7589 Carrier B 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9276 DISPOSABLE SENSOR FOR CONTINOUS GLUCOSE MONITORING SYSTEM DAILY 1 1 0 4.5 0 0 1 0 NA NA 7590 7590 Carrier B 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9276 DISPOSABLE SENSOR FOR CONTINOUS GLUCOSE MONITORING SYSTEM DAILY 1 1 0 4.5 0 0 1 0 NA NA 7591 7591 Carrier B 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9277 EXTERNAL TRANSMITTER CONTINOUS GLUCOSE MONITOR DAILY 28 1 0 120.48 0 0 28 0 NA NA 7592 7592 Carrier B 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 EXTERNAL AMBULATORY INFUSION PUMP, INSULIN 30 0.9667 0 111.81 0 0 30 0 NA NA 7593 7593 Carrier B 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9278 EXTERNAL RECEIVER FOR CONTINOUS GLUCOSE MONITORING 10 0.8333 0 101.92 0 0 10 0 NA NA 7594 7594 Carrier B 2024 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0784 EXTERNAL AMBULATORY INFUSION PUMP, INSULIN 30 0.0333 0 111.81 0 0 30 0 NA NA 7595 7595 Carrier B 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 2242 0.839 0 0 362 1880 Semaglutide Ozempic 7596 7596 Carrier B 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 818 0.302 0 1 98 720 Clobetasol Propionate Clobetasol 7597 7597 Carrier B 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 560 0.7107 0 1 131 429 Lisdexamfetamine Dimesylate Lisdexamfeta 7598 7598 Carrier B 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 488 0.3238 0 1 123 365 Pregabalin Pregabalin 7599 7599 Carrier B 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 478 0.9372 0 0 105 373 Dulaglutide Trulicity 7600 7600 Carrier B 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 467 0.6938 0 0 90 377 Liraglutide Victoza 7601 7601 Carrier B 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 451 0.4812 0 1 32 419 Tretinoin Tretinoin 7602 7602 Carrier B 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 415 0.9301 0 1 132 283 Hydrocodone-Acetaminophen Hydroco/apap 7603 7603 Carrier B 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 412 0.6626 0 3 70 342 Continuous Glucose System Sensor Freesty Libr 7604 7604 Carrier B 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 323 0.774 0 1 107 216 Adalimumab Humira Pen 7605 7605 Carrier B 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 36 1 0 1 15 21 Insulin Degludec Ins Degl Flx 7606 7606 Carrier B 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 29 1 3 0 25 4 Abemaciclib Verzenio 7607 7607 Carrier B 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 27 1 0 0 8 19 Sodium Zirconium Cyclosilicate Lokelma 7608 7608 Carrier B 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 25 1 0 1 9 16 Insulin Aspart Insulin Aspa 7609 7609 Carrier B 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 16 1 2 0 13 3 Lenvatinib Mesylate Lenvima 7610 7610 Carrier B 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 16 1 1 2 8 8 Olaparib Lynparza 7611 7611 Carrier B 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 16 1 0 2 5 11 Dextromethorphan Hydrobromide-Bupropion Hydrochloride Auvelity 7612 7612 Carrier B 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 11 1 0 1 1 10 Segesterone Acetate-Ethinyl Estradiol Annovera 7613 7613 Carrier B 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 10 1 1 1 8 2 Lenalidomide Revlimid 7614 7614 Carrier B 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 10 1 1 0 6 4 Metronidazole Metronidazol 7615 7615 Carrier O 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) 12 1 24.31 49.63 1 11 NA NA 7616 7616 Carrier O 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22633 Filter, disposable, used with positive airway pressure device 9 1 24.31 68 1 8 NA NA 7617 7617 Carrier O 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44207 LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH ANASTOMOSIS, WITH COLOPROCTOSTOMY (LOW PELVIC ANASTOMOSIS) 8 0.875 10.23 60.04 4 4 NA NA 7618 7618 Carrier O 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22840 Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) 7 1 39.23 7 NA NA 7619 7619 Carrier O 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63052 LAMINECTOMY, FACETECTOMY, OR FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT[S] [EG, SPINAL OR LATERAL RECESS STENOSIS]), DURING POSTERIOR INTERBODY ARTHRODESIS, LUMBAR; SINGLE VERTEBRAL SEGMENT 7 1 24.31 57.65 1 6 NA NA 7620 7620 Carrier O 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44213 Filter, disposable, used with positive airway pressure device 7 0.8571 7.87 46.08 5 2 NA NA 7621 7621 Carrier O 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63048 Room & Board Semiprivate (Two Beds)-Psychiatric 6 1 24.3 63.25 1 5 NA NA 7622 7622 Carrier O 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 38724 CERVICAL LYMPHADENECTOMY (MODIFIED RADICAL NECK DISSECTION) 6 0.6667 2.03 52.67 3 3 NA NA 7623 7623 Carrier O 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22614 Room & Board Semiprivate (Two Beds)-Detoxification 6 1 24.31 62.94 1 5 NA NA 7624 7624 Carrier O 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45330 SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE) 6 0.8333 16.75 28.04 1 5 NA NA 7625 7625 Carrier O 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22853 Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) 12 1 24.31 49.63 1 11 NA NA 7626 7626 Carrier O 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22633 Filter, disposable, used with positive airway pressure device 9 1 24.31 68 1 8 NA NA 7627 7627 Carrier O 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63052 LAMINECTOMY, FACETECTOMY, OR FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT[S] [EG, SPINAL OR LATERAL RECESS STENOSIS]), DURING POSTERIOR INTERBODY ARTHRODESIS, LUMBAR; SINGLE VERTEBRAL SEGMENT 7 1 24.31 57.65 1 6 NA NA 7628 7628 Carrier O 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22840 Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) 7 1 39.23 7 NA NA 7629 7629 Carrier O 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63048 Room & Board Semiprivate (Two Beds)-Psychiatric 6 1 24.3 63.25 1 5 NA NA 7630 7630 Carrier O 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22614 Room & Board Semiprivate (Two Beds)-Detoxification 6 1 24.31 62.94 1 5 NA NA 7631 7631 Carrier O 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 61783 STEREOTACTIC COMPUTER-ASSISTED (NAVIGATIONAL) PROCEDURE; SPINAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 4 1 24.31 46.64 1 3 NA NA 7632 7632 Carrier O 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63047 Room & Board Private (One Bed)-Psychiatric 4 1 68.27 4 NA NA 7633 7633 Carrier O 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 20936 Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure) 4 1 24.31 46.99 1 3 NA NA 7634 7634 Carrier O 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44620 CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE; 4 1 1.87 17.92 1 3 NA NA 7635 7635 Carrier O 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 32100 THORACOTOMY, MAJOR; WITH EXPLORATION AND BIOPSY 1 1 91.71 1 NA NA 7636 7636 Carrier O 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. 534 0.676 1.37 8.71 54 480 NA NA 7637 7637 Carrier O 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. 506 0.6917 1.4 8.57 53 453 NA NA 7638 7638 Carrier O 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99203 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. 506 0.6976 1.43 8.75 50 456 NA NA 7639 7639 Carrier O 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99205 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. 501 0.6886 1.41 8.63 52 449 NA NA 7640 7640 Carrier O 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99204 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. 501 0.6926 1.43 8.81 50 451 NA NA 7641 7641 Carrier O 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99215 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. 499 0.6994 1.41 8.89 51 448 NA NA 7642 7642 Carrier O 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99202 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded. 497 0.6942 1.47 8.93 52 445 NA NA 7643 7643 Carrier O 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded. 491 0.6945 1.56 8.75 51 440 NA NA 7644 7644 Carrier O 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99211 Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional 490 0.6959 1.45 9.02 49 441 NA NA 7645 7645 Carrier O 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) 399 0.9398 7.96 25.7 48 351 NA NA 7646 7646 Carrier O 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 78815 Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; skull base to mid-thigh 33 1 0.86 2.89 18 15 NA NA 7647 7647 Carrier O 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 78816 Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; whole body 33 1 0.89 2.81 17 16 NA NA 7648 7648 Carrier O 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 78813 POSITRON EMISSION TOMOGRAPHY (PET) IMAGING; WHOLE BODY 32 1 0.89 2.89 17 15 NA NA 7649 7649 Carrier O 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 78812 POSITRON EMISSION TOMOGRAPHY (PET) IMAGING; SKULL BASE TO MID-THIGH 32 1 0.89 2.89 17 15 NA NA 7650 7650 Carrier O 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 78811 POSITRON EMISSION TOMOGRAPHY (PET) IMAGING; LIMITED AREA (EG, CHEST, HEAD/NECK) 32 1 0.89 2.89 17 15 NA NA 7651 7651 Carrier O 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77067 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed 29 1 0.94 2.65 3 26 NA NA 7652 7652 Carrier O 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77065 DIAGNOSTIC MAMMOGRAPHY, INCLUDING COMPUTER-AIDED DETECTION (CAD) WHEN PERFORMED; UNILATERAL 25 1 0.84 2.25 4 21 NA NA 7653 7653 Carrier O 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70460 COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITH CONTRAST MATERIAL(S) 25 1 1.43 3.05 5 20 NA NA 7654 7654 Carrier O 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70470 COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS 25 1 1.43 3.05 5 20 NA NA 7655 7655 Carrier O 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70450 COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL 25 1 1.43 3.04 5 20 NA NA 7656 7656 Carrier O 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft 4 0.16 145.62 4 NA NA 7657 7657 Carrier O 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 2 0.0065 128.13 2 NA NA 7658 7658 Carrier O 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 2 0.0059 128.13 2 NA NA 7659 7659 Carrier O 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 73720 Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) and further sequences 2 0.008 102.66 2 NA NA 7660 7660 Carrier O 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 73722 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY; WITH CONTRAST MATERIAL(S) 2 0.008 102.66 2 NA NA 7661 7661 Carrier O 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 62323 Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT) 2 0.0645 81.42 2 NA NA 7662 7662 Carrier O 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97116 THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; GAIT TRAINING (INCLUDES STAIR CLIMBING) 2 0.0093 128.13 2 NA NA 7663 7663 Carrier O 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64483 INJECTION, ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL; LUMBAR OR SACRAL, SINGLE LEVEL 2 0.0345 71.96 2 NA NA 7664 7664 Carrier O 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 73719 MAGNETIC RESONANCE (EG, PROTON) IMAGING, LOWER EXTREMITY OTHER THAN JOINT; WITH CONTRAST MATERIAL(S) 2 0.008 102.66 2 NA NA 7665 7665 Carrier O 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64493 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level 2 0.0952 52.95 2 NA NA 7666 7666 Carrier O 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0018 Behavioral health; short-term residential (nonhospital residential treatment program), without room and board, per diem 10 1 72.81 10 NA NA 7667 7667 Carrier O 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 Room & Board in a psychiatric setting (semi-private/two-bed). Used for inpatient psychiatric services 8 1 16.6 8 NA NA 7668 7668 Carrier O 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0011 ALCOHOL AND/OR DRUG SERVICES; ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION PROGRAM INPATIENT) 6 0.1667 19.83 24.69 1 5 NA NA 7669 7669 Carrier O 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0010 ALCOHOL AND/OR DRUG SERVICES; SUB-ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION PROGRAM INPATIENT) 5 1 19.44 5 NA NA 7670 7670 Carrier O 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 99221 INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A DETAILED 5 0.8 37.79 5 NA NA 7671 7671 Carrier O 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 126 Semi-private, two-bed room for detoxification services in a hospital setting. 4 0.5 22.85 11.22 1 3 NA NA 7672 7672 Carrier O 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 114 Private room & board for psychiatric services. 4 1 18.09 4 NA NA 7673 7673 Carrier O 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC S9485 CRISIS INTERVENTION MENTAL HEALTH SERVICES, PER DIEM 1 1 17.8 1 NA NA 7674 7674 Carrier O 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H2013 PSYCHIATRIC HEALTH FACILITY SERVICE, PER DIEM 1 1 3.44 1 NA NA 7675 7675 Carrier O 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0018 Behavioral health; short-term residential (nonhospital residential treatment program), without room and board, per diem 10 1 72.81 10 NA NA 7676 7676 Carrier O 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 Room & Board in a psychiatric setting (semi-private/two-bed). Used for inpatient psychiatric services 8 1 16.6 8 NA NA 7677 7677 Carrier O 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0010 ALCOHOL AND/OR DRUG SERVICES; SUB-ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION PROGRAM INPATIENT) 5 1 19.44 5 NA NA 7678 7678 Carrier O 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 114 Private room & board for psychiatric services. 4 1 18.09 4 NA NA 7679 7679 Carrier O 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S9485 CRISIS INTERVENTION MENTAL HEALTH SERVICES, PER DIEM 1 1 17.8 1 NA NA 7680 7680 Carrier O 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H2013 PSYCHIATRIC HEALTH FACILITY SERVICE, PER DIEM 1 1 3.44 1 NA NA 7681 7681 Carrier O 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99221 INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A DETAILED 4 0.8 41.14 4 NA NA 7682 7682 Carrier O 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 126 Semi-private, two-bed room for detoxification services in a hospital setting. 2 0.5 15.92 2 NA NA 7683 7683 Carrier O 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0011 ALCOHOL AND/OR DRUG SERVICES; ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION PROGRAM INPATIENT) 1 0.1667 42.22 1 NA NA 7684 7684 Carrier O 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY, 60 MINUTES WITH PATIENT 49 0.2857 8.21 107.26 9 40 NA NA 7685 7685 Carrier O 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC S9480 INTENSIVE OUTPATIENT PSYCHIATRIC SERVICES, PER DIEM 25 0.48 6.13 44.39 3 22 NA NA 7686 7686 Carrier O 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION 17 0.2941 1.7 7.12 2 15 NA NA 7687 7687 Carrier O 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90834 PSYCHOTHERAPY, 45 MINUTES WITH PATIENT 13 0.3846 1.36 8.82 2 11 NA NA 7688 7688 Carrier O 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 11 0.4545 2.95 72.76 1 10 NA NA 7689 7689 Carrier O 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION TREATMENT; DELIVERY AND MANAGEMENT, PER SESSION 11 0.4545 2.95 72.76 1 10 NA NA 7690 7690 Carrier O 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION TREATMENT; PLANNING 11 0.4545 2.95 72.75 1 10 NA NA 7691 7691 Carrier O 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. 10 0.2 1.6 10 NA NA 7692 7692 Carrier O 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90832 PSYCHOTHERAPY, 30 MINUTES WITH PATIENT 7 0.2857 2.43 15.3 1 6 NA NA 7693 7693 Carrier O 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 99204 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. 6 0.6667 3.1 6 NA NA 7694 7694 Carrier O 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99215 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. 2 1 2.61 2 NA NA 7695 7695 Carrier O 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99203 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. 2 1 0.56 2 NA NA 7696 7696 Carrier O 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99441 Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion 1 1 0.43 1 NA NA 7697 7697 Carrier O 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96127 Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument 1 1 4.77 1 NA NA 7698 7698 Carrier O 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96165 HEALTH BEHAVIOR INTERVENTION, GROUP (2 OR MORE PATIENTS), FACE-TO-FACE; EACH ADDITIONAL 15 1 1 69.52 1 NA NA 7699 7699 Carrier O 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99442 Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion 1 1 0.43 1 NA NA 7700 7700 Carrier O 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99211 Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional 1 1 0.46 1 NA NA 7701 7701 Carrier O 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded. 1 1 0.46 1 NA NA 7702 7702 Carrier O 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96164 HEALTH BEHAVIOR INTERVENTION, GROUP (2 OR MORE PATIENTS), FACE-TO-FACE; INITIAL 30 MINUTES 1 1 69.51 1 NA NA 7703 7703 Carrier O 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99204 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. 4 0.6667 0.58 4 NA NA 7704 7704 Carrier O 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICE 176 0.9659 23.03 5817.52 7 169 NA NA 7705 7705 Carrier O 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0562 HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE 107 0.9626 44.45 4355.19 8 99 NA NA 7706 7706 Carrier O 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 19 0.8947 39.55 1284.95 3 16 NA NA 7707 7707 Carrier O 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4222 INFUSION SUPPLIES FOR EXTERNAL DRUG INFUSION PUMP, PER CASSETTE OR BAG (LIST DRUGS SEPARATELY) 15 1 15.57 960.71 1 14 NA NA 7708 7708 Carrier O 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A7038 FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE 14 1 2.01 432.79 1 13 NA NA 7709 7709 Carrier O 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0781 Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient 13 1 15.57 1033.4 1 12 NA NA 7710 7710 Carrier O 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A7035 HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE 13 1 2.12 415.51 1 12 NA NA 7711 7711 Carrier O 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A7034 NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT HEAD STRAP 12 1 2.12 294.43 1 11 NA NA 7712 7712 Carrier O 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L1852 Knee orthosis (KO), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf 10 0.7 30.83 10 NA NA 7713 7713 Carrier O 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L3000 FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, 'UCB' TYPE, BERKELEY SHELL, EACH 10 0.8 71.31 10 NA NA 7714 7714 Carrier O 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4222 INFUSION SUPPLIES FOR EXTERNAL DRUG INFUSION PUMP, PER CASSETTE OR BAG (LIST DRUGS SEPARATELY) 14 1 2.1 33.29 1 13 NA NA 7715 7715 Carrier O 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A7038 FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE 14 1 15.57 72.53 1 13 NA NA 7716 7716 Carrier O 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0781 Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient 13 1 15.57 86.12 1 12 NA NA 7717 7717 Carrier O 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A7035 HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE 13 1 2.12 34.63 1 12 NA NA 7718 7718 Carrier O 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A7034 NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT HEAD STRAP 12 1 2.12 26.77 1 11 NA NA 7719 7719 Carrier O 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A7037 TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE 10 1 19.99 10 NA NA 7720 7720 Carrier O 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4604 TUBING WITH INTEGRATED HEATING ELEMENT FOR USE WITH POSITIVE AIRWAY PRESSURE DEVICE 10 1 2.08 25.47 1 9 NA NA 7721 7721 Carrier O 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1390 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate 7 1 1.77 25.46 2 5 NA NA 7722 7722 Carrier O 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A7036 CHINSTRAP USED WITH POSITIVE AIRWAY PRESSURE DEVICE 6 1 2.13 20.78 1 5 NA NA 7723 7723 Carrier O 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A7039 FILTER, NON DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE 6 1 2.08 17.83 1 5 NA NA 7724 7724 Carrier O 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L2820 ADDITION TO LOWER EXTREMITY ORTHOSIS, SOFT INTERFACE FOR MOLDED PLASTIC, BELOW KNEE SECTION 1 0.1111 193.29 1 NA NA 7725 7725 Carrier O 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L2750 ADDITION TO LOWER EXTREMITY ORTHOSIS, PLATING CHROME OR NICKEL, PER BAR 1 0.5 193.29 1 NA NA 7726 7726 Carrier O 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC A4222 INFUSION SUPPLIES FOR EXTERNAL DRUG INFUSION PUMP, PER CASSETTE OR BAG (LIST DRUGS SEPARATELY) 1 0.0667 17.83 1 NA NA 7727 7727 Carrier O 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC G0068 Professional services for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individual's home, each 15 min 1 1 17.83 1 NA NA 7728 7728 Carrier O 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L2755 Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only 1 0.25 193.29 1 NA NA 7729 7729 Carrier O 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L2036 Knee-ankle-foot orthosis (KAFO), full plastic, double upright, with or without free motion knee, with or without free motion ankle, custom fabricated 1 0.5 193.28 1 NA NA 7730 7730 Carrier O 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L2830 ADDITION TO LOWER EXTREMITY ORTHOSIS, SOFT INTERFACE FOR MOLDED PLASTIC, ABOVE KNEE SECTION 1 0.5 193.29 1 NA NA 7731 7731 Carrier O 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L2275 ADDITION TO LOWER EXTREMITY, VARUS/VALGUS CORRECTION, PLASTIC MODIFICATION, PADDED/LINED 1 0.125 193.29 1 NA NA 7732 7732 Carrier O 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L2415 ADDITION TO KNEE LOCK WITH INTEGRATED RELEASE MECHANISM ( BAIL, CABLE, OR EQUAL), ANY MATERIAL, EACH JOINT 1 0.5 193.29 1 NA NA 7733 7733 Carrier O 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 EXTERNAL AMBULATORY INFUSION PUMP, INSULIN 19 0.9474 103 1155.1 4 15 NA NA 7734 7734 Carrier O 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with nondurable medical equipment interstitial continuous glucose monitoring system (CGM), one unit = 1 day supply 14 1 49.61 699.96 3 11 NA NA 7735 7735 Carrier O 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4239 Supply allowance for nonadjunctive, nonimplanted continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service 14 0.8571 524.55 14 NA NA 7736 7736 Carrier O 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4221 SUPPLIES FOR MAINTENANCE OF NON-INSULIN DRUG INFUSION CATHETER, PER WEEK (LIST DRUGS SEPARATELY) 12 0.9167 15.57 419.13 1 11 NA NA 7737 7737 Carrier O 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9277 TRANSMITTER; EXTERNAL, FOR USE WITH INTERSTITIAL CONTINUOUS GLUCOSE MONITORING SYSTEM 11 1 32.77 620.05 2 9 NA NA 7738 7738 Carrier O 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4224 SUPPLIES FOR MAINTENANCE OF INSULIN INFUSION CATHETER, PER WEEK 8 1 529.58 8 NA NA 7739 7739 Carrier O 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4225 SUPPLIES FOR EXTERNAL INSULIN INFUSION PUMP, SYRINGE TYPE CARTRIDGE, STERILE, EACH 7 1 410.96 7 NA NA 7740 7740 Carrier O 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2103 NON-ADJUNCTIVE, NON-IMPLANTED CONTINUOUS GLUCOSE MONITOR OR RECEIVER 6 0.8333 179.17 6 NA NA 7741 7741 Carrier O 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4232 SYRINGE WITH NEEDLE FOR EXTERNAL INSULIN PUMP, STERILE, 3CC 6 1 352.01 6 NA NA 7742 7742 Carrier O 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4230 INFUSION SET FOR EXTERNAL INSULIN PUMP, NON NEEDLE CANNULA TYPE 4 1 222.61 4 NA NA 7743 7743 Carrier O 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with nondurable medical equipment interstitial continuous glucose monitoring system (CGM), one unit = 1 day supply 14 1 16.54 63.63 3 11 NA NA 7744 7744 Carrier O 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9277 TRANSMITTER; EXTERNAL, FOR USE WITH INTERSTITIAL CONTINUOUS GLUCOSE MONITORING SYSTEM 11 1 16.39 68.89 2 9 NA NA 7745 7745 Carrier O 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4224 SUPPLIES FOR MAINTENANCE OF INSULIN INFUSION CATHETER, PER WEEK 7 1 61.78 7 NA NA 7746 7746 Carrier O 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4225 SUPPLIES FOR EXTERNAL INSULIN INFUSION PUMP, SYRINGE TYPE CARTRIDGE, STERILE, EACH 6 1 52.31 6 NA NA 7747 7747 Carrier O 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4232 SYRINGE WITH NEEDLE FOR EXTERNAL INSULIN PUMP, STERILE, 3CC 6 1 58.67 6 NA NA 7748 7748 Carrier O 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4230 INFUSION SET FOR EXTERNAL INSULIN PUMP, NON NEEDLE CANNULA TYPE 4 1 55.65 4 NA NA 7749 7749 Carrier O 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4238 Supply allowance for adjunctive, nonimplanted continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service 2 1 21.34 2 NA NA 7750 7750 Carrier O 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2102 ADJUNCTIVE, NONIMPLANTED CONTINUOUS GLUCOSE MONITOR (CGM) OR RECEIVER 1 1 21.06 1 NA NA 7751 7751 Carrier O 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 EXTERNAL AMBULATORY INFUSION PUMP, INSULIN 17 0.9474 25.54 75.57 3 14 NA NA 7752 7752 Carrier O 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4221 SUPPLIES FOR MAINTENANCE OF NON-INSULIN DRUG INFUSION CATHETER, PER WEEK (LIST DRUGS SEPARATELY) 11 0.9167 15.57 41.81 1 10 NA NA 7753 7753 Carrier O 2024 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC A4224 SUPPLIES FOR MAINTENANCE OF INSULIN INFUSION CATHETER, PER WEEK 1 1 97.09 1 NA NA 7754 7754 Carrier O 2024 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0784 EXTERNAL AMBULATORY INFUSION PUMP, INSULIN 1 1 97.09 1 NA NA 7755 7755 Carrier O 2024 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC A4225 SUPPLIES FOR EXTERNAL INSULIN INFUSION PUMP, SYRINGE TYPE CARTRIDGE, STERILE, EACH 1 1 97.09 1 NA NA 7756 7756 Carrier O 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 146 0.9 0 2.887096774 22 124 DULAGLUTIDE NA 7757 7757 Carrier O 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 143 0.94 0 0.324675325 66 77 APIXABAN NA 7758 7758 Carrier O 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 95 0.96 0 0.172839506 14 81 EMPAGLIFLOZIN NA 7759 7759 Carrier O 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 94 0.98 0 1.308641975 13 81 EMPAGLIFLOZIN NA 7760 7760 Carrier O 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 91 0.96 0.481481481 0.640625 0.22 27 64 1 ADALIMUMAB NA 7761 7761 Carrier O 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 73 0.68 0 7.253968254 10 63 TIRZEPATIDE NA 7762 7762 Carrier O 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 67 0.57 0 0.387096774 5 62 FLASH GLUCOSE SENSOR NA 7763 7763 Carrier O 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 57 0.93 0 0.066666667 12 45 DULAGLUTIDE NA 7764 7764 Carrier O 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 54 0.94 0 0.56 4 50 DUPILUMAB NA 7765 7765 Carrier O 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 52 0.94 0 0.024390244 11 41 RIVAROXABAN NA 7766 7766 Carrier O 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 39 1 0 0 6 33 DEXTROAMPHETAMINE/AMPHETAMINE NA 7767 7767 Carrier O 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 28 1 0 0.063596491 9 19 ETANERCEPT NA 7768 7768 Carrier O 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 27 1 0 0 5 22 DEXTROAMPHETAMINE/AMPHETAMINE NA 7769 7769 Carrier O 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 23 1 0 0 8 15 DEXTROAMPHETAMINE/AMPHETAMINE NA 7770 7770 Carrier O 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 21 1 0 0 4 17 DEXTROAMPHETAMINE/AMPHETAMINE NA 7771 7771 Carrier O 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 17 1 0 0 5 12 DEXTROAMPHETAMINE/AMPHETAMINE NA 7772 7772 Carrier O 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 16 1 0 0 2 14 DAPAGLIFLOZIN PROPANEDIOL NA 7773 7773 Carrier O 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 15 1 0 0 7 8 RISANKIZUMAB-RZAA NA 7774 7774 Carrier O 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 15 1 0 0.002777778 5 10 OFATUMUMAB NA 7775 7775 Carrier O 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 15 1 0 0 3 12 METHYLPHENIDATE HCL NA 7776 7776 Carrier N 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96416 CHEMO PROLONG INFUSE W/PUMP 7 1 24 40 0 1 6 0 NA NA 7777 7777 Carrier N 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22633 ARTHRD CMBN 1NTRSPC LUMBAR 3 0 0 80 0 0 3 0 NA NA 7778 7778 Carrier N 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44626 REPAIR BOWEL OPENING 2 1 0 12 0 0 2 0 NA NA 7779 7779 Carrier N 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT S2068 BREAST DIEP OR SIEA FLAP 2 1 0 36 0 0 2 0 NA NA 7780 7780 Carrier N 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 55920 PLACE NEEDLES PELVIC FOR RT 2 1 0 48 0 0 2 0 NA NA 7781 7781 Carrier N 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 42415 EXCISE PAROTID GLAND/LESION 2 0 0 120 0 0 2 0 NA NA 7782 7782 Carrier N 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 50543 LAPARO PARTIAL NEPHRECTOMY 1 1 0 0 0 0 1 0 NA NA 7783 7783 Carrier N 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 32667 THORACOSCOPY W/W RESECT ADDL 1 1 0 72 0 0 1 0 NA NA 7784 7784 Carrier N 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 48999 UNLISTED PROCEDURE PANCREAS 1 1 0 24 0 0 1 0 NA NA 7785 7785 Carrier N 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22800 ARTHRD PST DFRM<6 VRT SGM 1 1 0 96 0 0 1 0 NA NA 7786 7786 Carrier N 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96416 CHEMO PROLONG INFUSE W/PUMP 7 1 24 40 0 1 6 0 NA NA 7787 7787 Carrier N 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44626 REPAIR BOWEL OPENING 2 1 0 12 0 0 2 0 NA NA 7788 7788 Carrier N 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT S2068 BREAST DIEP OR SIEA FLAP 2 1 0 36 0 0 2 0 NA NA 7789 7789 Carrier N 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 55920 PLACE NEEDLES PELVIC FOR RT 2 1 0 48 0 0 2 0 NA NA 7790 7790 Carrier N 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 50543 LAPARO PARTIAL NEPHRECTOMY 1 1 0 0 0 0 1 0 NA NA 7791 7791 Carrier N 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 32667 THORACOSCOPY W/W RESECT ADDL 1 1 0 72 0 0 1 0 NA NA 7792 7792 Carrier N 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 48999 UNLISTED PROCEDURE PANCREAS 1 1 0 24 0 0 1 0 NA NA 7793 7793 Carrier N 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22800 ARTHRD PST DFRM<6 VRT SGM 1 1 0 96 0 0 1 0 NA NA 7794 7794 Carrier N 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 32608 THORACOSCOPY W/BX NODULE 1 1 0 24 0 0 1 0 NA NA 7795 7795 Carrier N 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 54125 REMOVAL OF PENIS 1 1 0 48 0 0 1 0 NA NA 7796 7796 Carrier N 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95810 POLYSOM 6/> YRS 4/> PARAM 35 0.886 0 80.9 0 0 35 0 NA NA 7797 7797 Carrier N 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT J0585 INJECTION,ONABOTULINUMTOXINA 29 0.897 24 26.8 0 3 26 0 NA NA 7798 7798 Carrier N 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 OFFICE O/P EST MOD 30 MIN 22 0.727 12 126 0 2 20 0 NA NA 7799 7799 Carrier N 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64615 CHEMODENERV MUSC MIGRAINE 18 0.889 24 24 0 2 16 0 NA NA 7800 7800 Carrier N 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT J7323 EUFLEXXA INJ PER DOSE 15 1 0 8.6 0 1 14 0 NA NA 7801 7801 Carrier N 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95811 POLYSOM 6/>YRS CPAP 4/> PARM 13 0.846 0 81.2 0 0 13 0 NA NA 7802 7802 Carrier N 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99213 OFFICE O/P EST LOW 20 MIN 13 0.692 0 174 0 1 12 0 NA NA 7803 7803 Carrier N 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT Q5103 INJECTION, INFLECTRA 10 0.9 144 130.7 0 1 9 0 NA NA 7804 7804 Carrier N 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 INSJ BIOMECHANICAL DEVICE 10 0.6 0 74.4 0 0 10 0 NA NA 7805 7805 Carrier N 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22845 INSERT SPINE FIXATION DEVICE 9 0.778 0 80 0 0 9 0 NA NA 7806 7806 Carrier N 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95810 POLYSOM 6/> YRS 4/> PARAM 31 0.886 0 35.6 0 0 31 0 NA NA 7807 7807 Carrier N 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J0585 INJECTION,ONABOTULINUMTOXINA 26 0.897 24 26.1 0 3 23 0 NA NA 7808 7808 Carrier N 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99214 OFFICE O/P EST MOD 30 MIN 16 0.727 12 87.4 0 2 14 0 NA NA 7809 7809 Carrier N 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64615 CHEMODENERV MUSC MIGRAINE 16 0.889 24 22.3 0 2 14 0 NA NA 7810 7810 Carrier N 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J7323 EUFLEXXA INJ PER DOSE 15 1 0 8.6 0 1 14 0 NA NA 7811 7811 Carrier N 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95811 POLYSOM 6/>YRS CPAP 4/> PARM 11 0.846 0 63.3 0 0 11 0 NA NA 7812 7812 Carrier N 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99213 OFFICE O/P EST LOW 20 MIN 9 0.692 0 108 0 1 8 0 NA NA 7813 7813 Carrier N 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J0178 AFLIBERCEPT INJECTION 9 1 0 24 0 2 7 0 NA NA 7814 7814 Carrier N 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT Q5103 INJECTION, INFLECTRA 9 0.9 144 111 0 1 8 0 NA NA 7815 7815 Carrier N 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J9306 INJECTION, PERTUZUMAB, 1 MG 8 1 0 68.6 0 1 7 0 NA NA 7816 7816 Carrier N 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT J0585 Injection, Botox 5 1 0 2784 0 0 5 0 NA NA 7817 7817 Carrier N 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 99214 Established patient office or other outpatient visit, 30-39 minutes 1 1 0 72 0 0 1 0 NA NA 7818 7818 Carrier N 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 93655 Intracardiac Electrophysiological Procedures/Studies 1 1 0 48 0 0 1 0 NA NA 7819 7819 Carrier N 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 33249 Pacemaker or Implantable Defibrillator Procedure 1 1 0 288 0 0 1 0 NA NA 7820 7820 Carrier N 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT J0741 Injection, Cabenuva 1 1 0 0 0 0 1 0 NA NA 7821 7821 Carrier N 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT J1437 Injection, Monoferric 1 1 0 24 0 0 1 0 NA NA 7822 7822 Carrier N 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1002 SUBSTANCE ABUSE RESIDENTIAL 2 1 0 0 2 0 0 NA NA 7823 7823 Carrier N 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 126 DETOX 1 1 0 0 1 0 0 NA NA 7824 7824 Carrier N 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1001 EATING DISORDER RESIDENTIAL 1 1 0 0 1 0 0 NA NA 7825 7825 Carrier N 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1002 SUBSTANCE ABUSE RESIDENTIAL 2 1 0 0 2 0 0 NA NA 7826 7826 Carrier N 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 126 DETOX 1 1 0 0 1 0 0 NA NA 7827 7827 Carrier N 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1001 EATING DISORDER RESIDENTIAL 1 1 0 0 1 0 0 NA NA 7828 7828 Carrier N 2024 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 1001 Eating Disorder Residential 1 1 24 0 0 1 0 0 NA NA 7829 7829 Carrier N 2024 Inpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal Revenue 1002 Substance Abuse Residential 1 1 48 0 0 1 0 0 NA NA 7830 7830 Carrier N 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 TRANSCRANIAL MAGNETIC STIMULATION (TMS) 3 1 0 0 0 3 0 NA NA 7831 7831 Carrier N 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 0362T APPLIED BEHAVIORAL ANALYSIS 1 1 0 0 0 1 0 NA NA 7832 7832 Carrier N 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 PSYCHIATRIC TREATMENT PARTIAL HOSPITALIZATION 1 1 0 0 0 1 0 NA NA 7833 7833 Carrier N 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90867 TRANSCRANIAL MAGNETIC STIMULATION (TMS) 3 1 0 0 0 3 0 NA NA 7834 7834 Carrier N 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 0362T APPLIED BEHAVIORAL ANALYSIS 1 1 0 0 0 1 0 NA NA 7835 7835 Carrier N 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0035 PSYCHIATRIC TREATMENT PARTIAL HOSPITALIZATION 1 1 0 0 0 1 0 NA NA 7836 7836 Carrier N 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L8680 IMPLT NEUROSTIM ELCTR EACH 1 1 0 0 0 0 1 0 NA NA 7837 7837 Carrier N 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L8614 COCHLEAR DEVICE 1 1 0 24 0 0 1 0 NA NA 7838 7838 Carrier N 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0760 OSTEOGEN ULTRASOUND STIMLTOR 1 1 0 24 0 0 1 0 NA NA 7839 7839 Carrier N 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L8688 IMPLT NROSTM PLS GEN DUA NON 1 1 0 0 0 0 1 0 NA NA 7840 7840 Carrier N 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0466 HOME VENT NON-INVASIVE INTER 1 1 0 48 0 0 1 0 NA NA 7841 7841 Carrier N 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L1846 KO W ADJ FLEX/EXT ROTAT MOLD 1 1 0 0 0 0 1 0 NA NA 7842 7842 Carrier N 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L8680 IMPLT NEUROSTIM ELCTR EACH 1 1 0 0 0 0 1 0 NA NA 7843 7843 Carrier N 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L8614 COCHLEAR DEVICE 1 1 0 24 0 0 1 0 NA NA 7844 7844 Carrier N 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0760 OSTEOGEN ULTRASOUND STIMLTOR 1 1 0 24 0 0 1 0 NA NA 7845 7845 Carrier N 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L8688 IMPLT NROSTM PLS GEN DUA NON 1 1 0 0 0 0 1 0 NA NA 7846 7846 Carrier N 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0466 HOME VENT NON-INVASIVE INTER 1 1 0 48 0 0 1 0 NA NA 7847 7847 Carrier N 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L1846 KO W ADJ FLEX/EXT ROTAT MOLD 1 1 0 0 0 0 1 0 NA NA 7848 7848 Carrier N 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year NA NA DEXCOM G7 SENSOR 82 0.5366 3.9 7 0 17 65 0 NA NA 7849 7849 Carrier N 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year NA NA DEXCOM G6 SENSOR 34 0.8824 0.5 6.5 0 7 27 0 NA NA 7850 7850 Carrier N 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year NA NA FREESTYLE LIBRE 3 SENSOR 34 0.3824 18.5 16 0 6 28 0 NA NA 7851 7851 Carrier N 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year NA NA DEXCOM G7 RECEIVER 22 0.3636 9.3 7.1 0 3 19 0 NA NA 7852 7852 Carrier N 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year NA NA DEXCOM G6 TRANSMITTER 21 0.7619 0.1 3.5 0 4 17 0 NA NA 7853 7853 Carrier N 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year NA NA FREESTYLE LIBRE 3 PLUS SENSOR 10 0.3 1.6 27.3 0 4 6 0 NA NA 7854 7854 Carrier N 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year NA NA FREESTYLE LIBRE 2 SENSOR 9 0.2222 61.1 10.7 0 1 8 0 NA NA 7855 7855 Carrier N 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year NA NA FREESTYLE LIBRE 14 DAY SENSOR 5 0 5 19.3 0 1 4 0 NA NA 7856 7856 Carrier N 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year NA NA TRUE METRIX GLUCOSE TEST STRIP 3 0.3333 0.1 0.4 0 2 1 0 NA NA 7857 7857 Carrier N 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year NA NA FREESTYLE LIBRE 3 READER 3 0.3333 0 0.6 0 1 2 0 NA NA 7858 7858 Carrier N 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA CONTOUR NEXT TEST STRIP 2 1 0 47 0 1 1 0 NA NA 7859 7859 Carrier N 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA FREESTYLE LIBRE 2 READER 1 1 61.1 1.7 0 0 1 0 NA NA 7860 7860 Carrier N 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA FREESTYLE TEST STRIPS 1 1 0 0 0 1 0 0 NA NA 7861 7861 Carrier N 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA ACCU-CHEK GUIDE TEST STRIP 1 1 0 0.2 0 0 1 0 NA NA 7862 7862 Carrier N 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA DEXCOM G6 SENSOR 34 0.8824 0.5 6.5 0 7 27 0 NA NA 7863 7863 Carrier N 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA DEXCOM G6 TRANSMITTER 21 0.7619 0.1 3.5 0 4 17 0 NA NA 7864 7864 Carrier N 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA DEXCOM G7 SENSOR 44 0.5366 3.9 7 0 17 65 0 NA NA 7865 7865 Carrier N 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA FREESTYLE LIBRE 3 SENSOR 34 0.3824 18.5 16 0 6 28 0 NA NA 7866 7866 Carrier N 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA DEXCOM G7 RECEIVER 82 0.3636 9.3 7.1 0 3 19 0 NA NA 7867 7867 Carrier N 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA FREESTYLE LIBRE 3 READER 3 0.3333 0 0.6 0 1 2 0 NA NA 7868 7868 Carrier N 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 195 0.5385 3.9 7 0 27 168 0 semaglutide OZEMPIC .25 OR 0.5 PEN INJCTR 7869 7869 Carrier N 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 161 0.7826 0.1 6.2 0 21 140 0 tirzepatide ZEPBOUND 2.5 MG/0.5 PEN INJCTR 7870 7870 Carrier N 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 146 0.4521 0.8 6.9 0 26 120 0 tirzepatide MOUNJARO 2.5 MG/0.5 PEN INJCTR 7871 7871 Carrier N 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 94 0.7766 2.2 3.9 0 8 86 0 semaglutide WEGOVY 0.25MG/0.5 PEN INJCTR 7872 7872 Carrier N 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 82 0.5366 0 6.2 0 17 65 0 Dexcom DEXCOM G7 SENSOR EACH 7873 7873 Carrier N 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 69 0.8382 0.2 8.5 0 18 51 0 semaglutide OZEMPIC 1/0.75 (3) PEN INJCTR 7874 7874 Carrier N 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 68 0.6957 0 2.9 0 8 60 0 rimegepant NURTEC ODT 75 MG TAB RAPDIS 7875 7875 Carrier N 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 53 0.8491 0.7 8.8 0 27 26 0 apixaban ELIQUIS 5 MG TABLET 7876 7876 Carrier N 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 49 0.8571 2.7 3 0 8 41 0 dupillamab DUPIXENT PEN 300 MG/2ML PEN INJCTR 7877 7877 Carrier N 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 49 0.6939 1.9 3.9 0 2 47 0 ruxolitinib OPZELURA 1.5 % CREAM (G) 7878 7878 Carrier N 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 34 1 0.1 7.8 0 4 30 0 dextroamphetamine DEXTROAMPHETAMINE-AMPH 20 MG CAP.SR 24H 7879 7879 Carrier N 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 28 1 1 0.9 0 15 13 0 rivaroxaban XARELTO 20 MG TABLET 7880 7880 Carrier N 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 22 1 13.7 0 0 5 17 0 dextroamphetamine DEXTROAMPHETAMINE-AMPH 10 MG TABLET 7881 7881 Carrier N 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 20 1 3.6 0.1 0 5 15 0 dextroamphetamine DEXTROAMPHETAMINE-AMPHET ER 20 MG CAP.SR 24H 7882 7882 Carrier N 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 16 1 0 2.6 0 4 12 0 upadacitinib RINVOQ 15 MG TAB ER 24H 7883 7883 Carrier N 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 16 1 0 0.1 0 5 11 0 dextroamphetamine DEXTROAMPHETAMINE-AMPHET ER 10 MG CAP.SR 24H 7884 7884 Carrier N 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 14 1 5.3 3.3 0 5 9 0 methylphenidate METHYLPHENIDATE HCL 10 MG TABLET 7885 7885 Carrier N 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 13 1 0 0 0 3 10 0 methylphenidate METHYLPHENIDATE ER 36 MG TAB ER 24 7886 7886 Carrier N 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 13 1 0 0.1 0 4 9 0 atogepant QULIPTA 60 MG TABLET 7887 7887 Carrier N 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 13 1 17.2 5.4 0 3 10 0 etanercept ENBREL SURECLICK 50MG/ML(1) PEN INJCTR 7888 7888 Carrier N 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 5 1 0 768 0 0 5 0 Evolocumab REPATHA 7889 7889 Carrier N 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 2 1 0 216 0 0 2 0 Fremanezumab AJOVY 7890 7890 Carrier N 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 2 1 0 48 0 0 2 0 Dupilumab DUPIXENT 7891 7891 Carrier N 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 2 1 0 984 0 0 2 0 Semaglutide OZEMPIC 7892 7892 Carrier N 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 2 1 0 744 0 0 2 0 Semaglutide WEGOVY 7893 7893 Carrier N 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 2 1 0 384 0 0 2 0 Tirzepatide ZEPBOUND 7894 7894 Carrier N 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 1 1 0 168 0 0 1 0 Eerenumab AIMOVIG 7895 7895 Carrier N 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 1 1 0 432 0 0 1 0 Eerenumab AIMOVIG AUTOINJECTOR 7896 7896 Carrier N 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 1 1 0 48 0 0 1 0 Bupropion Hydrochloride APLENZIN 7897 7897 Carrier N 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 1 1 0 192 0 0 1 0 Dextromethorphan/Bupropion AUVELITY 7898 7898 Carrier C 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 59400 FULL ROUT OBSTE CARE,VAGINAL DELIV 43 1 0.51 0 43 0 NA NA 7899 7899 Carrier C 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 59510 FULL ROUT OBSTE CARE,CESAREAN DELIV 35 1 0.8 12.5 1 34 0 NA NA 7900 7900 Carrier C 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44204 COLECTOMY LAP PARTIAL W/ ANAST 14 1 1 4 2 12 0 NA NA 7901 7901 Carrier C 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96416 CHEMO ADMIN IV INFUS >8 HRS W/PORT/IMPLANTED PUMP 13 1 3 28.92 1 12 0 NA NA 7902 7902 Carrier C 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 ARTHRODESIS ANT INTERBODY W/ DISKECTOMY LU 8 0.75 12 63.67 2 6 0 NA NA 7903 7903 Carrier C 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 120.101 REF SKILLED NURSING FACILITY (SNF) 6 0.2587 85 3 5 1 0 NA NA 7904 7904 Carrier C 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 33361 REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH 6 1 42.67 0 6 0 NA NA 7905 7905 Carrier C 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27447 TOTAL KNEE ARTHROPLASTY 6 0 59 0 6 0 NA NA 7906 7906 Carrier C 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95720 EEG, CONT RECORD, EA INCRMNT >12 HRS, UP TO 26 HRS, INTERP & REP AFTER EA 24 HR; W/VIDEO 5 1 0.12 0 5 0 NA NA 7907 7907 Carrier C 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT G4033 SKILLED NURSING FACILITY SS 5 0.2 459 3 2 0 NA NA 7908 7908 Carrier C 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 59400 FULL ROUT OBSTE CARE,VAGINAL DELIV 43 1 0.51 0 43 0 NA NA 7909 7909 Carrier C 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 59510 FULL ROUT OBSTE CARE,CESAREAN DELIV 35 1 0.8 12.5 1 34 0 NA NA 7910 7910 Carrier C 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44204 COLECTOMY LAP PARTIAL W/ ANAST 14 1 1 4 2 12 0 NA NA 7911 7911 Carrier C 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96416 CHEMO ADMIN IV INFUS >8 HRS W/PORT/IMPLANTED PUMP 13 1 3 28.92 1 12 0 NA NA 7912 7912 Carrier C 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33361 REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH 6 1 42.67 0 6 0 NA NA 7913 7913 Carrier C 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95720 EEG, CONT RECORD, EA INCRMNT >12 HRS, UP TO 26 HRS, INTERP & REP AFTER EA 24 HR; W/VIDEO 5 1 0.12 0 5 0 NA NA 7914 7914 Carrier C 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 61624 TRANSCATH OCCLUSION/EMBOLIZAT PERCUT CNS 5 1 16 32 1 4 0 NA NA 7915 7915 Carrier C 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 36430 TRANSFUSION BLOOD/BLOOD COMPONENTS 5 1 24.4 0 5 0 NA NA 7916 7916 Carrier C 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 50360 TRANSPLANTATION OF KIDNEY 5 1 30.6 0 5 0 NA NA 7917 7917 Carrier C 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 59409 VAG DELIVERY ONLY (W/WO EPISIOTOMY &/OR FORCEPS) 4 1 0.56 0 4 0 NA NA 7918 7918 Carrier C 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 61512 CRANIECT TREPH BONE FLAP CRANIO EXC MENINGIO SUPR 3 0.6667 48.67 0 3 0 NA NA 7919 7919 Carrier C 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN 57616 0.9853 4.95 7.05 4832 52784 0 NA NA 7920 7920 Carrier C 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97110 THERA PROC 1+ AREAS EA 15 MIN THERA EXERCISES 9685 0.9922 3.44 5.91 326 9359 0 NA NA 7921 7921 Carrier C 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97124 THERA PROC 1+ AREAS EA 15 MIN MASSAGE 7060 0.9918 1.54 2.51 139 6921 0 NA NA 7922 7922 Carrier C 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 COLONOSCOPY W/ BX SINGLE/MULT 3305 0.9973 1.34 5.5 91 3214 0 NA NA 7923 7923 Carrier C 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 TTE (ECHO) WITH SPECTRAL & COLOR FLOW DOPPLER 1616 0.9963 1.78 10.02 176 1440 0 NA NA 7924 7924 Carrier C 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97530 THERA ACTVI DIRECT PAT CONTACT EA 15 MIN 1541 0.989 2.59 8.95 72 1469 0 NA NA 7925 7925 Carrier C 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99202 OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES 1482 0.973 3.88 14.47 176 1306 0 NA NA 7926 7926 Carrier C 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 MRI BRAIN W/ & W/O CONTRAST, 1365 0.8359 7.75 32.84 197 1168 0 NA NA 7927 7927 Carrier C 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99201.555 REF MISCELLANEOUS EXTERNAL 1306 0.9387 15.4 28.94 142 1164 0 NA NA 7928 7928 Carrier C 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 MRI ANY JOINT 1185 0.8034 4.73 26.87 97 1088 0 NA NA 7929 7929 Carrier C 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96040 GENETICS COUNSELING, EACH 30 MIN, W/ PT/FAMILY 996 1 0.57 4.6 347 649 0 NA NA 7930 7930 Carrier C 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95806 SLEEP STUDY, UNATTENDED 353 1 1.68 5.94 2 351 0 NA NA 7931 7931 Carrier C 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93015 ETT STRESS &/OR PHARMACOLOGICAL STRESS 344 1 1.72 5.79 18 326 0 NA NA 7932 7932 Carrier C 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 45389 COLONOSCOPY, FLEXIBLE; WITH ENDOSCOPIC STENT PLACEMENT 304 1 1.15 5.84 13 291 0 NA NA 7933 7933 Carrier C 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 52000 CYSTOURETHROSCOPY (SEP PROC) 235 1 2.58 30.81 12 223 0 NA NA 7934 7934 Carrier C 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 17000 DESTRUCT 1ST AK PREMALIG LESION 228 1 1.33 2.5 6 222 0 NA NA 7935 7935 Carrier C 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93922 NON-INVASIVE STUDY EXTREMITY ARTERY BILAT SINGLE 204 1 0.28 6.51 11 193 0 NA NA 7936 7936 Carrier C 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99024 POST OP FOLLOW-UP VISIT GLOBAL 197 1 3.75 20.97 28 169 0 NA NA 7937 7937 Carrier C 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93970 DUPLEX SCAN, VEINS, BILATERAL 178 1 0.86 8.13 14 164 0 NA NA 7938 7938 Carrier C 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99201.144 REF PODIATRY - INTERNAL 177 1 39.81 147.77 21 156 0 NA NA 7939 7939 Carrier C 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 0169U NUDT15 & TPMT GENE ANALYSIS COMMON VARIANTS 2 0.5 28.5 0 2 0 NA NA 7940 7940 Carrier C 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 36474 VENOUS ABLATION MECHANOCHEMICAL, EA ADDL VEIN 2 0.5 1 75 1 1 0 NA NA 7941 7941 Carrier C 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43497 TRANSORAL LOWER ESOPHAGEAL MYOTOMY 2 0.5 40 0 2 0 NA NA 7942 7942 Carrier C 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 61736 LITT LES ICR SINGLE TRAJECTORY 1 SIMPLE LESION 2 0.5 40.5 0 2 0 NA NA 7943 7943 Carrier C 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT S9341 HIT ENTERAL GRAV DIEM 2 0.5 58.5 0 2 0 NA NA 7944 7944 Carrier C 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 0479T FRACTIONAL ABL LASER FENESTRATION; FIRST 100 SQCM 3 0.3333 16 48 1 2 0 NA NA 7945 7945 Carrier C 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64555 PERCUT IMPLANT NEUROSTIM ELECTRO 3 0.3333 57 0 3 0 NA NA 7946 7946 Carrier C 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 81170 ABL1,GENE ANALYSIS, VARIANTS IN THE KINASE DOMAIN 3 0.3333 26 45.5 1 2 0 NA NA 7947 7947 Carrier C 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 81201 APC GENE ANALYSIS FULL GENE SEQUENCE 3 0.3333 40.67 0 3 0 NA NA 7948 7948 Carrier C 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 81324 PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS 3 0.3333 40.67 0 3 0 NA NA 7949 7949 Carrier C 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 128.102 REF IP CD RESIDENTIAL TREATMENT CENTER 3 1 15 3 0 0 NA NA 7950 7950 Carrier C 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT H2020 THER BEHAV SVC, PER DIEM 1 1 70 1 0 0 NA NA 7951 7951 Carrier C 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 128.102 REF IP CD RESIDENTIAL TREATMENT CENTER 3 1 15 3 0 0 NA NA 7952 7952 Carrier C 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT H2020 THER BEHAV SVC, PER DIEM 1 1 70 1 0 0 NA NA 7953 7953 Carrier C 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY 60 MIN PATIENT 8544 0.9963 0.92 2.72 306 8238 0 NA NA 7954 7954 Carrier C 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90836 PSYCHOTHERAPY 45 MIN PATIENT WITH MEDICAL SVCS 3219 0.9984 0.55 4.13 191 3028 0 NA NA 7955 7955 Carrier C 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90791 PSYCHIATRIC DIAGNOSTIC EVAL W/O MEDICAL SERVICES 678 0.9602 6.92 11.29 27 651 0 NA NA 7956 7956 Carrier C 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90853 GROUP PSYCHOTHERAPY 494 0.996 5.4 7.29 5 489 0 NA NA 7957 7957 Carrier C 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96130 PSYCHOLOGICAL TESTING EVAL BY PHYS OR QUAL PROF; FIRST HOUR 320 0.9719 20.5 8.38 2 318 0 NA NA 7958 7958 Carrier C 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 TRANSCRANIAL MAG STIMJ TX DLVR & MGMT 235 0.8383 35 56.62 2 233 0 NA NA 7959 7959 Carrier C 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 BEHAV IDENTIFICATION ASSESSMNT, ADM BY PHYS OR QUAL PROF, EA 15 MINS 185 0.8541 72 99.03 1 184 0 NA NA 7960 7960 Carrier C 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96132 NEUROPSYCHOLOGICAL TEST EVAL BY PHYS OR QUAL PROF; FIRST HOUR 172 0.8721 18.5 40.52 2 170 0 NA NA 7961 7961 Carrier C 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90792 PSYCHIATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES 135 0.9778 19.2 39.07 5 130 0 NA NA 7962 7962 Carrier C 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT H0020 ALCOHOL AND/OR DRUG SERVICES 102 1 2.57 0 102 0 NA NA 7963 7963 Carrier C 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT H0020 ALCOHOL AND/OR DRUG SERVICES 102 1 2.57 0 102 0 NA NA 7964 7964 Carrier C 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90833 PSYCHOTHERAPY 30 MIN PATIENT WITH MEDICAL SVCS 88 1 1.2 7.16 5 83 0 NA NA 7965 7965 Carrier C 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90806.102 REF MENTAL HEALTH EXTERNAL 46 1 26.98 0 46 0 NA NA 7966 7966 Carrier C 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT S9480 PSYCH SVC INTENSIVE OUTPT 19 1 12.95 0 19 0 NA NA 7967 7967 Carrier C 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96156 HEALTH BEHAVIOR ASSESSMENT, OR RE-ASSESSMENT 7 1 2.14 0 7 0 NA NA 7968 7968 Carrier C 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96116 NEUROBEHAVIORAL STATUS EXAM, PHYS OR QUAL PROF, FIRST HOUR 6 1 7 0 6 0 NA NA 7969 7969 Carrier C 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90849 MULT-FAMILY GROUP PSYCHOTHERAPY 4 1 2.5 0 4 0 NA NA 7970 7970 Carrier C 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90870 ECT (W/ MONITORING) SINGLE SEIZURE 4 1 339 52.33 1 3 0 NA NA 7971 7971 Carrier C 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99214.103 REF SUBSTANCE USE DISORDER TREATMENT - EXTERNAL 3 1 1.33 0 3 0 NA NA 7972 7972 Carrier C 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96136 PSYCHOLOGICAL OR NEUROPSYCHOLOGICAL TEST BY PHYS,2 OR MORE;FIRST 30 MINS 2 1 60.5 0 2 0 NA NA 7973 7973 Carrier C 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90868 TRANSCRANIAL MAG STIMJ TX DLVR & MGMT 235 0.0128 35 56.62 2 233 0 NA NA 7974 7974 Carrier C 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97151 BEHAV IDENTIFICATION ASSESSMNT, ADM BY PHYS OR QUAL PROF, EA 15 MINS 185 0.0054 72 99.03 1 184 0 NA NA 7975 7975 Carrier C 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90837 PSYCHOTHERAPY 60 MIN PATIENT 8544 0.0001 0.92 2.72 306 8238 0 NA NA 7976 7976 Carrier C 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0601 CPAP DEVICE 2136 0.993 0.72 5.31 528 1608 0 NA NA 7977 7977 Carrier C 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0603 DME ELECTRIC BREAST PUMP KIT PURCHASE 1306 0.9985 1.68 8.95 752 554 0 NA NA 7978 7978 Carrier C 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0604 DME ELECTRIC BREAST PUMP KIT RENTAL 719 0.9972 0.32 5.69 525 194 0 NA NA 7979 7979 Carrier C 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0143 WALKER, FOLDING, WHEELED, ADJUSTABLE OR FIXED HEIGHT 537 0.9981 2.67 7.65 261 276 0 NA NA 7980 7980 Carrier C 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0114 CRUTCHES METAL UNDERARM PAIR 511 0.998 1.88 2 24 487 0 NA NA 7981 7981 Carrier C 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L4361 PNEUMATIC, WALKING BOOT 493 1 3.8 3.79 5 488 0 NA NA 7982 7982 Carrier C 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT A7027 COMB ORAL/NASAL MASK USED W/CPAP DEVICE EA 490 0.998 1.11 3.83 57 433 0 NA NA 7983 7983 Carrier C 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L3908 WRIST SPLINT W/WO COCK-UP 307 1 2 3.71 8 299 0 NA NA 7984 7984 Carrier C 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0118 CRUTCH SUBSTITUTE, LOWER LEG PLATFORM, WITH OR WITHOUT WHEELS, EACH 301 0.9867 2.49 10.63 134 167 0 NA NA 7985 7985 Carrier C 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E1390 OXYGEN CONCENTRATOR 288 0.9861 1.8 4.89 97 191 0 NA NA 7986 7986 Carrier C 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L4361 PNEUMATIC, WALKING BOOT 493 1 3.8 3.79 5 488 0 NA NA 7987 7987 Carrier C 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L3908 WRIST SPLINT W/WO COCK-UP 307 1 2 3.71 8 299 0 NA NA 7988 7988 Carrier C 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L3809 WRIST THUMB SPICA 261 1 0.5 3.41 6 255 0 NA NA 7989 7989 Carrier C 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT DME0003 DME ELECTRIC BREAST PUMP KIT PURCHASE (E0603) 260 1 14.71 18.75 209 51 0 NA NA 7990 7990 Carrier C 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L3670 SHLDER IMMOB W/ABDUCTION PILLOW 260 1 0.5 3.4 2 258 0 NA NA 7991 7991 Carrier C 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L3660 SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND 209 1 1.31 0 209 0 NA NA 7992 7992 Carrier C 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4670 AUTOMATIC BP MONITOR DIAL 184 1 0.56 2.79 39 145 0 NA NA 7993 7993 Carrier C 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4388 DRAINABLE PCH W EX WEAR BARR 173 1 0.69 5.44 77 96 0 NA NA 7994 7994 Carrier C 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L1852 KNEE ORTHOSIS, DOUBLE UPRIGHT, THIGH/CALF, PREFAB, OFF-THE-SHELF 153 1 0.87 8.54 23 130 0 NA NA 7995 7995 Carrier C 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0156 SEAT ATTACHMENT, WALKER 120 1 2.24 2.33 69 51 0 NA NA 7996 7996 Carrier C 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L5020 PARTIAL FOOT MOLDED SOCKET 2 0.5 44 0 2 0 NA NA 7997 7997 Carrier C 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0483 HIGH FREQ CHEST WALL OCSILLATION SYSTEM, INCL ALL ACCESSORIES/SUPPLIES, EA 15 0.0667 1 64.07 1 14 0 NA NA 7998 7998 Carrier C 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT B4149 ENTERAL FORMULA, MANUFACT, ADM VIA ENTERAL FEED TUBE, 100 CALORIES=1UN 17 0.0588 25 48.8 2 15 0 NA NA 7999 7999 Carrier C 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT B4161 ENTERAL FORM,PEDS, HYDROLYZED/AMINO ACID/PEPTIDE CHAIN PROT,100 CAL=1 UN 25 0.04 39.84 0 25 0 NA NA 8000 8000 Carrier C 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L1960 AFO POS SOLID ANK PLASTIC MO 28 0.0357 0.07 20.93 1 27 0 NA NA 8001 8001 Carrier C 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0760 OSTEOGEN U/S STIMLTOR 63 0.0317 9.19 48.47 16 47 0 NA NA 8002 8002 Carrier C 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L3010 FOOT INSERT REMOVABLE LONG ARCH SPPT 155 0.0129 1 10.88 1 154 0 NA NA 8003 8003 Carrier C 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L3030 FOOT INSERT REMOVABLE FORMED TO PT 86 0.0116 12.65 0 86 0 NA NA 8004 8004 Carrier C 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT E2103 NONADJUNCTIVE NONIMPLANTED CGM/RECEIVER 1552 0.7899 2.48 22.11 99 1453 0 NA NA 8005 8005 Carrier C 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN 952 0.9895 1.98 6.39 51 901 0 NA NA 8006 8006 Carrier C 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A4239 SPLY ALW NONADJUNC NONIMPL CGM 1 MO SPLY= 1 UOS 304 0.9605 2.26 17.66 57 247 0 NA NA 8007 8007 Carrier C 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A4221 WEEKLY SUPPLIES DRUG INFUS CATH 274 0.9854 4.99 17.72 52 222 0 NA NA 8008 8008 Carrier C 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT 97802 MED NUTRIT THRPY INIT ASSESS 15 MIN 263 0.9962 2.1 5.07 10 253 0 NA NA 8009 8009 Carrier C 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A5500 DIAB ONLY FIT CSTM PREP&SPL SHOE MX DNSITY INSRT PER SHOE 165 0.9939 1.33 13.62 3 162 0 NA NA 8010 8010 Carrier C 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT E0784 EXTERN AMBUL INSULIN INFUS PUMP 130 0.9231 4.5 24.62 6 124 0 NA NA 8011 8011 Carrier C 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT E2102 ADJUNCTIVE NONIMPLANTED CGM/RECEIVER 80 0.675 10.5 30.73 2 78 0 NA NA 8012 8012 Carrier C 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT J0178 INJ AFLIBERCEPT (EYLEA) 1 MG 71 0.9859 5.89 23.03 9 62 0 NA NA 8013 8013 Carrier C 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT G0108 DIAB MGMT TRN PER INDIV 60 1 2 15.53 2 58 0 NA NA 8014 8014 Carrier C 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT G0108 DIAB MGMT TRN PER INDIV 60 1 2 15.53 2 58 0 NA NA 8015 8015 Carrier C 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A5501 DIABETIC CUSTOM MOLDED SHOE 58 1 1 13.93 4 54 0 NA NA 8016 8016 Carrier C 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J9035 INJ BEVACIZUMAB 10 MG 40 1 2.33 18.78 3 37 0 NA NA 8017 8017 Carrier C 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4224 SUPPLIES FOR MAINTENANCE OF INSULIN INFUSION CATH, PER WEEK 25 1 0.4 14.05 5 20 0 NA NA 8018 8018 Carrier C 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 92012 INTERMEDIATE EYE EXAM ESTABLISHED PATIENT 21 1 8.24 0 21 0 NA NA 8019 8019 Carrier C 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A5513 FOR DIAB ONLY MX DNSITY INSRT CSTM MOLD CSTM EA 19 1 11.37 0 19 0 NA NA 8020 8020 Carrier C 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95250 GLUCOSE MONITORING 72 HRS MD OR OTH QUAL, EQUIP PROV, REC/STORAGE GL 18 1 11.17 0 18 0 NA NA 8021 8021 Carrier C 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A9274 EXTERNAL AMB INSULIN DEL SYSTEM DISPOSABLE EA 18 1 0.07 12 2 16 0 NA NA 8022 8022 Carrier C 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 67028 GLUCOSE MONITORING 72 HRS MD OR OTH QUAL, EQUIP PROV, REC/STORAGE GL 15 1 2 33.14 1 14 0 NA NA 8023 8023 Carrier C 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99201.555 REF MISCELLANEOUS EXTERNAL 14 1 28.79 0 14 0 NA NA 8024 8024 Carrier C 2024 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT DME0063 REF DME CONTINUOUS GLUCOSE MONITOR AND SUPPLIES 53 0.0189 14 32.42 1 52 0 NA NA 8025 8025 Carrier C 2024 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E2102 ADJUNCTIVE NONIMPLANTED CGM/RECEIVER 80 0.0125 10.5 30.73 2 78 0 NA NA 8026 8026 Carrier C 2024 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A4221 WEEKLY SUPPLIES DRUG INFUS CATH 274 0.0036 4.99 17.72 52 222 0 NA NA 8027 8027 Carrier C 2024 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E2103 NONADJUNCTIVE NONIMPLANTED CGM/RECEIVER 1552 0.0013 2.48 22.11 99 1453 0 NA NA 8028 8028 Carrier C 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 3370 0.4246 0.19 57.99 68 3302 semaglutide Ozempic, Rybelsus 8029 8029 Carrier C 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 1305 0.4199 0.39 55.61 53 1252 lisdexamfetamine Vyvanse 8030 8030 Carrier C 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 820 0.772 0.1 38.6 3 817 cyclosporine Cequa, Restasis, Verkazia, Vevye 8031 8031 Carrier C 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 813 0.6064 0.33 44.33 25 788 budesonide-formoterol Symbicort, Breyna 8032 8032 Carrier C 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 793 0.5032 0.51 57.36 24 769 liraglutide Victoza 8033 8033 Carrier C 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 736 0.8628 0.35 18.91 105 631 rivaroxaban Xarelto 8034 8034 Carrier C 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 655 0.5802 1.2 42.88 109 546 apixaban Eliquis 8035 8035 Carrier C 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 654 0.0765 0.29 79.42 17 637 tirzepatide Mounjaro 8036 8036 Carrier C 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 587 0.0835 0.08 81.62 4 583 semaglutide Wegovy 8037 8037 Carrier C 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 553 0.9312 0.76 31.81 25 528 adalimumab-atto Amjevita 8038 8038 Carrier C 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 20 1 0 7 4 16 lenalidomide Revlimid 8039 8039 Carrier C 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 18 1 0 22 3 15 lenvatinib Lenvima 8040 8040 Carrier C 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 18 1 0 51 3 15 tocilizumab Tyenne 8041 8041 Carrier C 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 17 1 2 22 2 15 eltrombopag Alvaiz 8042 8042 Carrier C 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 16 1 0 26 2 14 osimertinib Tagrisso 8043 8043 Carrier C 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 12 1 1 28 1 11 vedolizumab Entyvio 8044 8044 Carrier C 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 11 1 0 2 2 9 dofetilide Tikosyn 8045 8045 Carrier C 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 11 1 0 29 1 10 lasmiditan Reyvow 8046 8046 Carrier C 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 10 1 4 22 3 7 pomalidomide Pomalyst 8047 8047 Carrier C 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 0 28 1 6 voriconazole Vfend 8048 8048 Carrier C 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 121.25 1 belzutifan Welireg 8049 8049 Carrier C 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 0.5 62.2 2 clobazam Sympazan 8050 8050 Carrier C 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 0.5 63.86 2 interferon-beta 1a Avonex 8051 8051 Carrier C 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 0.5 26.27 2 fenfluramine Fintepla 8052 8052 Carrier C 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 5 0.4 82.99 5 cenegermin Oxervate 8053 8053 Carrier C 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 5 0.4 3.22 58.72 1 4 esketamine Spravato 8054 8054 Carrier C 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 8 0.375 0.29 38.24 1 7 mavacamten Camzyos 8055 8055 Carrier C 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 8 0.375 0.18 54.9 2 6 nintedanib Ofev 8056 8056 Carrier C 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 0.3333 37.71 3 cabozantinib Cabometyx 8057 8057 Carrier C 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 0.3333 22.29 17.77 2 1 ponatinib Iclusig 8058 8058 Carrier D 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96416 CHEMO ADMIN IV INFUS >8 HRS W/PORT/IMPLANTED PUMP 22 1 8.71 29.73 7 15 0 NA NA 8059 8059 Carrier D 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 59510 FULL ROUT OBSTE CARE,CESAREAN DELIV 19 1 5 0 19 0 NA NA 8060 8060 Carrier D 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 59400 FULL ROUT OBSTE CARE,VAGINAL DELIV 14 1 1.14 0 14 0 NA NA 8061 8061 Carrier D 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44204 COLECTOMY LAP PARTIAL W/ ANAST 8 1 2 0 8 0 NA NA 8062 8062 Carrier D 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 ARTHRODESIS ANT INTERBODY W/ DISKECTOMY LU 6 0.6667 34.33 0 6 0 NA NA 8063 8063 Carrier D 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43644 LAP GASTRIC BYPASS/ROUX-EN-Y 6 0.8333 8 108.6 1 5 0 NA NA 8064 8064 Carrier D 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 MRI BRAIN W/ & W/O CONTRAST, 5 0.2 39.8 0 5 0 NA NA 8065 8065 Carrier D 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 61624 TRANSCATH OCCLUSION/EMBOLIZAT PERCUT CNS 4 1 5.25 0 4 0 NA NA 8066 8066 Carrier D 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22633 ARTHDSIS POST/POSTEROLATRL/POSTINTERBODY LUMBAR 3 0.3333 4 84 1 2 0 NA NA 8067 8067 Carrier D 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44620 CLOSE ENTEROSTOMY LARGE/SMALL INTESTINE 3 1 1 0 3 0 NA NA 8068 8068 Carrier D 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96416 CHEMO ADMIN IV INFUS >8 HRS W/PORT/IMPLANTED PUMP 22 1 8.71 29.73 7 15 0 NA NA 8069 8069 Carrier D 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 59510 FULL ROUT OBSTE CARE,CESAREAN DELIV 19 1 5 0 19 0 NA NA 8070 8070 Carrier D 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 59400 FULL ROUT OBSTE CARE,VAGINAL DELIV 14 1 1.14 0 14 0 NA NA 8071 8071 Carrier D 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44204 COLECTOMY LAP PARTIAL W/ ANAST 8 1 2 0 8 0 NA NA 8072 8072 Carrier D 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 61624 TRANSCATH OCCLUSION/EMBOLIZAT PERCUT CNS 4 1 5.25 0 4 0 NA NA 8073 8073 Carrier D 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44620 CLOSE ENTEROSTOMY LARGE/SMALL INTESTINE 3 1 1 0 3 0 NA NA 8074 8074 Carrier D 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 45378 COLONOSCOPY DX W/WO SPEC/COLON DECOMP (SEP PROC) 3 1 17.33 0 3 0 NA NA 8075 8075 Carrier D 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 61510 CRANIECT TREPH BONE FLAP CRANIO EXC TUMOR SUPRA 3 1 0.1 35.5 1 2 0 NA NA 8076 8076 Carrier D 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 51590 CYSTECTOMY W/ URETEROILEAL CONDUIT/SIGMOID BLADR 3 1 22.33 0 3 0 NA NA 8077 8077 Carrier D 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 78264 GASTRIC EMPTYING STUDY 3 1 2.67 0 3 0 NA NA 8078 8078 Carrier D 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27130 TOTAL HIP ARTHROPLASTY 2 0.5 23.5 0 2 0 NA NA 8079 8079 Carrier D 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22558 ARTHRODESIS ANT INTERBODY W/ DISKECTOMY LU 6 0.1667 34.33 0 6 0 NA NA 8080 8080 Carrier D 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43644 LAP GASTRIC BYPASS/ROUX-EN-Y 6 0.1667 8 108.6 1 5 0 NA NA 8081 8081 Carrier D 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN 20445 0.992 3.1 5.09 1386 19059 0 NA NA 8082 8082 Carrier D 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97110 THERA PROC 1+ AREAS EA 15 MIN THERA EXERCISES 3261 0.9957 2.55 4.46 92 3169 0 NA NA 8083 8083 Carrier D 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97124 THERA PROC 1+ AREAS EA 15 MIN MASSAGE 1686 0.9958 0.55 3.27 22 1664 0 NA NA 8084 8084 Carrier D 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 MRI ANY JOINT 1120 0.7411 8.89 33.96 151 969 0 NA NA 8085 8085 Carrier D 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 MRI BRAIN W/ & W/O CONTRAST, 918 0.7386 9.25 36.77 107 811 0 NA NA 8086 8086 Carrier D 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 COLONOSCOPY W/ BX SINGLE/MULT 913 0.988 1.67 5.24 48 865 0 NA NA 8087 8087 Carrier D 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 TTE (ECHO) WITH SPECTRAL & COLOR FLOW DOPPLER 762 1 2.5 9.55 80 682 0 NA NA 8088 8088 Carrier D 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72158 MRI LUMBAR W/WO CONTRST SPINE 612 0.4248 12.06 32.3 53 559 0 NA NA 8089 8089 Carrier D 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72148 MAGNETIC RESONANCE (EG, PROTON) LUMBAR 551 0.4029 11.39 40.68 71 480 0 NA NA 8090 8090 Carrier D 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99202 OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES 516 0.9942 3 12.4 35 481 0 NA NA 8091 8091 Carrier D 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93306 TTE (ECHO) WITH SPECTRAL & COLOR FLOW DOPPLER 762 1 2.5 9.55 80 682 0 NA NA 8092 8092 Carrier D 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77080 DXA BONE DENSITY STUDY 1+ SITS AXIAL SKE 298 1 0.6 2.25 15 283 0 NA NA 8093 8093 Carrier D 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96040 GENETICS COUNSELING, EACH 30 MIN, W/ PT/FAMILY 282 1 0.72 3.81 82 200 0 NA NA 8094 8094 Carrier D 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99203 OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES 279 1 11.67 9.33 36 243 0 NA NA 8095 8095 Carrier D 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99201.114 REF GASTROENTEROLOGY - INTERNAL 263 1 22.11 52.53 9 254 0 NA NA 8096 8096 Carrier D 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95806 SLEEP STUDY, UNATTENDED 201 1 1 7.22 1 200 0 NA NA 8097 8097 Carrier D 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 98941 CHIROPRACTIC MANIP TX (CMT) SPINAL 3-4 REGIONS 165 1 3.89 0 165 0 NA NA 8098 8098 Carrier D 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 11102 TANGENTIAL BIOPSY OF SKIN; FIRST LESION 163 1 0.65 2.29 1 162 0 NA NA 8099 8099 Carrier D 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 17311 MOHS HD, NCK, HND, FEET, GEN 1ST STGE UP TO 5 BLCK 160 1 0.75 3.06 16 144 0 NA NA 8100 8100 Carrier D 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97810 ACUPUNCTURE, 1ST 15 MIN, W/O ELECT STIM 156 1 0.02 3.61 1 155 0 NA NA 8101 8101 Carrier D 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21743 RECON REP PECTUS EXCAVATM/CARINATM; W/THORACSCPY 1 1 148 0 1 0 NA NA 8102 8102 Carrier D 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 37761 SUBFASCIAL LIGATION PERFORATOR VEIN, OPEN, 1 LEG 2 0.5 56.5 0 2 0 NA NA 8103 8103 Carrier D 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 42145 PALATOPHARYNGOPLASTY 2 0.5 74 0 2 0 NA NA 8104 8104 Carrier D 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 81425 GENOME SEQUENCE ANALYSIS 2 0.5 96 0 2 0 NA NA 8105 8105 Carrier D 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT A9513 LUTETIUM LU 177, DOTATATE, THERAPEUTIC, 1 MCI 2 0.5 37 0 2 0 NA NA 8106 8106 Carrier D 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT J9225 HISTRELIN IMPLANT 2 0.5 21.11 0 2 0 NA NA 8107 8107 Carrier D 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L8693 AUDITORY OSSEOINTEGRATED DEVICE ABUTMENT, ANY LENGTH, REPLACEMENT ONLY 2 0.5 31.5 0 2 0 NA NA 8108 8108 Carrier D 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 33285 INSERT SUBCUTANEOUS CARDIAC RHYTHM MONITOR, INCL PROGRAM 6 0.3333 41.5 0 6 0 NA NA 8109 8109 Carrier D 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 81404 MOLECULAR PATHOLOGY PROCEDURE LEVEL 5 4 0.25 66.75 0 4 0 NA NA 8110 8110 Carrier D 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT J3241 INJ, TEPROTUMUMAB-TRBW, 10 MG 4 0.25 17.53 0 4 0 NA NA 8111 8111 Carrier D 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT H0045 RESPITE NOT-IN-HOME PER DIEM 1 0 144 0 1 0 NA NA 8112 8112 Carrier D 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT H2020 THER BEHAV SVC, PER DIEM 1 1 4 1 0 0 NA NA 8113 8113 Carrier D 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT H0045 RESPITE NOT-IN-HOME PER DIEM 1 0 144 0 1 0 NA NA 8114 8114 Carrier D 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT H2020 THER BEHAV SVC, PER DIEM 1 1 4 1 0 0 NA NA 8115 8115 Carrier D 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY 60 MIN PATIENT 700 0.9957 1.1 2.22 73 627 0 NA NA 8116 8116 Carrier D 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90836 PSYCHOTHERAPY 45 MIN PATIENT WITH MEDICAL SVCS 381 1 0.43 1.65 56 325 0 NA NA 8117 8117 Carrier D 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90791 PSYCHIATRIC DIAGNOSTIC EVAL W/O MEDICAL SERVICES 251 0.9721 6.2 15.24 10 241 0 NA NA 8118 8118 Carrier D 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96132 NEUROPSYCHOLOGICAL TEST EVAL BY PHYS OR QUAL PROF; FIRST HOUR 94 0.9043 30.02 0 94 0 NA NA 8119 8119 Carrier D 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 TRANSCRANIAL MAG STIMJ TX DLVR & MGMT 93 0.828 31.5 60.96 2 91 0 NA NA 8120 8120 Carrier D 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96130 PSYCHOLOGICAL TESTING EVAL BY PHYS OR QUAL PROF; FIRST HOUR 65 0.9846 7.82 0 65 0 NA NA 8121 8121 Carrier D 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 BEHAV IDENTIFICATION ASSESSMNT, ADM BY PHYS OR QUAL PROF, EA 15 MINS 64 0.7656 101.88 0 64 0 NA NA 8122 8122 Carrier D 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90792 PSYCHIATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES 31 0.9677 15.46 35.12 5 26 0 NA NA 8123 8123 Carrier D 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90853 GROUP PSYCHOTHERAPY 28 1 2.29 0 28 0 NA NA 8124 8124 Carrier D 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97153 ADAPTIVE BEHAV TX BY PROTOCOL, ADM BY TECH/SUP BY PHYS, EA 15 MINS 23 0.8696 109.45 0 23 0 NA NA 8125 8125 Carrier D 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90836 PSYCHOTHERAPY 45 MIN PATIENT WITH MEDICAL SVCS 381 1 0.43 1.65 56 325 0 NA NA 8126 8126 Carrier D 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90853 GROUP PSYCHOTHERAPY 28 1 2.29 0 28 0 NA NA 8127 8127 Carrier D 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99214 OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN 15 1 4 21.43 1 14 0 NA NA 8128 8128 Carrier D 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96136 PSYCHOLOGICAL OR NEUROPSYCHOLOGICAL TEST BY PHYS,2 OR MORE;FIRST 30 MINS 12 1 10.08 0 12 0 NA NA 8129 8129 Carrier D 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97155 ADAPTIVE BEHAV TX W/PROTOCOL MOD, ADM BY PHYS OR QUAL PROF, EA 15 MINS 3 1 83 0 3 0 NA NA 8130 8130 Carrier D 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT H0020 ALCOHOL AND/OR DRUG SERVICES 3 1 1 0 3 0 NA NA 8131 8131 Carrier D 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90834 PSYCHOTHERAPY 45 MIN PATIENT 2 1 18 0 2 0 NA NA 8132 8132 Carrier D 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90870 ECT (W/ MONITORING) SINGLE SEIZURE 2 1 47 138 1 1 0 NA NA 8133 8133 Carrier D 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96131 PSYCHOLOGICAL TESTING EVAL BY PHYS OR QUAL PROF; EA ADDL HOUR 2 1 26 0 2 0 NA NA 8134 8134 Carrier D 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90833 PSYCHOTHERAPY 30 MIN PATIENT WITH MEDICAL SVCS 2 1 0 0 2 0 NA NA 8135 8135 Carrier D 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90792 PSYCHIATRIC DIAGNOSTIC EVALUATION W/MEDICAL SERVICES 31 0.0323 15.46 35.12 5 26 0 NA NA 8136 8136 Carrier D 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90868 TRANSCRANIAL MAG STIMJ TX DLVR & MGMT 93 0.0215 31.5 60.96 2 91 0 NA NA 8137 8137 Carrier D 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0601 CPAP DEVICE 912 0.9912 0.84 9.98 159 753 0 NA NA 8138 8138 Carrier D 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L4361 PNEUMATIC, WALKING BOOT 303 1 0.18 2.49 1 302 0 NA NA 8139 8139 Carrier D 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0114 CRUTCHES METAL UNDERARM PAIR 297 1 0.76 1.98 2 295 0 NA NA 8140 8140 Carrier D 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0603 DME ELECTRIC BREAST PUMP KIT PURCHASE 288 1 2.28 11.33 255 33 0 NA NA 8141 8141 Carrier D 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT A7027 COMB ORAL/NASAL MASK USED W/CPAP DEVICE EA 244 1 7.45 4.56 11 233 0 NA NA 8142 8142 Carrier D 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L3908 WRIST SPLINT W/WO COCK-UP 190 0.9947 2.19 3.08 3 187 0 NA NA 8143 8143 Carrier D 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0604 DME ELECTRIC BREAST PUMP KIT RENTAL 183 0.9945 0.36 8.13 137 46 0 NA NA 8144 8144 Carrier D 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E0143 WALKER, FOLDING, WHEELED, ADJUSTABLE OR FIXED HEIGHT 180 0.9889 3.9 9.26 60 120 0 NA NA 8145 8145 Carrier D 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L3809 WRIST THUMB SPICA 154 1 2.33 2.69 3 151 0 NA NA 8146 8146 Carrier D 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L3660 SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND 136 1 1.42 0 136 0 NA NA 8147 8147 Carrier D 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L4361 PNEUMATIC, WALKING BOOT 303 1 0.18 2.49 1 302 0 NA NA 8148 8148 Carrier D 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0114 CRUTCHES METAL UNDERARM PAIR 297 1 0.76 1.98 2 295 0 NA NA 8149 8149 Carrier D 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0603 DME ELECTRIC BREAST PUMP KIT PURCHASE 288 1 2.28 11.33 255 33 0 NA NA 8150 8150 Carrier D 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A7027 COMB ORAL/NASAL MASK USED W/CPAP DEVICE EA 244 1 7.45 4.56 11 233 0 NA NA 8151 8151 Carrier D 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L3809 WRIST THUMB SPICA 154 1 2.33 2.69 3 151 0 NA NA 8152 8152 Carrier D 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L3660 SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND 136 1 1.42 0 136 0 NA NA 8153 8153 Carrier D 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E1390 OXYGEN CONCENTRATOR 119 1 4.29 9.92 49 70 0 NA NA 8154 8154 Carrier D 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L3670 SHLDER IMMOB W/ABDUCTION PILLOW 115 1 0.57 3.36 2 113 0 NA NA 8155 8155 Carrier D 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L1902 ANKLE LACE UP BRACE 97 1 3.74 0 97 0 NA NA 8156 8156 Carrier D 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E0260 HOSPITAL BED, SEMI-ELECTRIC, W/ANY TYPE SIDE RAILS, W/MATTRESS 86 1 1.21 4.3 66 20 0 NA NA 8157 8157 Carrier D 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0986 MANUAL WHEELCHAIR ACCESS, PUSH-RIM ACTIVATED POWER ASSIST SYS 1 1 54 0 1 0 NA NA 8158 8158 Carrier D 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E2224 PROPULSION WHL EXCLUDES TIRE 2 0.5 33 0 2 0 NA NA 8159 8159 Carrier D 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L5700 REPLACE SOCKET BEL KNEE PT MODEL 4 0.25 83.5 0 4 0 NA NA 8160 8160 Carrier D 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT K0005 ULTRALIGHTWEIGHT WHEELCHAIR 8 0.125 67.39 0 8 0 NA NA 8161 8161 Carrier D 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT L8010 BREAST PROSTHESIS MASTECTOMY SLEEVE 8 0.125 14 34.29 1 7 0 NA NA 8162 8162 Carrier D 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0766 ELECT STIMULATION DEV USED FOR CANCER TX, INCL ALL ACCESS, ANY TYPE 8 0.125 0 45.25 0 8 0 NA NA 8163 8163 Carrier D 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0760 OSTEOGEN U/S STIMLTOR 27 0.037 2.5 44.92 2 25 0 NA NA 8164 8164 Carrier D 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E0601 CPAP DEVICE 912 0.0011 0.84 9.98 159 753 0 NA NA 8165 8165 Carrier D 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT E2103 NONADJUNCTIVE NONIMPLANTED CGM/RECEIVER 423 0.7565 6 37.74 24 399 0 NA NA 8166 8166 Carrier D 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN 352 0.9858 4.06 4.19 17 335 0 NA NA 8167 8167 Carrier D 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A4239 SPLY ALW NONADJUNC NONIMPL CGM 1 MO SPLY= 1 UOS 124 0.9435 1.11 15.97 9 115 0 NA NA 8168 8168 Carrier D 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A4221 WEEKLY SUPPLIES DRUG INFUS CATH 99 0.9798 4.5 11.33 18 81 0 NA NA 8169 8169 Carrier D 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT 97802 MED NUTRIT THRPY INIT ASSESS 15 MIN 93 1 0 6.5 1 92 0 NA NA 8170 8170 Carrier D 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT E0784 EXTERN AMBUL INSULIN INFUS PUMP 59 0.9322 11 26.61 2 57 0 NA NA 8171 8171 Carrier D 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT G0108 DIAB MGMT TRN PER INDIV 47 1 0 13.15 1 46 0 NA NA 8172 8172 Carrier D 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT J0178 INJ AFLIBERCEPT (EYLEA) 1 MG 46 0.9565 35.5 21.58 2 44 0 NA NA 8173 8173 Carrier D 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT J9035 INJ BEVACIZUMAB 10 MG 41 1 2.25 16.03 4 37 0 NA NA 8174 8174 Carrier D 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT A5500 DIAB ONLY FIT CSTM PREP&SPL SHOE MX DNSITY INSRT PER SHOE 37 1 0.32 11.25 1 36 0 NA NA 8175 8175 Carrier D 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97802 MED NUTRIT THRPY INIT ASSESS 15 MIN 93 1 0 6.5 1 92 0 NA NA 8176 8176 Carrier D 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT G0108 DIAB MGMT TRN PER INDIV 47 1 0 13.15 1 46 0 NA NA 8177 8177 Carrier D 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT J9035 INJ BEVACIZUMAB 10 MG 41 1 2.25 16.03 4 37 0 NA NA 8178 8178 Carrier D 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A5500 DIAB ONLY FIT CSTM PREP&SPL SHOE MX DNSITY INSRT PER SHOE 37 1 0.32 11.25 1 36 0 NA NA 8179 8179 Carrier D 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 67228 DESTRUCT EXTENSIVE/PROG RETINOPATHY PHOTOCOAGULATN 12 1 1 17.88 4 8 0 NA NA 8180 8180 Carrier D 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A5501 DIABETIC CUSTOM MOLDED SHOE 9 1 0.27 7.13 1 8 0 NA NA 8181 8181 Carrier D 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99204 OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES 8 1 9.13 0 8 0 NA NA 8182 8182 Carrier D 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 0403T PREV BEHAVIOR CHANGE, INTENS DIAB PRGRM TO INDIVIDUAL IN A GRP SETTING, MINIMUM 60 MIN, PR DY 8 1 13.25 0 8 0 NA NA 8183 8183 Carrier D 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4238 SPL ALW ADJ NI CGM 1 MONTH SUPPLY = 1 UOS 8 1 1.1 12.29 1 7 0 NA NA 8184 8184 Carrier D 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95250 GLUCOSE MONITORING 72 HRS MD OR OTH QUAL, EQUIP PROV, REC/STORAGE GL 6 1 7.33 0 6 0 NA NA 8185 8185 Carrier D 2024 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT E2103 NONADJUNCTIVE NONIMPLANTED CGM/RECEIVER 423 0.0024 6 37.74 24 399 0 NA NA 8186 8186 Carrier D 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 1804 0.3043 0.77 54.7 123 1681 semaglutide Ozempic, Rybelsus 8187 8187 Carrier D 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 957 0.3406 0.88 49.35 92 865 lisdexamfetamine Vyvanse 8188 8188 Carrier D 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 747 0.0884 1.17 61.75 54 693 tirzepatide Mounjaro 8189 8189 Carrier D 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 378 0.4286 1.23 47.88 41 337 budesonide-formoterol Symbicort, Breyna 8190 8190 Carrier D 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 307 0.3518 0.17 59.85 16 291 liraglutide Victoza 8191 8191 Carrier D 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 281 0.089 0.28 76.73 5 276 semaglutide Wegovy 8192 8192 Carrier D 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 254 0.5591 0.41 44.22 6 248 cyclosporine Cequa, Restasis, Verkazia, Vevye 8193 8193 Carrier D 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 253 0.3083 2.58 44.03 64 189 apixaban Eliquis 8194 8194 Carrier D 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 195 0.5078 1.48 63.62 23 172 dupilumab Dupixent 8195 8195 Carrier D 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 192 0.7552 1.39 15.74 46 146 adalimumab-atto Amjevita 8196 8196 Carrier D 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 12 1 0 31 3 9 cannabidiol Epidiolex 8197 8197 Carrier D 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 0 30 2 5 ribociclib Kisqali 8198 8198 Carrier D 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 6 1 0 68 0 6 immune globulin Hizentra 8199 8199 Carrier D 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 6 1 0 37 0 6 grass pollen allergen extract (timothy gras) Grastek 8200 8200 Carrier D 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 6 1 4 39 2 4 enzalutamide Xtandi 8201 8201 Carrier D 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 5 1 1 0 5 0 posaconzole Noxafil 8202 8202 Carrier D 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 5 1 0 45 0 5 olaparib Lynparza 8203 8203 Carrier D 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 5 1 0 11 0 5 tiotropium Spiriva Respimat 8204 8204 Carrier D 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 5 1 3 9 1 4 salmeterol xinafoate Serevent 8205 8205 Carrier D 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 5 1 1 28 1 4 vedolizumab Entyvio 8206 8206 Carrier D 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 68 0 1 cortrophin Acthar 8207 8207 Carrier D 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 70.93 0 1 ritlecitinib tosylate Litfulo 8208 8208 Carrier D 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 0.5 72.33 0 2 umeclidinium Incruse Ellipta 8209 8209 Carrier D 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 5 0.4 10.82 27.43 3 2 esketamine Spravato 8210 8210 Carrier D 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 0.3333 119.15 0 3 albuterol Proventil HFA 8211 8211 Carrier D 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 12 0.25 2.06 86.11 1 11 tezepelumab-ekko Tezspire 8212 8212 Carrier D 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 4 0.25 0.07 55.87 1 3 nintedanib Ofev 8213 8213 Carrier D 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 4 0.25 0.48 9.09 2 2 Golimumab Simponi 8214 8214 Carrier D 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 5 0.2 0.54 27.94 1 4 netarsudil/latanoprost Rocklatan 8215 8215 Carrier D 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 7 0.14 22.09 2 5 valbenazine Ingrezza 8216 8216 Carrier E 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 150 ROOM & BOARD, WARD - GENERAL 27 1 17.4 27 NA NA 8217 8217 Carrier E 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99223 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES 16 1 16.1 22.7 1 15 NA NA 8218 8218 Carrier E 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 762 SPECIALTY SERVICES, OBSERVATION HOURS 11 1 11.7 11 NA NA 8219 8219 Carrier E 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99291 CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN 9 1 34.1 9 NA NA 8220 8220 Carrier E 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 158 ROOM & BOARD, WARD - REHABILITATION 5 1 14.6 5 NA NA 8221 8221 Carrier E 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99222 1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES 4 1 8.1 4 NA NA 8222 8222 Carrier E 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 80053 COMPREHENSIVE METABOLIC PANEL 3 1 82.7 3 NA NA 8223 8223 Carrier E 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 71045 RADIOLOGIC EXAM CHEST SINGLE VIEW 3 1 34.1 3 NA NA 8224 8224 Carrier E 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27447 ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS 3 1 8.2 3 NA NA 8225 8225 Carrier E 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 152 ROOM & BOARD, WARD - OB 3 1 39 3 NA NA 8226 8226 Carrier E 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 150 ROOM & BOARD, WARD - GENERAL 27 1 17.4 27 NA NA 8227 8227 Carrier E 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99223 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES 16 1 16.1 22.7 1 15 NA NA 8228 8228 Carrier E 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 762 SPECIALTY SERVICES, OBSERVATION HOURS 11 1 11.7 11 NA NA 8229 8229 Carrier E 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99291 CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN 9 1 34.1 9 NA NA 8230 8230 Carrier E 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 158 ROOM & BOARD, WARD - REHABILITATION 5 1 14.6 5 NA NA 8231 8231 Carrier E 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99222 1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES 4 1 8.1 4 NA NA 8232 8232 Carrier E 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 80053 COMPREHENSIVE METABOLIC PANEL 3 1 82.7 3 NA NA 8233 8233 Carrier E 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 71045 RADIOLOGIC EXAM CHEST SINGLE VIEW 3 1 34.1 3 NA NA 8234 8234 Carrier E 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27447 ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS 3 1 8.2 3 NA NA 8235 8235 Carrier E 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 152 ROOM & BOARD, WARD - OB 3 1 39 3 NA NA 8236 8236 Carrier E 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97161 PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS 371 0.962 5.6 51.8 28 343 NA NA 8237 8237 Carrier E 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99203 OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES 176 0.989 3.5 59.3 13 163 NA NA 8238 8238 Carrier E 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99204 OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES 122 0.992 6.5 62.2 12 110 NA NA 8239 8239 Carrier E 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72148 MRI LUMBAR SPINE NO CONTRAST 121 1 11.9 29.6 18 103 NA NA 8240 8240 Carrier E 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 MRI BRAIN WO/W CONTRAST 90 1 8.8 29.4 21 69 NA NA 8241 8241 Carrier E 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 MRI LEFT KNEE NO CONTRAST 85 1 14.1 23.1 25 60 NA NA 8242 8242 Carrier E 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN 77 0.766 25.3 139.6 7 70 NA NA 8243 8243 Carrier E 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97530 THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN 77 0.974 9.1 71.6 3 74 NA NA 8244 8244 Carrier E 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 MRI RIGHT KNEE NO CONTRAST 68 1 8.2 44 24 44 NA NA 8245 8245 Carrier E 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97162 PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS 62 0.984 20.8 37.6 148.7 4 57 1 NA NA 8246 8246 Carrier E 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72148 MRI LUMBAR SPINE NO CONTRAST 121 1 11.9 29.6 18 103 NA NA 8247 8247 Carrier E 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70553 MRI BRAIN WO/W CONTRAST 90 1 8.8 29.4 21 69 NA NA 8248 8248 Carrier E 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 73721 MRI LEFT KNEE NO CONTRAST 85 1 14.1 23.1 25 60 NA NA 8249 8249 Carrier E 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 73721 MRI RIGHT KNEE NO CONTRAST 68 1 8.2 44 24 44 NA NA 8250 8250 Carrier E 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72141 MRI CERVICAL SPINE NO CONTRAST 58 1 10.2 18.8 18 40 NA NA 8251 8251 Carrier E 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 73221 MRI RIGHT SHOULDER NO CONTRAST 53 1 20.4 39.2 8 45 NA NA 8252 8252 Carrier E 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70551 MRI BRAIN NO CONTRAST 47 1 12.3 32.3 14 33 NA NA 8253 8253 Carrier E 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 73221 MRI LEFT SHOULDER NO CONTRAST 33 1 4.9 17.3 8 25 NA NA 8254 8254 Carrier E 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97112 THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA 27 1 0.5 47.8 3 24 NA NA 8255 8255 Carrier E 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT 27 1 44.7 27 NA NA 8256 8256 Carrier E 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64635 DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL 1 1 321.3 1 NA NA 8257 8257 Carrier E 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 23413 EXT REFERRAL GYNECOLOGY 1 1 143.1 1 NA NA 8258 8258 Carrier E 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC A9593 GALLIUM GA-68 PSMA-11 DIAGNOSTIC UCSF 1 MCI 1 1 455.8 1 NA NA 8259 8259 Carrier E 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES 8 0.125 0.5 194.5 2 6 NA NA 8260 8260 Carrier E 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 26660 MEMBER REQUEST, PRE-SERVICE 22 0.045 719.3 335.5 4 18 NA NA 8261 8261 Carrier E 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 21893 REFERRAL OCCUPATIONAL THERAPY PEDIATRICS 31 0.032 162.1 31 NA NA 8262 8262 Carrier E 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 92507 TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC IND 45 0.022 1 109 2 43 NA NA 8263 8263 Carrier E 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 97530 THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN 77 0.013 9.1 71.6 3 74 NA NA 8264 8264 Carrier E 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 99203 OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES 176 0.006 3.5 59.3 13 163 NA NA 8265 8265 Carrier E 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 ROOM & BOARD, SEMIPRIVATE TWO-BED - PSYCHIATRIC 58 1 17.5 31.8 46 12 NA NA 8266 8266 Carrier E 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 126 ROOM & BOARD, SEMIPRIVATE TWO-BED - DETOXIFICATION 51 1 35.9 48.3 33 18 NA NA 8267 8267 Carrier E 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1002 BEHAVIORAL HEALTH ACCOMMODATIONS, RESIDENTIAL TREATMENT, CHEM DEP 36 1 68.8 0.2 35 1 NA NA 8268 8268 Carrier E 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1001 BEHAVIORAL HEALTH ACCOMMODATIONS, RESIDENTIAL TREATMENT, PSYCHIATRIC 14 1 23.4 47.8 13 1 NA NA 8269 8269 Carrier E 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 194 SUBACUTE CARE, LEVEL IV 2 1 19.7 2 NA NA 8270 8270 Carrier E 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 154 ROOM & BOARD, WARD - PSYCHIATRIC 2 1 43.7 2 NA NA 8271 8271 Carrier E 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES 1 1 24 1 NA NA 8272 8272 Carrier E 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 80321 DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2 1 1 7.1 1 NA NA 8273 8273 Carrier E 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 914 BEHAVIORAL HEALTH TREATMENTS/SVCS, INDIVIDUAL THERAPY 1 1 169.7 1 NA NA 8274 8274 Carrier E 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 ROOM & BOARD, SEMIPRIVATE TWO-BED - PSYCHIATRIC 58 1 17.5 31.8 46 12 NA NA 8275 8275 Carrier E 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 126 ROOM & BOARD, SEMIPRIVATE TWO-BED - DETOXIFICATION 51 1 35.9 48.3 33 18 NA NA 8276 8276 Carrier E 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1002 BEHAVIORAL HEALTH ACCOMMODATIONS, RESIDENTIAL TREATMENT, CHEM DEP 36 1 68.8 0.2 35 1 NA NA 8277 8277 Carrier E 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1001 BEHAVIORAL HEALTH ACCOMMODATIONS, RESIDENTIAL TREATMENT, PSYCHIATRIC 14 1 23.4 47.8 13 1 NA NA 8278 8278 Carrier E 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 194 SUBACUTE CARE, LEVEL IV 2 1 19.7 2 NA NA 8279 8279 Carrier E 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 154 ROOM & BOARD, WARD - PSYCHIATRIC 2 1 43.7 2 NA NA 8280 8280 Carrier E 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES 1 1 24 1 NA NA 8281 8281 Carrier E 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 80321 DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2 1 1 7.1 1 NA NA 8282 8282 Carrier E 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 914 BEHAVIORAL HEALTH TREATMENTS/SVCS, INDIVIDUAL THERAPY 1 1 169.7 1 NA NA 8283 8283 Carrier E 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97153 ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN 61 1 50.1 61 NA NA 8284 8284 Carrier E 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION 57 0.877 91.6 57 NA NA 8285 8285 Carrier E 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN 38 1 26.7 38 NA NA 8286 8286 Carrier E 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN 23 1 236.3 23 NA NA 8287 8287 Carrier E 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 912 BEHAVIORAL HEALTH TREATMENTS/SVCS, PARTIAL HOSPITAL - LESS INTENSIVE 21 1 51.6 21 NA NA 8288 8288 Carrier E 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0001 ALCOHOL AND/OR DRUG ASSESS 19 1 53.7 27.3 18 1 NA NA 8289 8289 Carrier E 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES 19 0.895 102 19 NA NA 8290 8290 Carrier E 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC S9480 INTENSIVE OUTPATIENT PSYCHIA 15 1 69.4 69.9 14 1 NA NA 8291 8291 Carrier E 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0410 GRP PSYCHOTX NOT MX FAM GP PART HSP/OP 45-50 MIN 14 1 45.7 37 1 13 NA NA 8292 8292 Carrier E 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0020 ALCOHOL AND/OR DRUG SERVICES METHADONE ADMINISTRATION 11 1 101.9 125.3 10 1 NA NA 8293 8293 Carrier E 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97153 ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN 61 1 50.1 61 NA NA 8294 8294 Carrier E 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97151 BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN 38 1 26.7 38 NA NA 8295 8295 Carrier E 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99214 OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN 23 1 236.3 23 NA NA 8296 8296 Carrier E 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 912 BEHAVIORAL HEALTH TREATMENTS/SVCS, PARTIAL HOSPITAL - LESS INTENSIVE 21 1 51.6 21 NA NA 8297 8297 Carrier E 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0001 ALCOHOL AND/OR DRUG ASSESS 19 1 53.7 27.3 18 1 NA NA 8298 8298 Carrier E 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S9480 INTENSIVE OUTPATIENT PSYCHIA 15 1 69.4 69.9 14 1 NA NA 8299 8299 Carrier E 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC G0410 GRP PSYCHOTX NOT MX FAM GP PART HSP/OP 45-50 MIN 14 1 45.7 37 1 13 NA NA 8300 8300 Carrier E 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0020 ALCOHOL AND/OR DRUG SERVICES METHADONE ADMINISTRATION 11 1 101.9 125.3 10 1 NA NA 8301 8301 Carrier E 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99204 OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES 9 1 121.1 9 NA NA 8302 8302 Carrier E 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90792 PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES 9 1 56.6 26.4 8 1 NA NA 8303 8303 Carrier E 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION 57 0.018 91.6 57 NA NA 8304 8304 Carrier E 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0143 WALKER FOLDING WHEELED W/O S 157 0.994 242.2 11.6 1 156 NA NA 8305 8305 Carrier E 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4239 SPLY ALW NONADJUNC NONIMPL CGM 1 MO SPLY= 1 UOS 105 0.981 19.7 105 NA NA 8306 8306 Carrier E 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2103 NONADJUNCTIVE NONIMPLANTED CGM/RECEIVER 99 0.98 8.5 99 NA NA 8307 8307 Carrier E 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0604 BREAST PUMP HEAVY DUTY HOSP GRADE PISTON OP 84 1 0.3 16.4 1 83 NA NA 8308 8308 Carrier E 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0570 NEBULIZER WITH COMPRESSOR 76 0.987 2.4 7.1 7 69 NA NA 8309 8309 Carrier E 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L1852 KNEE ORTHOSIS DOUBLE UPRIGHT THIGH AND CALF 62 1 33.1 62 NA NA 8310 8310 Carrier E 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1390 OXYGEN CONCENTRATOR 62 1 1 11.2 4 58 NA NA 8311 8311 Carrier E 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0730 TENS DEVICE 4/MORE LEADS MULTI NERVE STIMULATION 55 1 22.2 55 NA NA 8312 8312 Carrier E 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A5500 DIAB ONLY FIT CSTM PREP&SPL SHOE MX DNSITY INSRT PER SHOE 50 1 24.4 50 NA NA 8313 8313 Carrier E 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0001 STANDARD WHEELCHAIR 25 1 1.3 20.4 1 24 NA NA 8314 8314 Carrier E 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0604 BREAST PUMP HEAVY DUTY HOSP GRADE PISTON OP 84 1 0.3 16.4 1 83 NA NA 8315 8315 Carrier E 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L1852 KNEE ORTHOSIS DOUBLE UPRIGHT THIGH AND CALF 62 1 33.1 62 NA NA 8316 8316 Carrier E 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1390 OXYGEN CONCENTRATOR 62 1 1 11.2 4 58 NA NA 8317 8317 Carrier E 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0730 TENS DEVICE 4/MORE LEADS MULTI NERVE STIMULATION 55 1 22.2 55 NA NA 8318 8318 Carrier E 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A5500 DIAB ONLY FIT CSTM PREP&SPL SHOE MX DNSITY INSRT PER SHOE 50 1 24.4 50 NA NA 8319 8319 Carrier E 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0001 STANDARD WHEELCHAIR 25 1 1.3 20.4 1 24 NA NA 8320 8320 Carrier E 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L0457 TLSO FLX SC JUNC TERM INF TO SCAP SPINE PREFAB 23 1 2 21.1 1 22 NA NA 8321 8321 Carrier E 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9999 MISCELLANEOUS DME SUPPLY OR ACCESSORY NOS 23 1 36.2 23 NA NA 8322 8322 Carrier E 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0202 PHOTOTHERAPY LIGHT W/ PHOTOM 22 1 2.2 19.9 6 16 NA NA 8323 8323 Carrier E 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A6212 FOAM DRESS STERL PAD SZ 16 SQ/> W/ADHES BORDR EA 22 1 18.2 22 NA NA 8324 8324 Carrier E 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year CPT 95250 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor f 115 0.704 30 115 NA NA 8325 8325 Carrier E 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 EXT AMB INFUSN PUMP INSULIN 21 1 27.6 21 NA NA 8326 8326 Carrier E 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4230 INFUS INSULIN PUMP NON NEEDL 15 1 103.5 15 NA NA 8327 8327 Carrier E 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4232 SYRINGE W/NEEDLE INSULIN 3CC 7 1 7.3 7 NA NA 8328 8328 Carrier E 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A6257 TRANSPARENT FILM STERL 16 SQ IN OR LESS EA DRESS 2 1 24.7 2 NA NA 8329 8329 Carrier E 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A5120 SKIN BARRIER WIPES OR SWABS EACH 1 1 3.1 1 NA NA 8330 8330 Carrier E 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 EXT AMB INFUSN PUMP INSULIN 21 1 27.6 21 NA NA 8331 8331 Carrier E 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4230 INFUS INSULIN PUMP NON NEEDL 15 1 103.5 15 NA NA 8332 8332 Carrier E 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4232 SYRINGE W/NEEDLE INSULIN 3CC 7 1 7.3 7 NA NA 8333 8333 Carrier E 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A6257 TRANSPARENT FILM STERL 16 SQ IN OR LESS EA DRESS 2 1 24.7 2 NA NA 8334 8334 Carrier E 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A5120 SKIN BARRIER WIPES OR SWABS EACH 1 1 3.1 1 NA NA 8335 8335 Carrier E 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95250 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor f 115 0.704 30 115 NA NA 8336 8336 Carrier E 2024 Diabetes Supplies and Equip Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 95250 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor f 115 0.009 30 115 NA NA 8337 8337 Carrier E 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 226 0.7522 26.07653392 0 226 0 EMPAGLIFLOZIN JARDIANCE 8338 8338 Carrier E 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 193 0.2798 33.80955671 0 193 0 SEMAGLUTIDE OZEMPIC 8339 8339 Carrier E 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 63 0.5079 29.24854497 0 63 0 LISDEXAMFETAMINE DIMESYLATE VYVANSE 8340 8340 Carrier E 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 53 1 28.14422956 0 53 0 ADALIMUMAB-ATTO AMJEVITA 8341 8341 Carrier E 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 53 0.9623 23.051174 0 53 0 FREMANEZUMAB-VFRM AJOVY 8342 8342 Carrier E 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 53 0.9245 23.55567086 0 53 0 UBROGEPANT UBRELVY 8343 8343 Carrier E 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 35 0.8857 9.610103175 0 35 0 RIVAROXABAN XARELTO 8344 8344 Carrier E 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 32 1 25.31947917 0 32 0 SECUKINUMAB COSENTYX 8345 8345 Carrier E 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 28 0.25 40.00420635 0 28 0 LIRAGLUTIDE VICTOZA 8346 8346 Carrier E 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 27 0.7778 15.12006173 0 27 0 TESTOSTERONE CYPIONATE DEPO-TESTOST 8347 8347 Carrier E 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 53 1 28.14422956 0 53 0 ADALIMUMAB-ATTO AMJEVITA 8348 8348 Carrier E 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 32 1 25.31947917 0 32 0 SECUKINUMAB COSENTYX 8349 8349 Carrier E 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 22 1 52.01157828 0 22 0 SACUBITRIL-VALSARTAN ENTRESTO 8350 8350 Carrier E 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 20 1 32.34644444 0 20 0 GALCANEZUMAB-GNLM EMGALITY 8351 8351 Carrier E 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 16 1 79.31449653 0 16 0 TICAGRELOR BRILINTA 8352 8352 Carrier E 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 12 1 30.24680556 0 12 0 CARIPRAZINE HCL VRAYLAR 8353 8353 Carrier E 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 10 1 19.76813889 0 10 0 ABATACEPT ORENCIA 8354 8354 Carrier E 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 10 1 38.07980556 0 10 0 GUSELKUMAB TREMFYA 8355 8355 Carrier E 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 35.66954861 0 8 0 OXYCODONE HCL OXYCONTIN 8356 8356 Carrier E 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 31.79440476 0 7 0 ERENUMAB-AOOE AIMOVIG 8357 8357 Carrier E 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 25.06333333 0 1 0 PEGVISOMANT SOMAVERT 8358 8358 Carrier E 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 0.5 49.05388889 0 2 0 PAROXETINE HCL PAXIL 8359 8359 Carrier E 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 0.5 3.415555556 0 2 0 MESALAMINE APRISO, LIALDA, PENTASA 8360 8360 Carrier E 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 5 0.2 44.0995 0 5 0 CLASCOTERONE WINLEVI 8361 8361 Carrier E 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 18 0.0556 44.67398148 0 18 0 DUPILUMAB DUPIXENT 8362 8362 Carrier F 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 121 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Medical/Surgical/GYN 277 0.4043 16 25 79 198 NA NA 8363 8363 Carrier F 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 13 0.6154 19 52 2 11 NA NA 8364 8364 Carrier F 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27447 Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) 11 0.1818 16 13 1 10 NA NA 8365 8365 Carrier F 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 9 0 18 6 1 8 NA NA 8366 8366 Carrier F 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44207 Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) 9 0.7778 10 22 3 6 NA NA 8367 8367 Carrier F 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22614 Arthrodesis, posterior or posterolateral technique, single interspace; each additional interspace (List separately in addition to code for primary procedure) 8 0.5 16 45 1 7 NA NA 8368 8368 Carrier F 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) 8 0.625 15 51 2 6 NA NA 8369 8369 Carrier F 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure) 7 0.5714 14 72 3 4 NA NA 8370 8370 Carrier F 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 7 0.4286 53 0 7 NA NA 8371 8371 Carrier F 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 7 0 21 0 7 NA NA 8372 8372 Carrier F 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 44204 Laparoscopy, surgical; colectomy, partial, with anastomosis 6 1 19 35 1 5 NA NA 8373 8373 Carrier F 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 49320 Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) 5 1 22 55 1 4 NA NA 8374 8374 Carrier F 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 47120 Hepatectomy, resection of liver; partial lobectomy 4 1 22 51 1 3 NA NA 8375 8375 Carrier F 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 20680 Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate) 3 1 20 42 1 2 NA NA 8376 8376 Carrier F 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63052 Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [eg, spinal or lateral recess stenosis]), during posterior interbody arthrodesis, lumbar; single vertebral segment (List separately in addition to code for primary procedure) 3 1 19 44 2 1 NA NA 8377 8377 Carrier F 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 32666 Thoracoscopy, surgical; with therapeutic wedge resection (eg, mass, nodule), initial unilateral 3 1 3 19 1 2 NA NA 8378 8378 Carrier F 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 32674 Thoracoscopy, surgical; with mediastinal and regional lymphadenectomy (List separately in addition to code for primary procedure) 3 1 3 19 1 2 NA NA 8379 8379 Carrier F 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33340 Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, when performed, and radiological supervision and interpretation 3 1 52 0 3 NA NA 8380 8380 Carrier F 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33430 Replacement, mitral valve, with cardiopulmonary bypass 3 1 22 19 2 1 NA NA 8381 8381 Carrier F 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33508 Endoscopy, surgical, including video-assisted harvest of vein(s) for coronary artery bypass procedure (List separately in addition to code for primary procedure) 3 1 29 18 2 1 NA NA 8382 8382 Carrier F 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple 485 0.9526 6 13 52 433 NA NA 8383 8383 Carrier F 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 453 0.9558 6 14 50 403 NA NA 8384 8384 Carrier F 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 160 0.925 9 15 9 151 NA NA 8385 8385 Carrier F 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 Colonoscopy, flexible; with biopsy, single or multiple 160 0.95 9 15 11 149 NA NA 8386 8386 Carrier F 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64483 Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, single level 133 0.9248 20 51 13 120 NA NA 8387 8387 Carrier F 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. 124 0.6532 23 58 35 89 NA NA 8388 8388 Carrier F 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43249 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter) 114 0.9474 5 17 11 103 NA NA 8389 8389 Carrier F 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 113 0.9381 10 15 9 104 NA NA 8390 8390 Carrier F 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 731 Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified 96 0.9375 13 19 8 88 NA NA 8391 8391 Carrier F 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27447 Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) 94 0.8298 15 54 3 91 NA NA 8392 8392 Carrier F 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43242 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis) 28 1 15 37 3 25 NA NA 8393 8393 Carrier F 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 45390 Colonoscopy, flexible; with endoscopic mucosal resection 24 1 15 7 1 23 NA NA 8394 8394 Carrier F 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64490 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level 23 1 11 43 2 21 NA NA 8395 8395 Carrier F 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 13152 Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm 20 1 29 21 3 17 NA NA 8396 8396 Carrier F 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 14060 Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less 20 1 12 4 1 19 NA NA 8397 8397 Carrier F 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation 20 1 21 41 4 16 NA NA 8398 8398 Carrier F 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64479 Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), cervical or thoracic, single level 20 1 3 58 1 19 NA NA 8399 8399 Carrier F 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 811 Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified 18 1 15 21 1 17 NA NA 8400 8400 Carrier F 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 66982 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; without endoscopic cyclophotocoagulation 18 1 17 0 18 NA NA 8401 8401 Carrier F 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15260 Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less 18 1 28 25 1 17 NA NA 8402 8402 Carrier F 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 33228 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system 1 1 22 1 0 NA NA 8403 8403 Carrier F 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 11621 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm 1 1 25 0 1 NA NA 8404 8404 Carrier F 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 93312 Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report 1 1 116 0 1 NA NA 8405 8405 Carrier F 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 60210 Partial thyroid lobectomy, unilateral; with or without isthmusectomy 1 1 26 0 1 NA NA 8406 8406 Carrier F 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 74183 Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s), followed by with contrast material(s) and further sequences 2 0.5 22 96 1 1 NA NA 8407 8407 Carrier F 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 76376 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation 2 0.5 22 96 1 1 NA NA 8408 8408 Carrier F 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 81371 HLA Class I and II typing, low resolution (eg, antigen equivalents); HLA-A, -B, and -DRB1 (eg, verification typing) 2 0.5 59 0 2 NA NA 8409 8409 Carrier F 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 81376 HLA Class II typing, low resolution (eg, antigen equivalents); one locus (eg, HLA-DRB1, -DRB3/4/5, -DQB1, -DQA1, -DPB1, or -DPA1), each 2 0.5 59 0 2 NA NA 8410 8410 Carrier F 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 81378 HLA Class I and II typing, high resolution (ie, alleles or allele groups), HLA-A, -B, -C, and -DRB1 2 0.5 59 0 2 NA NA 8411 8411 Carrier F 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 81379 HLA Class I typing, high resolution (ie, alleles or allele groups); complete (ie, HLA-A, -B, and -C) 2 0.5 59 0 2 NA NA 8412 8412 Carrier F 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Psychiatric 7 0 12 11 2 5 NA NA 8413 8413 Carrier F 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 126 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Detoxification 4 0 7 21 2 2 NA NA 8414 8414 Carrier F 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0010 Alcohol and/or drug services; subacute detoxification (residential addiction program inpatient) 3 1 19 0 3 NA NA 8415 8415 Carrier F 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 128 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Rehabilitation 3 1 44 98 1 2 NA NA 8416 8416 Carrier F 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0017 Behavioral health; residential (hospital residential treatment program), without room and board, per diem 3 0.3333 33 0 3 NA NA 8417 8417 Carrier F 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0011 Alcohol and/or drug services; acute detoxification (residential addiction program inpatient) 1 0 2 0 1 NA NA 8418 8418 Carrier F 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC G2083 Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of greater than 56 mg esketamine nasal self administration, includes 2 hours post administration observation 1 0 6 1 0 NA NA 8419 8419 Carrier F 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 1 0 11 0 1 NA NA 8420 8420 Carrier F 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 77412 Radiation treatment delivery, => 1 MeV; complex 1 0 14 1 0 NA NA 8421 8421 Carrier F 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 71250 Computed tomography, thorax, diagnostic; without contrast material 1 0 12 0 1 NA NA 8422 8422 Carrier F 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0010 Alcohol and/or drug services; subacute detoxification (residential addiction program inpatient) 3 1 19 0 3 NA NA 8423 8423 Carrier F 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 128 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Rehabilitation 3 1 43.916666 98 1 2 NA NA 8424 8424 Carrier F 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0017 Behavioral health; residential (hospital residential treatment program), without room and board, per diem 3 0.3333 33 0 3 NA NA 8425 8425 Carrier F 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Psychiatric 7 0 11.674999 11 2 5 NA NA 8426 8426 Carrier F 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 126 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Detoxification 4 0 7.124999 21 2 2 NA NA 8427 8427 Carrier F 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0011 Alcohol and/or drug services; acute detoxification (residential addiction program inpatient) 1 0 2 0 1 NA NA 8428 8428 Carrier F 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC G2083 Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of greater than 56 mg esketamine nasal self administration, includes 2 hours post administration observation 1 0 6.083333 1 0 NA NA 8429 8429 Carrier F 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 1 0 11 0 1 NA NA 8430 8430 Carrier F 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77412 Radiation treatment delivery, => 1 MeV; complex 1 0 13.683333 1 0 NA NA 8431 8431 Carrier F 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 71250 Computed tomography, thorax, diagnostic; without contrast material 1 0 12 0 1 NA NA 8432 8432 Carrier F 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC S9480 Intensive outpatient psychiatric services, per diem 97 0.6907 9 61 17 80 NA NA 8433 8433 Carrier F 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 Mental health partial hospitalization, treatment, less than 24 hours 74 0.8514 15 50 6 68 NA NA 8434 8434 Carrier F 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 65 0.8769 27 89 17 48 NA NA 8435 8435 Carrier F 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 50 0.88 24 93 8 42 NA NA 8436 8436 Carrier F 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 50 0.92 26 92 10 40 NA NA 8437 8437 Carrier F 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0015 Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education 41 0.8537 58 0 41 NA NA 8438 8438 Carrier F 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan 36 0.9167 22 88 2 34 NA NA 8439 8439 Carrier F 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC G2083 Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of greater than 56 mg esketamine nasal self administration, includes 2 hours post administration observation 33 0.7273 31 77 8 25 NA NA 8440 8440 Carrier F 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97153 Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes 30 0.9333 25 88 2 28 NA NA 8441 8441 Carrier F 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97156 Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes 27 0.9259 24 83 3 24 NA NA 8442 8442 Carrier F 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0032 Mental health service plan development by nonphysician 14 1 25 79 2 12 NA NA 8443 8443 Carrier F 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97152 Behavior identification-supporting assessment, administered by one technician under the direction of a physician or other qualified health care professional, face-to-face with the patient, each 15 minutes 5 1 88 0 5 NA NA 8444 8444 Carrier F 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H2019 Therapeutic behavioral services, per 15 minutes 5 1 110 0 5 NA NA 8445 8445 Carrier F 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97157 Multiple-family group adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of guardians/caregivers, each 15 minutes 2 1 65 0 2 NA NA 8446 8446 Carrier F 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96139 Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; each additional 30 minutes (List separately in addition to code for primary procedure) 1 1 193 0 1 NA NA 8447 8447 Carrier F 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96138 Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes 1 1 193 0 1 NA NA 8448 8448 Carrier F 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0019 Behavioral health; long-term residential (nonmedical, nonacute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem 1 1 111 0 1 NA NA 8449 8449 Carrier F 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0020 Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) 1 1 1 0 1 NA NA 8450 8450 Carrier F 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0031 Mental health assessment, by nonphysician 1 1 102 0 1 NA NA 8451 8451 Carrier F 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 96116 Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; first hour 1 1 193 0 1 NA NA 8452 8452 Carrier F 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC J0578 Injection, buprenorphine extended-release (Brixadi), greater than 7 days and up to 28 days of therapy 3 0.33 24 3 0 NA NA 8453 8453 Carrier F 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC S0013 Esketamine, nasal spray, 1 mg 7 0.14 10 107 3 4 NA NA 8454 8454 Carrier F 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 50 0.1 24 93 8 42 NA NA 8455 8455 Carrier F 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 50 0.1 26 92 10 40 NA NA 8456 8456 Carrier F 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 65 0.08 27 89 17 48 NA NA 8457 8457 Carrier F 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC G2083 Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of greater than 56 mg esketamine nasal self administration, includes 2 hours post administration observation 33 0.06 31 77 8 25 NA NA 8458 8458 Carrier F 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC G2082 Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of up to 56 mg of esketamine nasal self administration, includes 2 hours post administration observation 18 0.06 28 73 4 14 NA NA 8459 8459 Carrier F 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0486 Oral device/appliance used to reduce upper airway collapsibility, adjustable or nonadjustable, custom fabricated, includes fitting and adjustment 13 0.2308 3 74 1 12 NA NA 8460 8460 Carrier F 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A6550 Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories 12 0.8333 117 0 12 NA NA 8461 8461 Carrier F 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A7000 Canister, disposable, used with suction pump, each 12 0.8333 117 0 12 NA NA 8462 8462 Carrier F 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2402 Negative pressure wound therapy electrical pump, stationary or portable 12 0.8333 117 0 12 NA NA 8463 8463 Carrier F 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4604 Tubing with integrated heating element for use with positive airway pressure device 11 0.2727 27 51 3 8 NA NA 8464 8464 Carrier F 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0108 Wheelchair component or accessory, not otherwise specified 11 0.7273 17 61 1 10 NA NA 8465 8465 Carrier F 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0562 Humidifier, heated, used with positive airway pressure device 10 0.3 22.433333 41 1 9 NA NA 8466 8466 Carrier F 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A7030 Full face mask used with positive airway pressure device, each 9 0.3333 22.433333 59 1 8 NA NA 8467 8467 Carrier F 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 Continuous positive airway pressure (CPAP) device 9 0.3333 22.433333 41 1 8 NA NA 8468 8468 Carrier F 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 External ambulatory infusion pump, insulin 9 0.8889 43 0 9 NA NA 8469 8469 Carrier F 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0955 Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each 6 1 59 0 6 NA NA 8470 8470 Carrier F 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0748 Osteogenesis stimulator, electrical, noninvasive, spinal applications 5 1 60 0 5 NA NA 8471 8471 Carrier F 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1028 Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other 5 1 67 0 5 NA NA 8472 8472 Carrier F 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1390 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate 5 1 45 0 5 NA NA 8473 8473 Carrier F 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S9342 Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem 5 1 86 0 5 NA NA 8474 8474 Carrier F 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0466 Home ventilator, any type, used with noninvasive interface, (e.g., mask, chest shell) 4 1 24.116666 62 1 3 NA NA 8475 8475 Carrier F 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2620 Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 in, any height, including any type mounting hardware 4 1 79 0 4 NA NA 8476 8476 Carrier F 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC K0195 Elevating legrests, pair (for use with capped rental wheelchair base) 4 1 20.988888 22 3 1 NA NA 8477 8477 Carrier F 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L2820 Addition to lower extremity orthosis, soft interface for molded plastic, below knee section 4 1 85 0 4 NA NA 8478 8478 Carrier F 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5673 Addition to lower extremity, below knee (BK)/above knee (AK), custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism 4 1 28 0 4 NA NA 8479 8479 Carrier F 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC S9342 Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem 5 0.2 86 0 5 NA NA 8480 8480 Carrier F 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC B4150 Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit 6 0.1667 73 0 6 NA NA 8481 8481 Carrier F 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year NA NA Diabetes Supplies & Equip 15 0.8667 0 47 0 0 15 NA NA 8482 8482 Carrier F 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year NA NA Diabetes Supplies & Equip 15 0.8667 0 47 0 0 15 NA NA 8483 8483 Carrier F 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 228 0.6009 0.67 2.76 27 201 0 Semaglutide Ozempic 8484 8484 Carrier F 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 98 0.5714 0.03 2.84 12 86 0 Tirzepatide Mounjaro 8485 8485 Carrier F 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 89 0.7303 2.49 8.19 11 78 0 Rimegepant Nurtec 8486 8486 Carrier F 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 61 0.8689 6.02 10.19 13 48 0 Dupilumab Dupixent 8487 8487 Carrier F 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 59 0.8644 0.27 3.04 14 45 0 Empagliflozin Jardiance 8488 8488 Carrier F 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 51 0.9804 0.02 1.37 6 45 0 Galcanezumab Emgality 8489 8489 Carrier F 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 49 0.8776 2.73 7.21 17 32 0 Evolocumab Repatha 8490 8490 Carrier F 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 48 0.875 0.25 3.73 6 42 0 Empagliflozin Jardiance 8491 8491 Carrier F 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 39 0.7692 0.01 5.05 3 36 0 Liraglutide Victoza 8492 8492 Carrier F 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 37 0.7027 0.77 13.01 7 30 0 Risankizumab Skyrizi 8493 8493 Carrier F 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 18 1 7.08 10.1 3 15 0 Etanercept Enbrel 8494 8494 Carrier F 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 10 1 0.01 0.24 1 9 0 Erenumab Aimovig 8495 8495 Carrier F 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 10 1 2.1 10.19 2 8 0 Ustekinumab Stelara 8496 8496 Carrier F 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 10 1 0 0.01 3 7 0 Cariprazine Vraylar 8497 8497 Carrier F 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 8 1 0 6.28 1 7 0 Dapagliflozin Farxiga 8498 8498 Carrier F 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 7 1 0.45 6.31 2 5 0 Ubrogepant Ubrelvy 8499 8499 Carrier F 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 7 1 3.97 11.09 1 6 0 Naltrexone Vivitrol 8500 8500 Carrier F 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 6 1 0 9.74 1 5 0 Sitagliptin Januvia 8501 8501 Carrier F 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 6 1 5.9 16.95 1 5 0 Adalimumab Humira 8502 8502 Carrier F 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 6 1 0 5.39 1 5 0 Denosumab Prolia 8503 8503 Carrier F 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 1 0.3333 3.17 0 1 0 Leuprolide Lupron 8504 8504 Carrier F 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 1 1 0.13 0 1 0 Testosterone Testosterone 8505 8505 Carrier F 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 1 0.5 0.08 0 1 0 Buprenorphine-Naloxone Suboxone 8506 8506 Carrier F 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 1 1 1.91 1 0 0 Patiromer Veltassa 8507 8507 Carrier F 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 1 1 0.93 1 0 0 Filgrastim Neupogen 8508 8508 Carrier H 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year Revenue 121 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Medical/Surgical/GYN 150 0.3667 12.730952 29.746857 28 122 NA NA 8509 8509 Carrier H 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43644 Laparoscopy, Surg, Gastric Restrictive Procedure; W Gastric Bypass And Roux-En-Y Gastroent 44 0.8636 17.454552 0 44 NA NA 8510 8510 Carrier H 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 43775 Laps Gstrc Rstrictiv Px Longitudinal Gastrectomy 41 0.9024 16.2 0 41 NA NA 8511 8511 Carrier H 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22614 Arthrodesis, Posterior Or Posterolateral Technique, Single Interspace; Each Additional Int 31 1 18 34.666656 4 27 NA NA 8512 8512 Carrier H 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 Total Abdominal Hysterectomy (Corpus And Cervix), With Or Without Removal Of Tube(S), With 31 0.9677 0 12.444456 2 29 NA NA 8513 8513 Carrier H 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22585 Arthrodesis, Anterior/-Lateral,Ea Add.In 19 1 12 39.529416 2 17 NA NA 8514 8514 Carrier H 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 63053 Laminectomy, Facetectomy, Or Foraminotomy During Posterior Interbody Arthrodesis, Lumbar; 16 0.6875 46.5 0 16 NA NA 8515 8515 Carrier H 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22552 Arthrodesis, Anterior Interbody, Incl Disc Space Prep, Discectomy, Osteophytectomy & Decom 15 1 24 60 3 12 NA NA 8516 8516 Carrier H 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22634 Arthrodesis, Combined Posterior Or Posterolateral Technique With Posterior Interbody Techn 14 0.6429 39.428568 0 14 NA NA 8517 8517 Carrier H 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 27487 Revis.Totl Knee Arthroplas,W/Wo Allogft; 14 1 0 5.538456 1 13 NA NA 8518 8518 Carrier H 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22614 Arthrodesis, Posterior Or Posterolateral Technique, Single Interspace; Each Additional Int 31 1 18 34.666656 4 27 NA NA 8519 8519 Carrier H 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22585 Arthrodesis, Anterior/-Lateral,Ea Add.In 19 1 12 39.529416 2 17 NA NA 8520 8520 Carrier H 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22552 Arthrodesis, Anterior Interbody, Incl Disc Space Prep, Discectomy, Osteophytectomy & Decom 15 1 24 60 3 12 NA NA 8521 8521 Carrier H 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27487 Revis.Totl Knee Arthroplas,W/Wo Allogft; 14 1 0 5.538456 1 13 NA NA 8522 8522 Carrier H 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19328 Removal Of Intact Breast Implant 11 1 24 0 1 10 NA NA 8523 8523 Carrier H 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33340 Percutaneous Transcatheter Closure Of The Left Atrial Appendage With Endocardial Implant, 10 1 21.6 0 10 NA NA 8524 8524 Carrier H 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33361 Transcatheter Aortic Valve Replacement (Tavr/Tavi) With Prosthetic Valve; Percutaneous Fem 9 1 34.666656 0 9 NA NA 8525 8525 Carrier H 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 11971 Removal Of Tissue Expander Without Insertion Of Implant 9 1 0 0 9 NA NA 8526 8526 Carrier H 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27137 Revision Total Hip-Acetabular Only 9 1 12 24 2 7 NA NA 8527 8527 Carrier H 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27130 Replacement Hip Total Simple 7 1 6.857136 0 7 NA NA 8528 8528 Carrier H 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43644 Laparoscopy, Surg, Gastric Restrictive Procedure; W Gastric Bypass And Roux-En-Y Gastroent 44 1 17.454552 0 44 NA NA 8529 8529 Carrier H 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22614 Arthrodesis, Posterior Or Posterolateral Technique, Single Interspace; Each Additional Int 31 1 18 34.666656 4 27 NA NA 8530 8530 Carrier H 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22585 Arthrodesis, Anterior/-Lateral,Ea Add.In 19 1 12 39.529416 2 17 NA NA 8531 8531 Carrier H 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22552 Arthrodesis, Anterior Interbody, Incl Disc Space Prep, Discectomy, Osteophytectomy & Decom 15 1 24 60 3 12 NA NA 8532 8532 Carrier H 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 33361 Transcatheter Aortic Valve Replacement (Tavr/Tavi) With Prosthetic Valve; Percutaneous Fem 9 1 34.666656 0 9 NA NA 8533 8533 Carrier H 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 61863 Burr Hole Craniotomy With Implantation Of Subcortical Electrode Array, Wo Intraop Microele 6 1 16.000008 0 6 NA NA 8534 8534 Carrier H 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43659 Unlisted Laparoscopy Procedure, Stomach 5 1 30 0 5 NA NA 8535 8535 Carrier H 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 61864 Burr Hole Craniotomy W Implantation Of Subcortical Electrode Array, Wo Intraop Microelectr 4 1 24 0 4 NA NA 8536 8536 Carrier H 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 15879 Suction Assist Lipectomy Lower Extremity 1 1 24 0 1 NA NA 8537 8537 Carrier H 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 15878 Suction Assist Lipectomy Up Extrem 1 1 24 0 1 NA NA 8538 8538 Carrier H 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 Echo, Transthoracic W/Doppler, Complete 38758 0.9326 1.371429 5.803063 35 38723 NA NA 8539 8539 Carrier H 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 Continuous Airway Pressure (Cpap) Device [May Be Used For Either Cpap Or Apap] 34534 0.9729 1.665837 0 34534 NA NA 8540 8540 Carrier H 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 Mri, Lower Extremity Any Joint; Wo Contr 26541 0.8731 1.690141 7.770306 71 26470 NA NA 8541 8541 Carrier H 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT MSMPT Physical Therapy 21420 0.68 13 9 NA NA 8542 8542 Carrier H 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72148 Mri Of Lumbar Spine 19137 0.8792 0.96 7.645851 49 19088 NA NA 8543 8543 Carrier H 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 Mri Of Brain And Further Sequences 18487 0.9382 2.086957 5.063934 46 18441 NA NA 8544 8544 Carrier H 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74177 Ct Abd & Pelv W Contrast 17662 0.9321 0.338028 8.115948 71 17591 NA NA 8545 8545 Carrier H 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73221 Mri, Any Joint Of Upper Extremity; Wo Co 13375 0.8552 0.888889 8.691639 27 13348 NA NA 8546 8546 Carrier H 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72141 Mri Of Cervical Spine 11318 0.8771 0.8 8.12118 29 11289 NA NA 8547 8547 Carrier H 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 71260 Diagnostic Ct Thorax W/Contrast 10123 0.9429 0 4.934602 31 10092 NA NA 8548 8548 Carrier H 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95800 Sleep Study, Unattended, Simultaneous Recording; Heart Rate, Oxygen Saturation, Respiratory Analysis (E.G., By Air Flow Or Peripheral Arterial Tone) And Sleep Time 112 1 0 0 112 NA NA 8549 8549 Carrier H 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19380 Revision Of Reconstructed Breast (Eg, Significant Removal Of Tissue, Re-Advancement And/Or 61 1 0 14.89656 1 60 NA NA 8550 8550 Carrier H 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19357 Tissue Expander Placement In Breast Reconstruction, Including Subsequent Expansion(S) 45 1 0 9.081072 7 38 NA NA 8551 8551 Carrier H 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27446 Arthropls,Knee,Cond/Plat;Medor Lat 26 1 0 19.999992 2 24 NA NA 8552 8552 Carrier H 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 11970 Replacement Of Tissue Expander With Permanent Implant 20 1 21.6 0 20 NA NA 8553 8553 Carrier H 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 92250 Fundus photography with interpretation and report 33 1 2.216666 2.804166 1 32 NA NA 8554 8554 Carrier H 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64493 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level 27 1 17.036666 23.829545 5 22 NA NA 8555 8555 Carrier H 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64635 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint 19 1 2.991666 32.22745 2 17 NA NA 8556 8556 Carrier H 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99204 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. 19 1 0.008333 2.043137 2 17 NA NA 8557 8557 Carrier H 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93458 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed 17 1 16.456249 70.998147 8 9 NA NA 8558 8558 Carrier H 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27447 Replacement Knee Total 325 1 0 14.552376 10 315 NA NA 8559 8559 Carrier H 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 15771 Grafting Of Autologous Fat Harvested By Liposuction Technique To Trunk, Breasts, Scalp, Ar 89 1 26.157312 0 89 NA NA 8560 8560 Carrier H 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 36465 Injection Of Non-Compounded Foam Sclerosant W/ Ultrasound Compression Maneuvers To Guide D 79 1 0 20.7 4 75 NA NA 8561 8561 Carrier H 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 15772 Grafting Of Autologous Fat Harvested By Liposuction Technique To Trunk, Breasts, Scalp, Ar 61 1 22.426224 0 61 NA NA 8562 8562 Carrier H 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 36482 Endovenous Ablation Therapy Of Incompetent Vein, Extremity, By Transcatheter Delivery Of A 56 1 19.525416 0 56 NA NA 8563 8563 Carrier H 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22552 Arthrodesis, Anterior Interbody, Incl Disc Space Prep, Discectomy, Osteophytectomy & Decom 42 1 14.4 42.162168 5 37 NA NA 8564 8564 Carrier H 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 67904 Rep Blepharoptosis Levator External 40 1 21.142848 0 40 NA NA 8565 8565 Carrier H 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27446 Arthropls,Knee,Cond/Plat;Medor Lat 26 1 0 19.999992 2 24 NA NA 8566 8566 Carrier H 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 36476 Endovenous Ablation Tx Of Incompetent Vein, Extremity, Inclusive Imaging Guidance & Monito 24 1 21.12 0 24 NA NA 8567 8567 Carrier H 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64582 Open Implantation Of Hypoglossal Nerve Neurostimulator Array, Pulse Generator, And Distal 22 1 25.09092 0 22 NA NA 8568 8568 Carrier H 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 128 Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Rehabilitation 2 0 22.433333 114.316666 1 1 NA NA 8569 8569 Carrier H 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Psychiatric 2 0 11.1 50.2 1 1 NA NA 8570 8570 Carrier H 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 126 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Detoxification 2 0 3.958333 2 0 NA NA 8571 8571 Carrier H 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 1 0 7.666666 1 0 NA NA 8572 8572 Carrier H 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 1 0 7.666666 1 0 NA NA 8573 8573 Carrier H 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 1 0 7.666666 1 0 NA NA 8574 8574 Carrier H 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 1 0 50.2 0 1 NA NA 8575 8575 Carrier H 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 Mental health partial hospitalization, treatment, less than 24 hours 1 0 22.15 1 0 NA NA 8576 8576 Carrier H 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC J2777 Injection, faricimab-svoa, 0.1 mg 1 0 11.1 1 0 NA NA 8577 8577 Carrier H 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 64635 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint 1 0 0.25 1 0 NA NA 8578 8578 Carrier H 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue NA Accommodation Codes - Room & Board-Semiprivate (Two-Beds)-Rehabilitation 2 0 22.433333 114.316666 1 1 NA NA 8579 8579 Carrier H 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 128 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Psychiatric 2 0 11.1 50.2 1 1 NA NA 8580 8580 Carrier H 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 Accommodation Codes - Room & Board Semiprivate (Two Beds)-Detoxification 2 0 3.958333 2 0 NA NA 8581 8581 Carrier H 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 126 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 1 0 7.666666 1 0 NA NA 8582 8582 Carrier H 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 1 0 7.666666 1 0 NA NA 8583 8583 Carrier H 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 1 0 7.666666 1 0 NA NA 8584 8584 Carrier H 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 1 0 50.2 0 1 NA NA 8585 8585 Carrier H 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0035 Mental health partial hospitalization, treatment, less than 24 hours 1 0 22.15 1 0 NA NA 8586 8586 Carrier H 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC J2777 Injection, faricimab-svoa, 0.1 mg 1 0 11.1 1 0 NA NA 8587 8587 Carrier H 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64635 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint 1 0 0.25 1 0 NA NA 8588 8588 Carrier H 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Therapeutic Repetitive Transcranial Magnetic Simulation (Tms) Treatment; Initial, Includin 232 0.8147 16.615392 36.428568 13 219 NA NA 8589 8589 Carrier H 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 Therapeutic Repetitive Transcranial Magnetic Simulation (Tms) Treatment; Including Cortica 200 0.845 17.454552 37.20636 11 189 NA NA 8590 8590 Carrier H 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 Therapeutic Repetitive Transcranial Magnetic Stimulation (Tms) Treatment; Subsequent Motor 195 0.8513 16.000008 35.805408 12 183 NA NA 8591 8591 Carrier H 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 Mental health partial hospitalization, treatment, less than 24 hours 149 0.7987 19.707142 41.255868 7 142 NA NA 8592 8592 Carrier H 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan 110 0.7636 18.074358 71.811855 13 97 NA NA 8593 8593 Carrier H 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97155 Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes 102 0.7745 22.902083 70.11027 16 86 NA NA 8594 8594 Carrier H 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97153 Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes 96 0.7708 21.224999 68.501422 14 82 NA NA 8595 8595 Carrier H 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97156 Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes 95 0.7684 20.207142 70.574485 14 81 NA NA 8596 8596 Carrier H 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC S9480 Intensive outpatient psychiatric services, per diem 69 0.6957 21.399999 43.605472 2 67 NA NA 8597 8597 Carrier H 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0032 Mental health service plan development by nonphysician 52 0.7692 18.054166 57.667707 4 48 NA NA 8598 8598 Carrier H 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC S9480 Intensive Outpatient Psychiatric Services Per Diem 6 1 24 57.6 1 5 NA NA 8599 8599 Carrier H 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90837 Psychotherapy, 60 Minutes With Patient 5 1 38.4 0 5 NA NA 8600 8600 Carrier H 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90791 Psychiatric Diagnostic Evaluation 5 1 52.8 0 5 NA NA 8601 8601 Carrier H 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0020 Alcohol And/Or Drug Services 2 1 36 0 2 NA NA 8602 8602 Carrier H 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0035 Mental Health Partial Hospitalization, Treatment, Less Than 24 Hours 2 1 24 24 1 1 NA NA 8603 8603 Carrier H 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC G2067 Medication Assisted Treatment, Methadone; Weekly Bundle Including Dispensing And/Or Admini 2 1 36 0 2 NA NA 8604 8604 Carrier H 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S0201 Partial hospitalization services, less than 24 hours, per diem 5 1 67.789999 0 5 NA NA 8605 8605 Carrier H 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97155 Adptve Bhvr Trtmnt W/ Protocol Modifictn, Admnstrd By Phys Or Other Qualified Hlth Care Pr 1 1 72 0 1 NA NA 8606 8606 Carrier H 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97151 Behavior Identification Assessment, Administered By A Physician Or Other Qualified Health 1 1 72 0 1 NA NA 8607 8607 Carrier H 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90834 Psychotherapy; 45 Minutes With Patient 1 1 72 0 1 NA NA 8608 8608 Carrier H 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC G2083 Office Or Other Outpatient Visit For The Evaluation And Management Of An Established Patie 42 0.7143 13.333344 32.64 18 24 NA NA 8609 8609 Carrier H 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC S0013 Esketamine, Nasal Spray, 1 Mg 39 0.6667 10.285704 35.555544 14 25 NA NA 8610 8610 Carrier H 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90868 Therapeutic Repetitive Transcranial Magnetic Simulation (Tms) Treatment; Initial, Includin 232 0.5 16.615392 36.428568 13 219 NA NA 8611 8611 Carrier H 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC G2082 Office Or Other Outpatient Visit For The Evaluation And Management Of An Established Patie 17 0.5 10.285704 31.2 7 10 NA NA 8612 8612 Carrier H 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90867 Therapeutic Repetitive Transcranial Magnetic Simulation (Tms) Treatment; Including Cortica 200 0.4286 17.454552 37.20636 11 189 NA NA 8613 8613 Carrier H 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 90869 Therapeutic Repetitive Transcranial Magnetic Stimulation (Tms) Treatment; Subsequent Motor 195 0.4 16.000008 35.805408 12 183 NA NA 8614 8614 Carrier H 2024 Outpatient MH-SUD Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC S9480 Intensive Outpatient Psychiatric Services Per Diem 6 0 24 57.6 1 5 NA NA 8615 8615 Carrier H 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0486 Oral Device/Appliance Cusfab 226 0.9823 3.128964 0 1645 NA NA 8616 8616 Carrier H 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0108 Wheelchair Component Or Accessory, Not Otherwise Specified 86 0.8023 24.505272 0 86 NA NA 8617 8617 Carrier H 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC S1040 Cranial Remolding Orthosis, Rigid, With Soft Interface Material, Custom Fabricated, Includ 70 0.9571 16.457136 0 70 NA NA 8618 8618 Carrier H 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L8680 Implantable Neurostimulator Electrode Each 48 0.9167 24 49.534872 1 47 NA NA 8619 8619 Carrier H 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0748 Osteogenic Stimulator, Noninvasive, Spinal Applications 33 0.6061 0 99.096768 1 32 NA NA 8620 8620 Carrier H 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0760 Osteogenesis Stimulator Low Intensity Ultrasound Noninvasive 32 0 36.75 0 32 NA NA 8621 8621 Carrier H 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2620 Positioning Wheelchair Back Cushion, Planar Back With Lateral Supports, Width 25 0.96 24 0 25 NA NA 8622 8622 Carrier H 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0652 Pneumatic Compressor, Segmental Home Model With Calibrated Gradient Pr 25 0.72 24.96 0 25 NA NA 8623 8623 Carrier H 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0747 Osteogenesis Stimulator (Non-Invasive) 24 0.4167 30.26088 0 24 NA NA 8624 8624 Carrier H 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0005 Ultralightweight Wheelchair 24 1 21 0 24 NA NA 8625 8625 Carrier H 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0005 Ultralightweight Wheelchair 24 1 21 0 24 NA NA 8626 8626 Carrier H 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0260 Hospital Bed, Seimi-Electric (Head And Foot Adjustment), With Any Type 9 1 21.333336 0 9 NA NA 8627 8627 Carrier H 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8690 Aud Osseo Dev, Int/Ext Comp 8 1 30.857136 0 8 NA NA 8628 8628 Carrier H 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0766 Electrical Stimulation Device Used For Cancer Treatment, Includes All Accessories, Any Typ 8 1 21 0 8 NA NA 8629 8629 Carrier H 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8687 Implt Nrostm Pls Gen Dua Rec 7 1 24 19.999992 1 6 NA NA 8630 8630 Carrier H 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0465 Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) 7 1 72.707142 0 7 NA NA 8631 8631 Carrier H 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8686 Implt Nrostm Pls Gen Sng Non 6 1 14.4 0 6 NA NA 8632 8632 Carrier H 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2609 Custom Fabricated Wheelchair Seat Cushion, Any Size 6 1 24 0 6 NA NA 8633 8633 Carrier H 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2617 Custom Fabricated Wheelchair Back Cushion, Any Size, Including Any Type 5 1 24 0 5 NA NA 8634 8634 Carrier H 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2607 Skin Protection And Positioning Wheelchair Seat Cushion, Width Less Than 22 4 1 18 0 4 NA NA 8635 8635 Carrier H 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC K0606 Aed Garment With Electrocardiogram Analysis 11 1 6.545448 11 0 NA NA 8636 8636 Carrier H 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L8614 Cochlear Device/System 10 1 18.666672 0 10 NA NA 8637 8637 Carrier H 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0483 High Frequency Chest Wall Oscillation System, With Full Anterior And/Or Posterior Thoracic 8 1 33 0 8 NA NA 8638 8638 Carrier H 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E0766 Electrical Stimulation Device Used For Cancer Treatment, Includes All Accessories, Any Typ 8 1 21 0 8 NA NA 8639 8639 Carrier H 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L8686 Implt Nrostm Pls Gen Sng Non 6 1 14.4 0 6 NA NA 8640 8640 Carrier H 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E2609 Custom Fabricated Wheelchair Seat Cushion, Any Size 6 1 24 0 6 NA NA 8641 8641 Carrier H 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E2617 Custom Fabricated Wheelchair Back Cushion, Any Size, Including Any Type 5 1 24 0 5 NA NA 8642 8642 Carrier H 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC L5856 Addition To Lower Extremity Prosthesis, Endoskeletal Knee-Shin System, 5 1 33.6 0 5 NA NA 8643 8643 Carrier H 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E2607 Skin Protection And Positioning Wheelchair Seat Cushion, Width Less Than 22 4 1 18 0 4 NA NA 8644 8644 Carrier H 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year NA NA Diabetes Supplies & Equip 52 0.5577 2.017243577 9.671153808 0 9 43 0 NA NA 8645 8645 Carrier H 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year NA NA Diabetes Supplies & Equip 52 0.5577 2.017243577 9.671153808 0 9 43 0 NA NA 8646 8646 Carrier H 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 2282 0.5513 0.94 2.84 270 2012 0 Semaglutide Ozempic 8647 8647 Carrier H 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 1229 0.5159 0.5 2.34 135 1094 0 Tirzepatide Mounjaro 8648 8648 Carrier H 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 915 0.7628 2.63 8.44 163 752 0 Rimegepant Nurtec 8649 8649 Carrier H 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 663 0.7677 6.42 16.2 147 516 0 Dupilumab Dupixent 8650 8650 Carrier H 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 551 0.8475 0.89 2.93 135 416 0 Empagliflozin Jardiance 8651 8651 Carrier H 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 494 0.8158 1.63 5.76 62 432 0 Tirzepatide Zepbound 8652 8652 Carrier H 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 415 0.8096 1.4 7.99 80 335 0 Ubrogepant Ubrelvy 8653 8653 Carrier H 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 397 0.9647 0.42 2.06 98 299 0 Galcanezumab Emgality 8654 8654 Carrier H 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 386 0.6736 0.65 2.08 47 339 0 Semaglutide Ozempic 8655 8655 Carrier H 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 366 0.8525 1.1 7.51 64 302 0 Evolocumab Repatha 8656 8656 Carrier H 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year NDC9 NA NA 15 1 11.83 1.83 2 13 0 Linagliptin Tradjenta 8657 8657 Carrier H 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 14 1 4.57 36.15 9 5 0 Acalabrutinib Calquence 8658 8658 Carrier H 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 13 1 11.86 8.36 5 8 0 Glatiramer Glatiramer 8659 8659 Carrier H 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 12 1 1.67 28.8 4 8 0 Macitentan Opsumit 8660 8660 Carrier H 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 12 1 5.37 7.23 6 6 0 Dabrafenb Tafinlar 8661 8661 Carrier H 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 12 1 0 0.1 2 10 0 Sitagliptin Januvia 8662 8662 Carrier H 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 11 1 0.01 0.01 4 7 0 Cariprazine Vraylar 8663 8663 Carrier H 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 11 1 3.4 2.84 6 5 0 Abemaciclib Verzenio 8664 8664 Carrier H 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 10 1 0 3.35 3 7 0 Desvenlafaxine Er Desvenlafaxine Er 8665 8665 Carrier H 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year NDC9 NA NA 10 1 0.01 7.38 2 8 0 Lemborexant Dayvigo 8666 8666 Carrier H 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 17 0.1104 1.08 15.14 5 12 0 Dupilumab Dupixent 8667 8667 Carrier H 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 11 0.1294 1.88 18.69 2 9 0 Risankizumab Skyrizi 8668 8668 Carrier H 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 8 0.0516 0.58 33.49 2 6 0 Ruxolitinib Opzelura 8669 8669 Carrier H 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 8 0.036 1.89 28.27 1 7 0 Rifaximin Xifaxan 8670 8670 Carrier H 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 5 0.1563 18.97 0 5 0 Dupilumab Dupixent 8671 8671 Carrier H 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 5 0.2 1.24 22.49 2 3 0 Adalimumab Humira 8672 8672 Carrier H 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 4 0.044 35.02 0 4 0 Tirzepatide Zepbound 8673 8673 Carrier H 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 4 0.2857 1.08 0 4 0 Dupilumab Dupixent 8674 8674 Carrier H 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 4 0.0039 0.61 0.93 2 2 0 Semaglutide Ozempic 8675 8675 Carrier H 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal NDC9 NA NA 4 0.1026 18.21 18.53 2 2 0 Guselkumab Tremfya 8676 8676 Carrier J 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 56 0.7143 72.18194444 83.59531313 392.7473278 1 54 2 NA NA 8677 8677 Carrier J 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 96416 Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump 36 0 1.822523148 1.473171296 24 12 NA NA 8678 8678 Carrier J 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 30 0.7667 72.18194444 93.57715517 1 29 NA NA 8679 8679 Carrier J 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 29 0.8276 77.56280651 150.502625 29 1 NA NA 8680 8680 Carrier J 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) 28 0.8214 19.98180556 89.5417735 394.009833 2 26 9 NA NA 8681 8681 Carrier J 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44204 Laparoscopy, surgical; colectomy, partial, with anastomosis 27 0 1.466666667 0.381068376 1 26 NA NA 8682 8682 Carrier J 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) 27 0.7778 13.39296296 85.30444444 291.9845494 3 24 3 NA NA 8683 8683 Carrier J 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar 26 0.7692 72.18194444 80.61262222 634.9920306 1 25 1 NA NA 8684 8684 Carrier J 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22614 Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure) 25 0.88 19.98180556 90.31719807 441.1424498 2 23 9 NA NA 8685 8685 Carrier J 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44207 Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) 22 0 0.222055556 19.85996732 5 17 NA NA 8686 8686 Carrier J 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22600 Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment 9 1 96.5891358 574.7819999 9 4 NA NA 8687 8687 Carrier J 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar 7 1 39.75888889 114.7148148 613.1345389 1 6 1 NA NA 8688 8688 Carrier J 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63048 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; each additional segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure) 7 1 39.75888889 73.30351852 377.0117495 1 6 4 NA NA 8689 8689 Carrier J 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22212 Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; thoracic 6 1 69.37333333 6 NA NA 8690 8690 Carrier J 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22216 Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; each additional vertebral segment (List separately in addition to primary procedure) 5 1 83.21033333 646.7831486 5 2 NA NA 8691 8691 Carrier J 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63045 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; cervical 4 1 48.64680556 4 NA NA 8692 8692 Carrier J 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27134 Revision of total hip arthroplasty; both components, with or without autograft or allograft 4 1 29.90104167 278.5272397 4 1 NA NA 8693 8693 Carrier J 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64999 Unlisted procedure, nervous system 3 1 34.14657407 3 NA NA 8694 8694 Carrier J 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22610 Arthrodesis, posterior or posterolateral technique, single level; thoracic (with lateral transverse technique, when performed) 3 1 117.9865741 413.5715076 3 5 NA NA 8695 8695 Carrier J 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22802 Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to 12 vertebral segments 3 1 22.18925926 658.5742667 3 1 NA NA 8696 8696 Carrier J 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 38241 Hematopoietic progenitor cell (HPC); autologous transplantation 3 1 45.89935185 3 NA NA 8697 8697 Carrier J 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft 4 0.25 129.3272222 270.8097551 4 2 NA NA 8698 8698 Carrier J 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 30 0.1 72.18194444 93.57715517 1 29 NA NA 8699 8699 Carrier J 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar 26 0.0769 72.18194444 80.61262222 634.9920306 1 25 1 NA NA 8700 8700 Carrier J 2024 Inpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 56 0.0357 72.18194444 83.59531313 392.7473278 1 54 2 NA NA 8701 8701 Carrier J 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography 3791 0.9478 1.028611111 3.940282249 503.8950169 1 3790 7 NA NA 8702 8702 Carrier J 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 3520 0.9764 0.66202381 2.429828867 336.0553379 84 3436 4 NA NA 8703 8703 Carrier J 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 3343 0.8995 0.155138889 11.93305797 437.7033611 4 3339 72 NA NA 8704 8704 Carrier J 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 Colonoscopy, flexible; with biopsy, single or multiple 3171 0.9754 0.582642045 2.327970176 422.6796316 88 3083 16 NA NA 8705 8705 Carrier J 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 2861 0.9077 14.76361111 11.6278291 433.4146059 3 2858 65 NA NA 8706 8706 Carrier J 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material 2818 0.8616 1.118928571 7.650428059 513.5461227 14 2802 4 NA NA 8707 8707 Carrier J 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 2764 0.9801 0.600535475 2.302260586 325.3434495 83 2681 17 NA NA 8708 8708 Carrier J 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97112 Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities 2711 0.9004 14.46574074 10.55316152 397.5885053 3 2708 54 NA NA 8709 8709 Carrier J 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74177 Computed tomography, abdomen and pelvis; with contrast material(s) 2556 0.9566 2.269646465 3.571261842 509.7638371 11 2545 11 NA NA 8710 8710 Carrier J 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97140 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes 2419 0.9078 8.915722222 11.27250771 374.6192323 5 2414 36 NA NA 8711 8711 Carrier J 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 20680 Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate) 55 1 0.080277778 6.366172839 421.2178901 1 54 8 NA NA 8712 8712 Carrier J 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43260 Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 36 1 1.081111111 5.748404762 464.9407964 1 35 1 NA NA 8713 8713 Carrier J 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 43261 Endoscopic retrograde cholangiopancreatography (ERCP); with biopsy, single or multiple 26 1 1.081111111 7.7606 1 25 NA NA 8714 8714 Carrier J 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 52224 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of MINOR (less than 0.5 cm) lesion(s) with or without biopsy 25 1 0.960833333 0.22625 1 24 NA NA 8715 8715 Carrier J 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 32408 Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed 25 1 1.382962963 14.92536616 3 22 NA NA 8716 8716 Carrier J 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 21230 Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) 25 1 30.31373333 25 NA NA 8717 8717 Carrier J 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 78472 Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without additional quantitative processing 23 1 0.164951691 23 NA NA 8718 8718 Carrier J 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 52214 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands 23 1 0.960833333 0.066767677 1 22 NA NA 8719 8719 Carrier J 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27792 Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when performed 23 1 0.087962963 0.041944444 323.37173 9 14 2 NA NA 8720 8720 Carrier J 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 32555 Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance 22 1 1.006481481 6.600102339 258.247309 3 19 3 NA NA 8721 8721 Carrier J 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 64555 Percutaneous implantation of neurostimulator electrode array; peripheral nerve (excludes sacral nerve) 3 0.6667 6.655925926 3 NA NA 8722 8722 Carrier J 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 72295 Discography, lumbar, radiological supervision and interpretation 3 0.3333 136.3084259 3 NA NA 8723 8723 Carrier J 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 27420 Reconstruction of dislocating patella; (eg, Hauser type procedure) 3 0.3333 87.74425926 3 NA NA 8724 8724 Carrier J 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 43497 Lower esophageal myotomy, transoral 3 0.3333 106.1877778 84.64652778 1 2 NA NA 8725 8725 Carrier J 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22634 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; each additional interspace and segment (List separately in addition to code for primary procedure) 4 0.25 126.4635417 313.27 4 1 NA NA 8726 8726 Carrier J 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) 15 0.2 93.93064815 15 NA NA 8727 8727 Carrier J 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 29897 Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, limited 5 0.2 14.36666667 5 NA NA 8728 8728 Carrier J 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22514 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; lumbar 5 0.2 116.2152778 347.1774393 5 2 NA NA 8729 8729 Carrier J 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 62290 Injection procedure for discography, each level; lumbar 5 0.2 102.6071667 5 NA NA 8730 8730 Carrier J 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) 9 0.1111 97.37151235 395.9205704 9 3 NA NA 8731 8731 Carrier J 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1002 Residential treatment, Substance Use Disorder 67 0.9403 47.14222222 36.960194 608.6548083 1 66 1 NA NA 8732 8732 Carrier J 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1001 Residential treatment, Psychiatric 33 0.6667 24.8237963 43.85863027 3 30 NA NA 8733 8733 Carrier J 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 54520 Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach 17 0.7647 49.41284314 17 NA NA 8734 8734 Carrier J 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 56805 Clitoroplasty for intersex state 17 0.8235 57.57433007 17 NA NA 8735 8735 Carrier J 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 53430 Urethroplasty, reconstruction of female urethra 16 0.8125 50.80682292 16 NA NA 8736 8736 Carrier J 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 54125 Amputation of penis; complete 15 0.8 53.1567037 15 NA NA 8737 8737 Carrier J 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 57335 Vaginoplasty for intersex state 14 0.8571 54.62190476 14 NA NA 8738 8738 Carrier J 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 55175 Scrotoplasty; simple 12 0.8333 46.28229167 12 NA NA 8739 8739 Carrier J 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 14301 Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm 6 0.1667 35.13125 6 NA NA 8740 8740 Carrier J 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 124 Room and board, Semi-Private, Psychiatric 6 1 28.2925 619.9205375 6 4 NA NA 8741 8741 Carrier J 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 124 Room and board, Semi-Private, Psychiatric 6 1 28.2925 619.9205375 6 4 NA NA 8742 8742 Carrier J 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 53410 Urethroplasty, 1-stage reconstruction of male anterior urethra 2 1 90.70652778 2 NA NA 8743 8743 Carrier J 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 126 Room and board, Semi Private Detoxification 2 1 82.41583333 2 NA NA 8744 8744 Carrier J 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 76857 Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles) 1 1 162.1047222 1 NA NA 8745 8745 Carrier J 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 14040 Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less 1 1 162.1047222 1 NA NA 8746 8746 Carrier J 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 57106 Vaginectomy, partial removal of vaginal wall; 1 1 162.1047222 1 NA NA 8747 8747 Carrier J 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 56620 Vulvectomy simple; partial 1 1 162.1047222 1 NA NA 8748 8748 Carrier J 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 51102 Aspiration of bladder; with insertion of suprapubic catheter 1 1 162.1047222 1 NA NA 8749 8749 Carrier J 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 56800 Plastic repair of introitus 1 1 15.55861111 1 NA NA 8750 8750 Carrier J 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 13131 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm 1 1 162.1047222 1 NA NA 8751 8751 Carrier J 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 55180 Scrotoplasty; complicated 1 1 162.1047222 1 NA NA 8752 8752 Carrier J 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 56810 Perineoplasty, repair of perineum, nonobstetrical (separate procedure) 1 1 162.1047222 1 NA NA 8753 8753 Carrier J 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 53450 Urethromeatoplasty, with mucosal advancement 1 1 162.1047222 1 NA NA 8754 8754 Carrier J 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 71271 Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s) 316 0.9462 2.147284634 653.5 316 2 NA NA 8755 8755 Carrier J 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 185 0.8973 5.665972222 21.19044884 4 181 NA NA 8756 8756 Carrier J 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 176 0.8977 7.549722222 21.6486522 3 173 NA NA 8757 8757 Carrier J 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual 174 0.7989 16.02101852 58.17794347 274.4116901 3 171 23 NA NA 8758 8758 Carrier J 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 157 0.8917 7.549722222 19.75808889 545 3 154 1 NA NA 8759 8759 Carrier J 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 153 0.9739 3.127166667 15.89239087 11 142 NA NA 8760 8760 Carrier J 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0035 Mental Health Partial Hospitalization, Treatment, Less Than 24 Hours 87 0.8506 36.79083333 87 NA NA 8761 8761 Carrier J 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan 47 0.4255 2.1525 57.3347619 2 45 NA NA 8762 8762 Carrier J 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 19303 Mastectomy, simple, complete 45 0.8889 1.94 38.54463384 1 44 NA NA 8763 8763 Carrier J 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 19350 Nipple/areola reconstruction 43 0.8837 1.94 46.10008808 1 42 NA NA 8764 8764 Carrier J 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15773 Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate 13 1 31.10899573 13 NA NA 8765 8765 Carrier J 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 7 1 29.09107143 7 NA NA 8766 8766 Carrier J 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15774 Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; each additional 25 cc injectate, or part thereof (List separately in addition to code for primary procedure) 7 1 39.74900794 7 NA NA 8767 8767 Carrier J 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97112 Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities 7 1 27.1334127 489.6389425 7 1 NA NA 8768 8768 Carrier J 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 54520 Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach 6 1 46.11106481 6 NA NA 8769 8769 Carrier J 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81416 Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis, each comparator exome (eg, parents, siblings) (List separately in addition to code for primary procedure) 5 1 10.54655556 5 NA NA 8770 8770 Carrier J 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15828 Rhytidectomy; cheek, chin, and neck 5 1 15.99005556 5 NA NA 8771 8771 Carrier J 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 21122 Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) 5 1 24.33833333 5 NA NA 8772 8772 Carrier J 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81415 Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis 5 1 10.54655556 5 NA NA 8773 8773 Carrier J 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70450 Computed tomography, head or brain; without contrast material 4 1 0.000416667 4 NA NA 8774 8774 Carrier J 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 Cont Airway Pressure Device 4210 0.9629 1.743706651 486.0150337 4210 3 NA NA 8775 8775 Carrier J 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without backup rate 270 0.9667 2.388569959 270 NA NA 8776 8776 Carrier J 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate 88 0.9773 1.077493687 88 NA NA 8777 8777 Carrier J 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2402 Negative pressure wound therapy electrical pump, stationary or portable 41 0.3902 61.60180912 41 NA NA 8778 8778 Carrier J 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1399 Durable Medical Equipment Mi 40 0 0.145555556 16.40201754 1 39 NA NA 8779 8779 Carrier J 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1028 Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other 20 0 14.8895 20 NA NA 8780 8780 Carrier J 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0760 Osteogen Ultrasound Stimltor 17 0.2941 29.64620915 17 NA NA 8781 8781 Carrier J 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0955 Wheelchair accessory, headrest, cushioned, prefabricated, including fixed mounting hardware, each 16 0 18.33130208 16 NA NA 8782 8782 Carrier J 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0747 Elec Osteogen Stim Not Spine 14 0.1429 35.72694444 14 NA NA 8783 8783 Carrier J 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0748 Elec Osteogen Stim Spinal 13 0.3077 133.9647863 13 NA NA 8784 8784 Carrier J 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0766 ELEC STIM CANCER TREATMENT 5 1 3.21625 15.90138889 2 3 NA NA 8785 8785 Carrier J 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate 88 0.9773 1.077493687 88 NA NA 8786 8786 Carrier J 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without backup rate 270 0.9667 2.388569959 270 NA NA 8787 8787 Carrier J 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0601 Cont Airway Pressure Device 4210 0.9629 1.743706651 486.0150337 4210 3 NA NA 8788 8788 Carrier J 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0466 HOME VENT NON-INVASIVE INTER 6 0.5 3.893333333 24.3785 1 5 NA NA 8789 8789 Carrier J 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2402 Negative pressure wound therapy electrical pump, stationary or portable 41 0.3902 61.60180912 41 NA NA 8790 8790 Carrier J 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0748 Elec Osteogen Stim Spinal 13 0.3077 133.9647863 13 NA NA 8791 8791 Carrier J 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0760 Osteogen Ultrasound Stimltor 17 0.2941 29.64620915 17 NA NA 8792 8792 Carrier J 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0486 Oral device/appliance cusfab 6 0.1667 1.264444444 6.195833333 1 5 NA NA 8793 8793 Carrier J 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0747 Elec Osteogen Stim Not Spine 14 0.1429 35.72694444 14 NA NA 8794 8794 Carrier J 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4216 Sterile water/saline, 10 ml 19 0 0.008611111 0.429135802 1 18 NA NA 8795 8795 Carrier J 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply 6 0 3.323722222 6 NA NA 8796 8796 Carrier J 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9277 Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system 4 0 3.932777778 4 NA NA 8797 8797 Carrier J 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 3 0 4.149444444 3 NA NA 8798 8798 Carrier J 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4211 Supp For Self-Adm Injections 2 0 1.375555556 2 NA NA 8799 8799 Carrier J 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4239 Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service 2 0 20.75861111 2 NA NA 8800 8800 Carrier J 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4230 Infus Insulin Pump Non Needl 1 0 1.721388889 1 NA NA 8801 8801 Carrier J 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A5500 Diab Shoe For Density Insert 1 0 0.008888889 1 NA NA 8802 8802 Carrier J 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2103 Non-adjunctive, non-implanted continuous glucose monitor or receiver 1 0 23.59222222 1 NA NA 8803 8803 Carrier J 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4232 Syringe W/Needle Insulin 3cc 1 0 1.721388889 1 NA NA 8804 8804 Carrier J 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4238 Supply allowance for adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service 1 0 17.925 1 NA NA 8805 8805 Carrier J 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4216 Sterile water/saline, 10 ml 19 0 0.008611111 0.429135802 1 18 NA NA 8806 8806 Carrier J 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply 6 0 3.323722222 6 NA NA 8807 8807 Carrier J 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A9277 Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system 4 0 3.932777778 4 NA NA 8808 8808 Carrier J 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 Ext Amb Infusn Pump Insulin 3 0 4.149444444 3 NA NA 8809 8809 Carrier J 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4211 Supp For Self-Adm Injections 2 0 1.375555556 2 NA NA 8810 8810 Carrier J 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4239 Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service 2 0 20.75861111 2 NA NA 8811 8811 Carrier J 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4230 Infus Insulin Pump Non Needl 1 0 1.721388889 1 NA NA 8812 8812 Carrier J 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A5500 Diab Shoe For Density Insert 1 0 0.008888889 1 NA NA 8813 8813 Carrier J 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2103 Non-adjunctive, non-implanted continuous glucose monitor or receiver 1 0 23.59222222 1 NA NA 8814 8814 Carrier J 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4232 Syringe W/Needle Insulin 3cc 1 0 1.721388889 1 NA NA 8815 8815 Carrier J 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4238 Supply allowance for adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service 1 0 17.925 1 NA NA 8816 8816 Carrier J 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 1541 0.0324 46.68 9.36 150 1391 SEMAGLUTIDE (WEIGHT MANAGEMENT) WEGOVY 8817 8817 Carrier J 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 1324 0.0038 63.91 6.48 120 1204 TIRZEPATIDE (WEIGHT MANAGEMENT) ZEPBOUND 8818 8818 Carrier J 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 1113 0.7305 10.66 26.14 391 722 HYDROCODONE-ACETAMINOPHEN HYDROCODONE-ACETAMINOPHEN 8819 8819 Carrier J 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 1100 0.6373 6.84 7.03 175 925 SEMAGLUTIDE OZEMPIC (0.25 OR 0.5 MG/DOSE), OZEMPIC (1 MG/DOSE), OZEMPIC (2 MG/DOSE), RYBELSUS 8820 8820 Carrier J 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 1056 0.7699 7.75 17.04 395 661 OXYCODONE HCL OXYCODONE HCL, OXYCODONE HCL ER, OXYCONTIN, ROXICODONE 8821 8821 Carrier J 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 859 0.5669 8.93 6.33 99 760 TIRZEPATIDE MOUNJARO, MOUNJARO SUBCUTANEOUS SOLUTION PEN-INJECTOR 2.5 MG/0.5ML 8822 8822 Carrier J 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 756 0.7235 7.32 13.18 50 706 CYCLOSPORINE (OPHTH) CEQUA, CYCLOSPORINE, CYCLOSPORINE IN KLARITY, KLARITY-C DROPS, RESTASIS, RESTASIS MULTIDOSE, VEVYE 8823 8823 Carrier J 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 675 0.9081 18.38 16.89 190 485 ADALIMUMAB HUMIRA (2 PEN), HUMIRA (2 PEN) SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.4ML, HUMIRA (2 SYRINGE), HUMIRA-CD/UC/HS STARTER, HUMIRA-PED<40KG CROHNS STARTER, HUMIRA-PED>/=40KG UC STARTER, HUMIRA-PSORIASIS/UVEIT STARTER 8824 8824 Carrier J 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 607 0.8913 8.91 21.95 147 460 DUPILUMAB DUPIXENT 8825 8825 Carrier J 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 421 0.734 20.77 24.89 171 250 OXYCODONE W/ ACETAMINOPHEN ENDOCET, OXYCODONE-ACETAMINOPHEN, PERCOCET 8826 8826 Carrier J 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 31 1 6.91 7.74 19 12 LUMATEPERONE TOSYLATE CAPLYTA 8827 8827 Carrier J 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 27 1 1.93 4.02 2 25 VARENICLINE TARTRATE VARENICLINE TARTRATE, VARENICLINE TARTRATE (STARTER) 8828 8828 Carrier J 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 21 1 6.08 6.43 4 17 CARBIDOPA-LEVODOPA CARBIDOPA-LEVODOPA, RYTARY, SINEMET 8829 8829 Carrier J 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 17 1 6.53 11.08 13 4 AMPHETAMINE ADZENYS XR-ODT, DYANAVEL XR 8830 8830 Carrier J 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 16 1 4.43 3.42 5 11 CONTINUOUS GLUCOSE SYSTEM RECEIVER DEXCOM G6 RECEIVER, DEXCOM G7 RECEIVER, FREESTYLE LIBRE 2 READER 8831 8831 Carrier J 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 13 1 7.01 2.12 8 5 TOLVAPTAN JYNARQUE, TOLVAPTAN 8832 8832 Carrier J 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 12 1 4.65 2.15 10 2 RUXOLITINIB PHOSPHATE JAKAFI 8833 8833 Carrier J 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 12 1 3.62 0 12 ACOLTREMON TRYPTYR 8834 8834 Carrier J 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 12 1 2.44 9.9 6 6 ESCITALOPRAM OXALATE ESCITALOPRAM OXALATE, LEXAPRO 8835 8835 Carrier J 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 12 1 5.5 6.69 3 9 PAROXETINE HCL PAROXETINE HCL, PAROXETINE HCL ER 8836 8836 Carrier J 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 8 1 5.47 48.48 1 7 DEXTROMETHORPHAN HYDROBROMIDE-BUPROPION HYDROCHLORIDE AUVELITY 8837 8837 Carrier J 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 6 1 4.74 60.83 2 4 PRUCALOPRIDE SUCCINATE MOTEGRITY 8838 8838 Carrier J 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 5 1 10.81 99.03 2 3 BUPRENORPHINE BUPRENORPHINE, BUTRANS 8839 8839 Carrier J 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 4 1 22.02 43.05 1 3 TOFACITINIB CITRATE XELJANZ, XELJANZ XR 8840 8840 Carrier J 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 4 1 60.78 71.77 3 1 APREMILAST OTEZLA 8841 8841 Carrier J 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 1 11.64 3 0 SUVOREXANT BELSOMRA 8842 8842 Carrier J 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 1 22.97 3 0 TIVOZANIB HCL FOTIVDA 8843 8843 Carrier J 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 1 16.31 41.61 2 1 ERENUMAB-AOOE AIMOVIG 8844 8844 Carrier J 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 1 68.62 0 3 MORPHINE SULFATE MORPHINE SULFATE ER 8845 8845 Carrier J 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 1 32.17 2 0 IVOSIDENIB TIBSOVO 8846 8846 Carrier I 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44205 Laparoscopy, surgical; colectomy, partial, with removal of terminal ileum with ileocolostomy 10 0 1.281666667 0.804236111 2 8 NA NA 8847 8847 Carrier I 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44206 Laparoscopy, surgical; colectomy, partial, with end colostomy and closure of distal segment (Hartmann type procedure) 9 0 0.621018519 9 NA NA 8848 8848 Carrier I 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44204 Laparoscopy, surgical; colectomy, partial, with anastomosis 9 0 0.674382716 9 NA NA 8849 8849 Carrier I 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 44207 Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) 8 0 0.697465278 8 NA NA 8850 8850 Carrier I 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 8 0.75 50.68173611 8 NA NA 8851 8851 Carrier I 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64421 Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, each additional level (List separately in addition to code for primary procedure) 6 0 0.663888889 90.59772222 1 5 NA NA 8852 8852 Carrier I 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 31622 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure) 6 0 0.663888889 90.59761111 1 5 NA NA 8853 8853 Carrier I 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) 5 0.6 63.06127778 474.5755972 5 1 NA NA 8854 8854 Carrier I 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 52005 Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; 5 0.2 4.340111111 5 NA NA 8855 8855 Carrier I 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 4 0 1.384861111 4 NA NA 8856 8856 Carrier I 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45330 Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 4 0 0.841805556 4 NA NA 8857 8857 Carrier I 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) 4 0.75 43.75326389 4 NA NA 8858 8858 Carrier I 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 22614 Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure) 4 0.75 43.75326389 474.5755972 4 1 NA NA 8859 8859 Carrier I 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft 3 1 0.074259259 689.4079806 3 1 NA NA 8860 8860 Carrier I 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22551 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2 2 1 83.50708333 2 NA NA 8861 8861 Carrier I 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63048 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; each additional segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure) 2 1 81.26847222 2 NA NA 8862 8862 Carrier I 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar 2 1 81.26847222 2 NA NA 8863 8863 Carrier I 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22552 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2, each additional interspace (List separately in addition to code for separate procedure) 2 1 83.50708333 2 NA NA 8864 8864 Carrier I 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 2 1 23.0675 322.7895339 2 2 NA NA 8865 8865 Carrier I 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 37241 Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) 1 1 26.06722222 1 NA NA 8866 8866 Carrier I 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 37246 Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery 1 1 118.1091667 1 NA NA 8867 8867 Carrier I 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 38205 Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; allogeneic 1 1 20.56138889 1 NA NA 8868 8868 Carrier I 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 38240 Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor 1 1 20.56138889 1 NA NA 8869 8869 Carrier I 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 61863 Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array 1 1 25.62305556 1 NA NA 8870 8870 Carrier I 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 38724 Cervical lymphadenectomy (modified radical neck dissection) 1 1 1.181666667 1 NA NA 8871 8871 Carrier I 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63005 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; lumbar, except for spondylolisthesis 1 1 123.0016667 1 NA NA 8872 8872 Carrier I 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 63277 Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, lumbar 1 1 123.0016667 1 NA NA 8873 8873 Carrier I 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 39599 Unlisted procedure, diaphragm 1 1 135.3305556 1 NA NA 8874 8874 Carrier I 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22846 Anterior instrumentation; 4 to 7 vertebral segments (List separately in addition to code for primary procedure) 1 1 47.83388889 1 NA NA 8875 8875 Carrier I 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 61864 Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; each additional array (List separately in addition to primary procedure) 1 1 25.62305556 1 NA NA 8876 8876 Carrier I 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22999 Unlisted procedure, abdomen, musculoskeletal system 1 1 144.7780556 1 NA NA 8877 8877 Carrier I 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 27134 Revision of total hip arthroplasty; both components, with or without autograft or allograft 1 1 51.21638889 1 NA NA 8878 8878 Carrier I 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22325 Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; lumbar 1 1 123.0016667 1 NA NA 8879 8879 Carrier I 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 22634 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; each additional interspace and segment (List separately in addition to code for primary procedure) 1 1 111.1 1 NA NA 8880 8880 Carrier I 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 47135 Liver allotransplantation, orthotopic, partial or whole, from cadaver or living donor, any age 1 1 26.2 1 NA NA 8881 8881 Carrier I 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography 379 0.9024 7.120237467 379 NA NA 8882 8882 Carrier I 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 74177 Computed tomography, abdomen and pelvis; with contrast material(s) 285 0.9228 18.37277778 7.452548905 551.8094797 1 284 2 NA NA 8883 8883 Carrier I 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 70553 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences 267 0.9064 9.777399084 267 NA NA 8884 8884 Carrier I 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 73721 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material 184 0.7391 9.766171498 184 NA NA 8885 8885 Carrier I 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 72148 Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material 176 0.7045 2.756851852 25.61194284 3 173 NA NA 8886 8886 Carrier I 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 71260 Computed tomography, thorax, diagnostic; with contrast material(s) 143 0.9161 9.785207848 562.2420436 143 1 NA NA 8887 8887 Carrier I 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 141 0.922 1.190555556 2.685642741 4 137 NA NA 8888 8888 Carrier I 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 137 0.9197 3.426849148 328.4210565 137 4 NA NA 8889 8889 Carrier I 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 45380 Colonoscopy, flexible; with biopsy, single or multiple 126 0.9127 1.190555556 2.792313297 340.2249947 4 122 3 NA NA 8890 8890 Carrier I 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 71250 Computed tomography, thorax, diagnostic; without contrast material 123 0.8293 13.90338753 123 NA NA 8891 8891 Carrier I 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 74170 Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections 24 1 1.272164352 24 NA NA 8892 8892 Carrier I 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 70480 Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material 16 1 5.184253472 16 NA NA 8893 8893 Carrier I 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64484 Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, each additional level (List separately in addition to code for primary procedure) 13 1 1.913717949 13 NA NA 8894 8894 Carrier I 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58572 Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; 12 1 14.04861111 14.83073232 1 11 NA NA 8895 8895 Carrier I 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93312 Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report 11 1 0.000454545 11 NA NA 8896 8896 Carrier I 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 78816 Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; whole body 11 1 31.01876263 11 NA NA 8897 8897 Carrier I 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72192 Computed tomography, pelvis; without contrast material 10 1 24.22241667 10 NA NA 8898 8898 Carrier I 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 72193 Computed tomography, pelvis; with contrast material(s) 10 1 4.623388889 10 NA NA 8899 8899 Carrier I 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 31624 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage 10 1 0.866944444 1.130185185 4 6 NA NA 8900 8900 Carrier I 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58662 Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method 9 1 14.93222222 288.2662813 9 5 NA NA 8901 8901 Carrier I 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77078 Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) 9 1 2.363240741 9 NA NA 8902 8902 Carrier I 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 74174 Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing 9 1 5.304567901 9 NA NA 8903 8903 Carrier I 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 38222 Diagnostic bone marrow; biopsy(ies) and aspiration(s) 9 1 0.297055556 0.215 5 4 NA NA 8904 8904 Carrier I 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 70470 Computed tomography, head or brain; without contrast material, followed by contrast material(s) and further sections 5 0.2 4.202388889 5 NA NA 8905 8905 Carrier I 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 73222 Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) 18 0.0556 12.99748457 18 NA NA 8906 8906 Carrier I 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 72148 Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material 176 0.017 2.756851852 25.61194284 3 173 NA NA 8907 8907 Carrier I 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 72141 Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material 121 0.0083 19.36479109 517.6161111 121 1 NA NA 8908 8908 Carrier I 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 70553 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences 267 0.0037 9.777399084 267 NA NA 8909 8909 Carrier I 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1002 Residential treatment, Substance Use Disorder 8 1 49.4796875 8 NA NA 8910 8910 Carrier I 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year Revenue 1001 Residential treatment, Psychiatric 4 0.75 45.39465278 4 NA NA 8911 8911 Carrier I 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 15240 Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less 2 0 0.244027778 2 NA NA 8912 8912 Carrier I 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 56805 Clitoroplasty for intersex state 2 1 53.59708333 2 NA NA 8913 8913 Carrier I 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 54520 Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach 2 1 53.59708333 2 NA NA 8914 8914 Carrier I 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 15241 Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) 2 0 0.244027778 2 NA NA 8915 8915 Carrier I 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 53410 Urethroplasty, 1-stage reconstruction of male anterior urethra 2 1 53.59708333 2 NA NA 8916 8916 Carrier I 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 15876 Suction assisted lipectomy; head and neck 1 1 47.32361111 1 NA NA 8917 8917 Carrier I 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 54550 Exploration for undescended testis (inguinal or scrotal area) 1 0 0.017222222 1 NA NA 8918 8918 Carrier I 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 54530 Orchiectomy, radical, for tumor; inguinal approach 1 0 0.017222222 1 NA NA 8919 8919 Carrier I 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 57335 Vaginoplasty for intersex state 1 1 99.86166667 1 NA NA 8920 8920 Carrier I 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 55150 Resection of scrotum 1 0 0.470833333 1 NA NA 8921 8921 Carrier I 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 19325 Breast augmentation with implant 1 1 99.86166667 1 NA NA 8922 8922 Carrier I 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 49329 Unlisted laparoscopy procedure, abdomen, peritoneum and omentum 1 1 7.3325 1 NA NA 8923 8923 Carrier I 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 57425 Laparoscopy, surgical, colpopexy (suspension of vaginal apex) 1 0 0.470833333 1 NA NA 8924 8924 Carrier I 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 58999 Unlisted procedure, female genital system (nonobstetrical) 1 1 7.3325 1 NA NA 8925 8925 Carrier I 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 54125 Amputation of penis; complete 1 1 7.3325 1 NA NA 8926 8926 Carrier I 2024 Inpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 54120 Amputation of penis; partial 1 0 0.017222222 1 NA NA 8927 8927 Carrier I 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year Revenue 1002 Residential treatment, Substance Use Disorder 8 1 49.4796875 8 NA NA 8928 8928 Carrier I 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 56805 Clitoroplasty for intersex state 2 1 53.59708333 2 NA NA 8929 8929 Carrier I 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 54520 Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach 2 1 53.59708333 2 NA NA 8930 8930 Carrier I 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 53410 Urethroplasty, 1-stage reconstruction of male anterior urethra 2 1 53.59708333 2 NA NA 8931 8931 Carrier I 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15876 Suction assisted lipectomy; head and neck 1 1 47.32361111 1 NA NA 8932 8932 Carrier I 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 57335 Vaginoplasty for intersex state 1 1 99.86166667 1 NA NA 8933 8933 Carrier I 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19325 Breast augmentation with implant 1 1 99.86166667 1 NA NA 8934 8934 Carrier I 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 49329 Unlisted laparoscopy procedure, abdomen, peritoneum and omentum 1 1 7.3325 1 NA NA 8935 8935 Carrier I 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58999 Unlisted procedure, female genital system (nonobstetrical) 1 1 7.3325 1 NA NA 8936 8936 Carrier I 2024 Inpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 54125 Amputation of penis; complete 1 1 7.3325 1 NA NA 8937 8937 Carrier I 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session 18 0.6667 19.49333333 18.5529085 1 17 NA NA 8938 8938 Carrier I 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 18 0.6667 19.49333333 18.5529085 1 17 NA NA 8939 8939 Carrier I 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management 17 0.6471 19.49333333 19.34711806 1 16 NA NA 8940 8940 Carrier I 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 10 0.9 15.22194444 10.47753086 1 9 NA NA 8941 8941 Carrier I 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 71271 Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s) 10 0.7 11.52672222 10 NA NA 8942 8942 Carrier I 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual 6 0.6667 51.50717593 6 NA NA 8943 8943 Carrier I 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 19318 Breast reduction 4 1 3.064722222 4 NA NA 8944 8944 Carrier I 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 97151 Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan 4 0.25 24.15055556 4 NA NA 8945 8945 Carrier I 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 17380 Electrolysis epilation, each 30 minutes 4 0.75 331.8572222 4 NA NA 8946 8946 Carrier I 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year HCPC H2036 Alcohol and/or other drug treatment program, per diem 3 1 10.6525 3 NA NA 8947 8947 Carrier I 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 81415 Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis 3 0 3.894814815 3 NA NA 8948 8948 Carrier I 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 92523 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language) 3 0.6667 73.42824074 3 NA NA 8949 8949 Carrier I 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19318 Breast reduction 4 1 3.064722222 4 NA NA 8950 8950 Carrier I 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H2036 Alcohol and/or other drug treatment program, per diem 3 1 10.6525 3 NA NA 8951 8951 Carrier I 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19350 Nipple/areola reconstruction 2 1 4.001388889 2 NA NA 8952 8952 Carrier I 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19303 Mastectomy, simple, complete 2 1 4.001388889 2 NA NA 8953 8953 Carrier I 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0035 Mental Health Partial Hospitalization, Treatment, Less Than 24 Hours 2 1 16.08777778 2 NA NA 8954 8954 Carrier I 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 1 1 2.005555556 1 NA NA 8955 8955 Carrier I 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97535 Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact, each 15 minutes 1 1 2.005555556 1 NA NA 8956 8956 Carrier I 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97140 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes 1 1 2.005555556 1 NA NA 8957 8957 Carrier I 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 97152 Behavior identification-supporting assessment, administered by one technician under the direction of a physician or other qualified health care professional, face-to-face with the patient, each 15 minutes 1 1 3.056944444 1 NA NA 8958 8958 Carrier I 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC H0015 Alcohol And/Or Drug Services 10 0.9 15.22194444 10.47753086 1 9 NA NA 8959 8959 Carrier I 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0601 Cont Airway Pressure Device 372 0.9409 2.449742384 440.4642564 372 1 NA NA 8960 8960 Carrier I 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without backup rate 13 0.8462 4.690235043 13 NA NA 8961 8961 Carrier I 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1399 Durable Medical Equipment Mi 5 0 1.443333333 0.35875 1 4 NA NA 8962 8962 Carrier I 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0486 Oral device/appliance cusfab 2 0 2.540138889 2 NA NA 8963 8963 Carrier I 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2402 Negative pressure wound therapy electrical pump, stationary or portable 2 0.5 41.27930556 2 NA NA 8964 8964 Carrier I 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1236 Wheelchair, Pediatric Size, Folding, Adjustable, With Seating System 1 0 2.2425 1 NA NA 8965 8965 Carrier I 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0973 Wheelchair Adjustabl Height 1 0 1.442222222 1 NA NA 8966 8966 Carrier I 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0766 ELEC STIM CANCER TREATMENT 1 1 27.06694444 1 NA NA 8967 8967 Carrier I 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate 1 1 0.000277778 1 NA NA 8968 8968 Carrier I 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1028 Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other 1 0 1.442222222 1 NA NA 8969 8969 Carrier I 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2510 Speech generating device, synthesized speech, permitting multiple methods 1 0 8.193333333 1 NA NA 8970 8970 Carrier I 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0691 Ultraviolet Light Therapy System Panel, Includes Bulbs/Lamps, Timer An 1 0 23.18527778 1 NA NA 8971 8971 Carrier I 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2619 Replace cover w/c seat cush 1 0 0.294444444 1 NA NA 8972 8972 Carrier I 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0747 Elec Osteogen Stim Not Spine 1 0 51.39472222 1 NA NA 8973 8973 Carrier I 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2512 Accessory for speech generating device, mounting system 1 0 8.193333333 1 NA NA 8974 8974 Carrier I 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0748 Elec Osteogen Stim Spinal 1 0 0.0925 1 NA NA 8975 8975 Carrier I 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0260 Hosp Bed Semi-Electr W/ Matt 1 0 21.63972222 1 NA NA 8976 8976 Carrier I 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0760 Osteogen Ultrasound Stimltor 1 0 1.544722222 1 NA NA 8977 8977 Carrier I 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0766 ELEC STIM CANCER TREATMENT 1 1 27.06694444 1 NA NA 8978 8978 Carrier I 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate 1 1 0.000277778 1 NA NA 8979 8979 Carrier I 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0601 Cont Airway Pressure Device 372 0.9409 2.449742384 440.4642564 372 1 NA NA 8980 8980 Carrier I 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0470 Respiratory assist device, bi-level pressure capability, without backup rate 13 0.8462 4.690235043 13 NA NA 8981 8981 Carrier I 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2402 Negative pressure wound therapy electrical pump, stationary or portable 2 0.5 41.27930556 2 NA NA 8982 8982 Carrier I 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1399 Durable Medical Equipment Mi 5 0 1.443333333 0.35875 1 4 NA NA 8983 8983 Carrier I 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0486 Oral device/appliance cusfab 2 0 2.540138889 2 NA NA 8984 8984 Carrier I 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1236 Wheelchair, Pediatric Size, Folding, Adjustable, With Seating System 1 0 2.2425 1 NA NA 8985 8985 Carrier I 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0973 Wheelchair Adjustabl Height 1 0 1.442222222 1 NA NA 8986 8986 Carrier I 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1028 Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other 1 0 1.442222222 1 NA NA 8987 8987 Carrier I 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2510 Speech generating device, synthesized speech, permitting multiple methods 1 0 8.193333333 1 NA NA 8988 8988 Carrier I 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0691 Ultraviolet Light Therapy System Panel, Includes Bulbs/Lamps, Timer An 1 0 23.18527778 1 NA NA 8989 8989 Carrier I 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2619 Replace cover w/c seat cush 1 0 0.294444444 1 NA NA 8990 8990 Carrier I 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0747 Elec Osteogen Stim Not Spine 1 0 51.39472222 1 NA NA 8991 8991 Carrier I 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2512 Accessory for speech generating device, mounting system 1 0 8.193333333 1 NA NA 8992 8992 Carrier I 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0748 Elec Osteogen Stim Spinal 1 0 0.0925 1 NA NA 8993 8993 Carrier I 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0260 Hosp Bed Semi-Electr W/ Matt 1 0 21.63972222 1 NA NA 8994 8994 Carrier I 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0760 Osteogen Ultrasound Stimltor 1 0 1.544722222 1 NA NA 8995 8995 Carrier I 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2103 Non-adjunctive, non-implanted continuous glucose monitor or receiver 1 0 5.203055556 1 NA NA 8996 8996 Carrier I 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4239 Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service 1 0 2.074722222 1 NA NA 8997 8997 Carrier I 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2103 Non-adjunctive, non-implanted continuous glucose monitor or receiver 1 0 5.203055556 1 NA NA 8998 8998 Carrier I 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4239 Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service 1 0 2.074722222 1 NA NA 8999 8999 Carrier I 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 114 0.6754 13.16 14.95 31 83 HYDROCODONE-ACETAMINOPHEN HYDROCODONE-ACETAMINOPHEN 9000 9000 Carrier I 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 107 0.0374 5.1 7.11 8 99 SEMAGLUTIDE (WEIGHT MANAGEMENT) WEGOVY 9001 9001 Carrier I 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 107 0.6542 8.55 20.01 19 88 SEMAGLUTIDE OZEMPIC (0.25 OR 0.5 MG/DOSE), OZEMPIC (1 MG/DOSE), OZEMPIC (2 MG/DOSE), RYBELSUS 9002 9002 Carrier I 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 103 0.7476 5.96 27.27 36 67 OXYCODONE HCL OXYCODONE HCL, OXYCODONE HCL ER, OXYCONTIN 9003 9003 Carrier I 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 70 0.6429 7.29 6.75 3 67 CYCLOSPORINE (OPHTH) CEQUA, CYCLOSPORINE, RESTASIS, RESTASIS MULTIDOSE, VEVYE 9004 9004 Carrier I 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 68 0 5.39 7.39 9 59 TIRZEPATIDE (WEIGHT MANAGEMENT) ZEPBOUND 9005 9005 Carrier I 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 54 0.7407 5.88 3.53 8 46 TIRZEPATIDE MOUNJARO 9006 9006 Carrier I 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 44 0.7955 4.41 46.12 5 39 RIMEGEPANT SULFATE NURTEC 9007 9007 Carrier I 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 44 0.9773 6.19 12.75 11 33 ADALIMUMAB HUMIRA (2 PEN), HUMIRA (2 SYRINGE), HUMIRA-CD/UC/HS STARTER, HUMIRA-PED<40KG CROHNS STARTER 9008 9008 Carrier I 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 36 0.4444 20.26 9.22 4 32 LINACLOTIDE LINZESS 9009 9009 Carrier I 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 25 1 8.08 0 25 RISANKIZUMAB-RZAA SKYRIZI, SKYRIZI PEN 9010 9010 Carrier I 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 18 1 4.65 2.98 4 14 PLECANATIDE TRULANCE 9011 9011 Carrier I 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 13 1 2.07 4.73 2 11 SECUKINUMAB COSENTYX SENSOREADY (300 MG), COSENTYX SENSOREADY PEN, COSENTYX UNOREADY 9012 9012 Carrier I 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 11 1 2.27 6.43 3 8 ETANERCEPT ENBREL MINI, ENBREL SURECLICK 9013 9013 Carrier I 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 9 1 1.93 6.58 4 5 ABEMACICLIB VERZENIO 9014 9014 Carrier I 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 1.78 6.07 2 6 DULAGLUTIDE TRULICITY 9015 9015 Carrier I 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 1.96 7.27 3 4 LUMATEPERONE TOSYLATE CAPLYTA 9016 9016 Carrier I 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 7.29 0 7 LIFITEGRAST XIIDRA 9017 9017 Carrier I 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 2.49 6.25 3 4 LAMOTRIGINE LAMOTRIGINE, LAMOTRIGINE ER 9018 9018 Carrier I 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 6 1 2.53 3.06 2 4 ELTROMBOPAG OLAMINE PROMACTA 9019 9019 Carrier I 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 4 1 24.78 29.18 3 1 EVOLOCUMAB REPATHA SURECLICK 9020 9020 Carrier I 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 1 12.24 2 0 ADALIMUMAB HUMIRA (2 PEN) 9021 9021 Carrier I 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 1 25.65 0 2 PENTOSAN POLYSULFATE SODIUM ELMIRON 9022 9022 Carrier I 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 1 16.54 46.99 1 1 OXYCODONE W/ ACETAMINOPHEN OXYCODONE-ACETAMINOPHEN 9023 9023 Carrier I 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 1 4.51 2 0 IVABRADINE HCL CORLANOR 9024 9024 Carrier I 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 1 47.28 0 2 ERENUMAB-AOOE AIMOVIG 9025 9025 Carrier I 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 21.81 0 1 RIBOCICLIB SUCCINATE KISQALI (600 MG DOSE) 9026 9026 Carrier I 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 15.7 1 0 SEMAGLUTIDE OZEMPIC (0.25 OR 0.5 MG/DOSE) 9027 9027 Carrier I 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 23.08 0 1 BUTORPHANOL TARTRATE BUTORPHANOL TARTRATE 9028 9028 Carrier I 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 1 5.42 1 0 BUPRENORPHINE BUPRENORPHINE 9029 9029 Carrier G 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 32666 THORACOSCOPY W/THERA WEDGE RESEXN INITIAL UNILAT 3 1 1 2 NA NA 9030 9030 Carrier G 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 32674 THORCOSCPY W/MEDIASTINL AND REGIONL LYMPHDENECTOMY 3 0.3333 3 NA NA 9031 9031 Carrier G 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 33259 ATRIA ABLTJ AND RCNSTJ W/OTHER PX EXTEN W/BYPASS 3 1 1 2 NA NA 9032 9032 Carrier G 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 33405 RPLCMT PROST AORTIC VALVE OPEN XCP HOMOGRF/STENT 3 1 3 NA NA 9033 9033 Carrier G 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 33427 VLVP MITRAL VALVE W/BYPASS RAD RCNSTJ W/WO RING 3 1 1 2 NA NA 9034 9034 Carrier G 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 35371 TEAEC W/WO PATCH GRAFT COMMON FEMORAL 3 1 3 NA NA 9035 9035 Carrier G 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93355 ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN 3 1 3 NA NA 9036 9036 Carrier G 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 33340 PERQ CLSR TCAT L ATR APNDGE W/ENDOCARDIAL IMPLNT 2 1 2 NA NA 9037 9037 Carrier G 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 33361 REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH 2 1 1 1 NA NA 9038 9038 Carrier G 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 33413 REPLACEMENT AORTIC AND PULMON VALVES ROSS PROCEDUR 2 1 2 NA NA 9039 9039 Carrier G 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 32666 THORACOSCOPY W/THERA WEDGE RESEXN INITIAL UNILAT 3 1 1 2 NA NA 9040 9040 Carrier G 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33259 ATRIA ABLTJ AND RCNSTJ W/OTHER PX EXTEN W/BYPASS 3 1 1 2 NA NA 9041 9041 Carrier G 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33405 RPLCMT PROST AORTIC VALVE OPEN XCP HOMOGRF/STENT 3 1 3 NA NA 9042 9042 Carrier G 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33427 VLVP MITRAL VALVE W/BYPASS RAD RCNSTJ W/WO RING 3 1 1 2 NA NA 9043 9043 Carrier G 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 35371 TEAEC W/WO PATCH GRAFT COMMON FEMORAL 3 1 3 NA NA 9044 9044 Carrier G 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93355 ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN 3 1 3 NA NA 9045 9045 Carrier G 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33340 PERQ CLSR TCAT L ATR APNDGE W/ENDOCARDIAL IMPLNT 2 1 2 NA NA 9046 9046 Carrier G 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33361 REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH 2 1 1 3 NA NA 9047 9047 Carrier G 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33413 REPLACEMENT AORTIC AND PULMON VALVES ROSS PROCEDUR 2 1 2 NA NA 9048 9048 Carrier G 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 33416 VENTRICULOMYOTOMY-MYECTOMY 2 1 1 1 NA NA 9049 9049 Carrier G 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93306 ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC AND COLR D 1216 0.9622 17 1199 NA NA 9050 9050 Carrier G 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93971 DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY 208 0.9808 12 196 NA NA 9051 9051 Carrier G 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93015 CV STRS TST XERS AND /OR RX CONT ECG W/SI AND R 203 0.936 2 201 NA NA 9052 9052 Carrier G 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93248 EXTERNAL ECG REC GT 7D LT 15D REVIEW AND INTERPRETATION 201 0.9851 201 NA NA 9053 9053 Carrier G 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 78452 MYOCARDIAL SPECT MULTIPLE STUDIES 192 0.9271 3 189 NA NA 9054 9054 Carrier G 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93246 EXTERNAL ECG REC GT 7D LT 15D RECORDING 175 0.9829 175 NA NA 9055 9055 Carrier G 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93017 CV STRS TST XERS AND /OR RX CONT ECG TRCG ONLY 170 0.9471 170 NA NA 9056 9056 Carrier G 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 93970 DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY 156 0.9487 4 152 NA NA 9057 9057 Carrier G 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 77334 TX DEVICES DESIGN AND CONSTRUCTION COMPLEX 154 0.974 14 140 NA NA 9058 9058 Carrier G 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 77300 BASIC RADIATION DOSIMETRY CALCULATION 139 0.9784 10 129 NA NA 9059 9059 Carrier G 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77301 NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS 78 1 6 72 NA NA 9060 9060 Carrier G 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77338 MLC IMRT DESIGN AND CONSTRUCTION PER IMRT PLAN 75 1 6 69 NA NA 9061 9061 Carrier G 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77014 CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT 73 1 3 70 NA NA 9062 9062 Carrier G 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93325 DOP ECHOCARD COLOR FLOW VELOCITY MAPPING 72 1 72 NA NA 9063 9063 Carrier G 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93308 ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD 63 1 63 NA NA 9064 9064 Carrier G 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93922 NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL 52 1 3 49 NA NA 9065 9065 Carrier G 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77332 TX DEVICES DESIGN AND CONSTRUCTION SIMPLE 35 1 1 34 NA NA 9066 9066 Carrier G 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 77386 INTENSITY MODULATED RADIATION TX DLVR COMPLEX 34 1 2 32 NA NA 9067 9067 Carrier G 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93290 INTERROG DEV EVAL ICPMS PHYS/QHP IN PERSON 31 1 31 NA NA 9068 9068 Carrier G 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 93280 PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER 27 1 27 NA NA 9069 9069 Carrier G 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 93970 DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY 1 0.0048 0 1 NA NA 9070 9070 Carrier G 2024 Outpatient Med-Surg Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal CPT 93306 ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC AND COLR D 2 0.0016 0 2 NA NA 9071 9071 Carrier G 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 90875 INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 30 MIN 1 1 1 NA NA 9072 9072 Carrier G 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96116 NEUROBEHAVIORAL STATUS XM PHYS/QHP 1ST HOUR 1 0 11 1 NA NA 9073 9073 Carrier G 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96121 NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR 1 0 11 1 NA NA 9074 9074 Carrier G 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96132 NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR 1 0 11 1 NA NA 9075 9075 Carrier G 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96133 NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR 1 0 11 1 NA NA 9076 9076 Carrier G 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96136 PSYL/NRPSYCL TST PHYS/QHP 2 PLUS TST 1ST 30 MIN 1 0 11 1 NA NA 9077 9077 Carrier G 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96137 PSYCL/NRPSYCL TST PHYS/QHP 2 PLUS TST EA ADDL 30 MIN 1 0 11 1 NA NA 9078 9078 Carrier G 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96138 PSYCL/NRPSYCL TST TECH 2 PLUS TST 1ST 30 MIN 1 0 11 1 NA NA 9079 9079 Carrier G 2024 Outpatient MH-SUD Codes with the highest total number of prior authorization requests during the previous plan year CPT 96139 PSYCL/NRPSYCL TST TECH 2 PLUS TST EA ADDL 30 MIN 1 0 11 1 NA NA 9080 9080 Carrier G 2024 Outpatient MH-SUD Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 90875 INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 30 MIN 1 1 1 NA NA 9081 9081 Carrier G 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E1390 O2 CONC 1 DEL PORT 85 PCT OR GT 02 CONC AT PRSC FLW RATE 6 1 6 NA NA 9082 9082 Carrier G 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT K0738 PORTABLE GASEOUS O2 SYS RENTAL; HOME COMPRESSOR 5 1 5 NA NA 9083 9083 Carrier G 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L0650 LSO SAGITTAL-CORONAL CONTRL RIGD ANT POST PANELS 1 1 1 NA NA 9084 9084 Carrier G 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT L3933 FINGER ORTHOSIS W/O JOINTS CUSTOM FABRICATED 1 1 1 NA NA 9085 9085 Carrier G 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT A4649 SURGICAL SUPPLY; MISCELLANEOUS 1 1 1 NA NA 9086 9086 Carrier G 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year CPT E2298 COMPLEX REHAB PWR WC ACC PWR SEAT EL SYS ANY TYP 1 1 1 NA NA 9087 9087 Carrier G 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E1390 O2 CONC 1 DEL PORT 85 PCT OR GT 02 CONC AT PRSC FLW RATE 6 1 6 NA NA 9088 9088 Carrier G 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT K0738 PORTABLE GASEOUS O2 SYS RENTAL; HOME COMPRESSOR 5 1 5 NA NA 9089 9089 Carrier G 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L0650 LSO SAGITTAL-CORONAL CONTRL RIGD ANT POST PANELS 1 1 1 NA NA 9090 9090 Carrier G 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT L3933 FINGER ORTHOSIS W/O JOINTS CUSTOM FABRICATED 1 1 1 NA NA 9091 9091 Carrier G 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT A4649 SURGICAL SUPPLY; MISCELLANEOUS 1 1 1 NA NA 9092 9092 Carrier G 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT E2298 COMPLEX REHAB PWR WC ACC PWR SEAT EL SYS ANY TYP 1 1 1 NA NA 9093 9093 Carrier G 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 1124 0.898 11.1 20.9 325 799 AMPHETAMINE/DEXTROAMPHETAMINE ADDERALL 9094 9094 Carrier G 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 868 0.514 22.6 65.4 237 631 DEXCOM Receiver/Sensor/Transmiter DEXCOM Receiver/Sensor/Transmiter 9095 9095 Carrier G 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 526 0.513 18.7 38.8 91 435 SEMAGLUTIDE OZEMPIC 9096 9096 Carrier G 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 468 0.825 14.3 24.2 130 338 METHYLPHENIDATE HCL RITALIN 9097 9097 Carrier G 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 381 0.52 27.7 59.9 100 281 LISDEXAMFETAMINE DIMESYLATE VYVANSE 9098 9098 Carrier G 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 290 0.731 13.4 30.6 82 208 ADALIMUMAB HUMIRA 9099 9099 Carrier G 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 211 0.464 32.1 62.6 10 201 TRETINOIN RETIN-A 9100 9100 Carrier G 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 199 0.241 40.6 61.7 37 162 TERZEPATIDE MOUNJARO 9101 9101 Carrier G 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 191 0.571 28.7 42.7 6 185 TACROLIMUS PROTOPIC 9102 9102 Carrier G 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 189 0.794 13.7 25.5 44 145 EMPAGLIFLOZIN JARDIANCE 9103 9103 Carrier G 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 22 1 8.6 17.6 6 16 PANCRELIPASE CREON 9104 9104 Carrier G 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 21 1 1.4 28 2 19 GUSELKUMAB TREMFYA 9105 9105 Carrier G 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 16 1 4.3 1.2 11 5 CENOBAMATE XCORPI 9106 9106 Carrier G 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 10 1 12.1 14.1 3 7 CARBIDOPA/LEVODOPA RYTARY 9107 9107 Carrier G 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 10 1 11.6 17.2 3 7 AMBRISENTAN LETAIRIS 9108 9108 Carrier G 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 9 1 9.8 7.3 4 5 PALIPERIDONE INVEGA 9109 9109 Carrier G 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 9 1 11.5 28.4 5 4 LORAZEPAM ATIVAN 9110 9110 Carrier G 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 3 21.1 2 6 VILOXAZINE QELBREE 9111 9111 Carrier G 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 2.8 34.6 6 2 AZALABRUTINIB CALQUENCE 9112 9112 Carrier G 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 12 6.7 4 3 LINEZOLID ZYVOX 9113 9113 Carrier G 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 6 0.0069 0 8 DEXCOM Receiver/Sensor/Transmiter DEXCOM Receiver/Sensor/Transmiter 9114 9114 Carrier G 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 3 0.0057 0 5 SEMAGLUTIDE OZEMPIC 9115 9115 Carrier G 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 0.0052 0 3 LISDEXAMFETAMINE DIMESYLATE VYVANSE 9116 9116 Carrier G 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 2 0.0069 0 3 ADALIMUMAB HUMIRA 9117 9117 Carrier G 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 0.0047 0 1 TRETINOIN RETIN-A 9118 9118 Carrier G 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 1 0.005 0 3 TERZEPATIDE MOUNJARO 9119 9119 Carrier K 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64405 Injection(s), anesthetic agent(s) and/or steroid; greater occipital nerve 5 0 48.66 0 5 NA NA 9120 9120 Carrier K 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64483 Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, single level 5 0.8 21.52 0 5 NA NA 9121 9121 Carrier K 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 67900 Repair of brow ptosis (supraciliary, mid-forehead or coronal approach) 4 1 54.55 0 4 NA NA 9122 9122 Carrier K 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2370 Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only 3 0.6667 95.23 0 2 NA NA 9123 9123 Carrier K 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 14301 Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm 2 1 54.55 0 2 NA NA 9124 9124 Carrier K 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 14302 Adjacent tissue transfer or rearrangement, any area; each additional 30.0 sq cm, or part thereof 2 1 54.55 0 2 NA NA 9125 9125 Carrier K 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 15773 Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate 2 1 54.55 0 2 NA NA 9126 9126 Carrier K 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 15774 Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; each additional 25 cc injectate, or part thereof 2 1 54.55 0 2 NA NA 9127 9127 Carrier K 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 21089 Unlisted maxillofacial prosthetic procedure 2 0.5 34.95 0 2 NA NA 9128 9128 Carrier K 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 21139 Reduction forehead; contouring and setback of anterior frontal sinus wall� 2 1 54.55 0 2 NA NA 9129 9129 Carrier K 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 21175 Reconstruction, bifrontal, superior-lateral orbital rims and lower forehead, advancement or alteration (eg, plagiocephaly, trigonocephaly, brachycephaly), with or without grafts 2 1 54.55 0 2 NA NA 9130 9130 Carrier K 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 30117 Excision or destruction (eg, laser), intranasal lesion; internal approach 2 1 143.3 0 2 NA NA 9131 9131 Carrier K 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 30140 Submucous resection inferior turbinate, partial or complete, any method 2 1 143.3 0 2 NA NA 9132 9132 Carrier K 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64484 Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, each additional level 2 1 12.9 0 2 NA NA 9133 9133 Carrier K 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC J9039 Injection, blinatumomab, 1 microgram 2 1 34.1 1 1 NA NA 9134 9134 Carrier K 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0108 Wheelchair component or accessory, not otherwise specified 2 0.5 132.85 0 2 NA NA 9135 9135 Carrier K 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC K0739 Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes 2 0.5 132.85 0 2 NA NA 9136 9136 Carrier K 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 67900 Repair of brow ptosis (supraciliary, mid-forehead or coronal approach) 4 1 54.55 0 4 NA NA 9137 9137 Carrier K 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 14301 Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm 2 1 54.55 0 2 NA NA 9138 9138 Carrier K 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 14302 Adjacent tissue transfer or rearrangement, any area; each additional 30.0 sq cm, or part thereof 2 1 54.55 0 2 NA NA 9139 9139 Carrier K 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15773 Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate 2 1 54.55 0 2 NA NA 9140 9140 Carrier K 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15774 Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; each additional 25 cc injectate, or part thereof 2 1 54.55 0 2 NA NA 9141 9141 Carrier K 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 21139 Reduction forehead; contouring and setback of anterior frontal sinus wall� 2 1 54.55 0 2 NA NA 9142 9142 Carrier K 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 21175 Reconstruction, bifrontal, superior-lateral orbital rims and lower forehead, advancement or alteration (eg, plagiocephaly, trigonocephaly, brachycephaly), with or without grafts 2 1 54.55 0 2 NA NA 9143 9143 Carrier K 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 30117 Excision or destruction (eg, laser), intranasal lesion; internal approach 2 1 143.3 0 2 NA NA 9144 9144 Carrier K 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 30140 Submucous resection inferior turbinate, partial or complete, any method 2 1 143.3 0 2 NA NA 9145 9145 Carrier K 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64484 Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, each additional level 2 1 12.9 0 2 NA NA 9146 9146 Carrier K 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC J9039 Injection, blinatumomab, 1 microgram 2 1 34.1 1 1 NA NA 9147 9147 Carrier K 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 81420 Fetal chromosomal aneuploidy (eg, trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18, and 21 39 0.5897 32.96 0 39 NA NA 9148 9148 Carrier K 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 81479 Unlisted molecular pathology procedure 25 0.8 17.18 0 25 NA NA 9149 9149 Carrier K 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95810 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist 23 0.6087 24.5 20.71 1 22 NA NA 9150 9150 Carrier K 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64493 �Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level 19 0.8421 0.5 12.76 1 18 NA NA 9151 9151 Carrier K 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 30140 Submucous resection inferior turbinate, partial or complete, any method 12 0.75 43.6 0 12 NA NA 9152 9152 Carrier K 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 30520 Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft 12 0.75 46.44 0 12 NA NA 9153 9153 Carrier K 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95811 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist 12 0.5 36.81 0 12 NA NA 9154 9154 Carrier K 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 17106 Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm 11 1 0.69 0 11 NA NA 9155 9155 Carrier K 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 30465 Repair of nasal vestibular stenosis (eg, spreader grafting, lateral nasal wall reconstruction) 10 0.4 54.68 0 10 NA NA 9156 9156 Carrier K 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 36475 Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated 9 1 7.1 0 9 NA NA 9157 9157 Carrier K 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64494 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level 9 0.6667 14.02 0 9 NA NA 9158 9158 Carrier K 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 17106 Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm 11 1 0.69 0 11 NA NA 9159 9159 Carrier K 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 36475 Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated 9 1 7.1 0 9 NA NA 9160 9160 Carrier K 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 19318 Breast reduction 8 1 7.45 0 8 NA NA 9161 9161 Carrier K 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 52000 Cystourethroscopy (separate procedure) 7 1 0.71 0 7 NA NA 9162 9162 Carrier K 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 52356 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent 7 1 0.19 0 7 NA NA 9163 9163 Carrier K 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D and C 7 1 0.14 0 7 NA NA 9164 9164 Carrier K 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 31255 Nasal/sinus endoscopy, surgical with ethmoidectomy; total� 6 1 12.65 0 6 NA NA 9165 9165 Carrier K 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 36471 Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg 6 1 10.52 0 6 NA NA 9166 9166 Carrier K 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 49650 Laparoscopy, surgical; repair initial inguinal hernia 6 1 0.1 0.16 1 5 NA NA 9167 9167 Carrier K 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 50590 Lithotripsy, extracorporeal shock wave 6 1 0.2 0 6 NA NA 9168 9168 Carrier K 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC S1040 Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) 6 0.5 25.88 6 NA NA 9169 9169 Carrier K 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0760 Osteogenesis stimulator, low intensity ultrasound, non-invasive 2 1 16 2 NA NA 9170 9170 Carrier K 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4239 Supply allowance for nonadjunctive, nonimplanted continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service 1 0 38.5 1 NA NA 9171 9171 Carrier K 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0265 Hospital bed, total electric (head, foot, and height adjustments), with any type side rails, with mattress 1 0 42.5 0 NA NA 9172 9172 Carrier K 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0486 Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment 1 0 61.1 1 NA NA 9173 9173 Carrier K 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2103 Nonadjunctive, nonimplanted continuous glucose monitor (CGM) or receiver 1 0 38.5 1 NA NA 9174 9174 Carrier K 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2510 Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access 1 1 25.1 1 NA NA 9175 9175 Carrier K 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5301 Below knee, molded socket, shin, sach foot, endoskeletal system 1 1 4.5 1 NA NA 9176 9176 Carrier K 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L5968 Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature 1 1 4.5 1 NA NA 9177 9177 Carrier K 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC L8619 Cochlear implant, external speech processor and controller, integrated system, replacement 1 1 9.1 1 NA NA 9178 9178 Carrier K 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0760 Osteogenesis stimulator, low intensity ultrasound, non-invasive 2 1 16 2 NA NA 9179 9179 Carrier K 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2510 Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access 1 1 25.1 1 NA NA 9180 9180 Carrier K 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5301 Below knee, molded socket, shin, sach foot, endoskeletal system 1 1 4.5 1 NA NA 9181 9181 Carrier K 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L5968 Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature 1 1 4.5 1 NA NA 9182 9182 Carrier K 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC L8619 Cochlear implant, external speech processor and controller, integrated system, replacement 1 1 9.1 1 NA NA 9183 9183 Carrier K 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S1040 Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) 6 0.5 25.88 6 NA NA 9184 9184 Carrier K 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4239 Supply allowance for nonadjunctive, nonimplanted continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service 1 0 38.5 1 NA NA 9185 9185 Carrier K 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0265 Hospital bed, total electric (head, foot, and height adjustments), with any type side rails, with mattress 1 0 42.5 0 NA NA 9186 9186 Carrier K 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0486 Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment 1 0 61.1 1 NA NA 9187 9187 Carrier K 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2103 Nonadjunctive, nonimplanted continuous glucose monitor (CGM) or receiver 1 0 38.5 1 NA NA 9188 9188 Carrier K 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC A4239 Supply allowance for nonadjunctive, nonimplanted continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service 1 0 38.5 0 1 NA NA 9189 9189 Carrier K 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC E2103 Nonadjunctive, nonimplanted continuous glucose monitor (CGM) or receiver 1 0 38.5 0 1 NA NA 9190 9190 Carrier K 2024 DME Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal HCPC S1040 Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) 2 0 43.58 0 2 NA NA 9191 9191 Carrier K 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 External ambulatory infusion pump, insulin 3 1 1.2 3 NA NA 9192 9192 Carrier K 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 External ambulatory infusion pump, insulin 3 1 1.2 3 NA NA 9193 9193 Carrier L 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64483 Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, single level 19 0.8421 12.03 27.71 3 16 NA NA 9194 9194 Carrier L 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64484 Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, each additional level (List separately in addition to code for primary procedure) 11 0.8182 23.24 0 11 NA NA 9195 9195 Carrier L 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64405 Injection(s), anesthetic agent(s) and/or steroid; greater occipital nerve 5 0 25.02 0 5 NA NA 9196 9196 Carrier L 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 38525 Biopsy or excision of lymph node(s); open, deep axillary node(s) 4 0.75 0.33 0 4 NA NA 9197 9197 Carrier L 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s) 4 1 32.26 0 4 NA NA 9198 9198 Carrier L 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 62323 Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT) 4 0.5 40.15 0 4 NA NA 9199 9199 Carrier L 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 21089 Unlisted maxillofacial prosthetic procedure 3 0.6667 17.3 0 3 NA NA 9200 9200 Carrier L 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 31622 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure) 3 1 21.1 0 3 NA NA 9201 9201 Carrier L 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58571 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) 3 0.3333 13 0 3 NA NA 9202 9202 Carrier L 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64454 Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed 3 0 23.23 0 3 NA NA 9203 9203 Carrier L 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 66991 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more 3 1 192.96 0 3 NA NA 9204 9204 Carrier L 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 97803 Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes 3 0.6667 37.06 0 3 NA NA 9205 9205 Carrier L 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 99183 Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session 3 1 1.5 0 3 NA NA 9206 9206 Carrier L 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0277 Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval 3 1 1.5 0 3 NA NA 9207 9207 Carrier L 2024 Inpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year HCPC G0299 Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting, each 15 minutes 3 0.6667 84.5 0 3 NA NA 9208 9208 Carrier L 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s) 4 1 32.26 0 4 NA NA 9209 9209 Carrier L 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 31622 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure) 3 1 21.1 0 3 NA NA 9210 9210 Carrier L 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 66991 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more 3 1 192.96 0 3 NA NA 9211 9211 Carrier L 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99183 Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session 3 1 1.5 0 3 NA NA 9212 9212 Carrier L 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC G0277 Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval 3 1 1.5 0 3 NA NA 9213 9213 Carrier L 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 15004 Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or 1% of body area of infants and children 2 1 20.9 0 2 NA NA 9214 9214 Carrier L 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 30130 Excision inferior turbinate, partial or complete, any method 2 1 22.55 0 2 NA NA 9215 9215 Carrier L 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 52235 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; MEDIUM bladder tumor(s) (2.0 to 5.0 cm) 2 1 0.9 0 2 NA NA 9216 9216 Carrier L 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 54520 Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach 2 1 26.7 0 2 NA NA 9217 9217 Carrier L 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 67950 Canthoplasty (reconstruction of canthus) 2 1 18 0 2 NA NA 9218 9218 Carrier L 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation 2 1 43.9 0 2 NA NA 9219 9219 Carrier L 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95700 Electroencephalogram (EEG) continuous recording, with video when performed, setup, patient education, and takedown when performed, administered in person by EEG technologist, minimum of 8 channels 2 1 13.2 0 2 NA NA 9220 9220 Carrier L 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 95716 Electroencephalogram with video (VEEG), review of data, technical description by EEG technologist, each increment of 12-26 hours; with continuous, real-time monitoring and maintenance 2 1 13.2 0 2 NA NA 9221 9221 Carrier L 2024 Inpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 99152 Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intraservice time, patient age 5 years or older 2 1 22.9 0 2 NA NA 9222 9222 Carrier L 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95810 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist 80 0.625 21.1 80 NA NA 9223 9223 Carrier L 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 81479 Unlisted molecular pathology procedure 78 0.8846 14.58 78 NA NA 9224 9224 Carrier L 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 81420 Fetal chromosomal aneuploidy (eg, trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18, and 21 73 0.7808 13.15 73 NA NA 9225 9225 Carrier L 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 95811 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist 60 0.6167 15.9 60 NA NA 9226 9226 Carrier L 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 30140 Submucous resection inferior turbinate, partial or complete, any method 34 0.9118 40.24 34 NA NA 9227 9227 Carrier L 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 30520 Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft 31 0.9355 42 31 NA NA 9228 9228 Carrier L 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 52356 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (eg, Gibbons or double-J type) 31 1 0.15 1.15 4 27 NA NA 9229 9229 Carrier L 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58571 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) 29 0.6897 23.9 33.58 4 25 NA NA 9230 9230 Carrier L 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 64493 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level 29 0.8966 12.09 29 NA NA 9231 9231 Carrier L 2024 Outpatient Med-Surg Codes with the highest total number of prior authorization requests during the previous plan year CPT 58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D and C 26 1 0.2 2.48 1 25 NA NA 9232 9232 Carrier L 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 52356 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (eg, Gibbons or double-J type) 31 1 0.15 1.15 4 27 NA NA 9233 9233 Carrier L 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D and C 26 1 0.2 2.48 1 25 NA NA 9234 9234 Carrier L 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 49650 Laparoscopy, surgical; repair initial inguinal hernia 22 1 1.46 22 NA NA 9235 9235 Carrier L 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 34675 Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated 20 1 19.67 20 NA NA 9236 9236 Carrier L 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 52332 Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type) 16 1 0.1 3.62 2 14 NA NA 9237 9237 Carrier L 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81229 Cytogenomic (genome-wide) analysis for constitutional chromosomal abnormalities; interrogation of genomic regions for copy number and single nucleotide polymorphism (SNP) variants, comparative genomic hybridization (CGH) microarray analysis 13 1 4.95 13 NA NA 9238 9238 Carrier L 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 36471 Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg 12 1 19.18 12 NA NA 9239 9239 Carrier L 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81162 BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and full duplication/deletion analysis 12 1 10.02 12 NA NA 9240 9240 Carrier L 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 64721 Neuroplasty and/or transposition; median nerve at carpal tunnel 11 1 2.4 0.16 1 10 NA NA 9241 9241 Carrier L 2024 Outpatient Med-Surg Codes with the highest percentage of approved prior authorization requests during the previous plan year CPT 81416 Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis, each comparator exome (eg, parents, siblings) 11 1 0.47 11 NA NA 9242 9242 Carrier L 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A4239 Supply allowance for nonadjunctive, nonimplanted continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service 17 0.5294 22.82 0 17 NA NA 9243 9243 Carrier L 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2103 Nonadjunctive, nonimplanted continuous glucose monitor (CGM) or receiver 11 0.4545 13.15 0 11 NA NA 9244 9244 Carrier L 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2402 Negative pressure wound therapy electrical pump, stationary or portable 6 0.6667 20.2 22.12 1 5 NA NA 9245 9245 Carrier L 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC S1040 Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) 5 1 37.98 0 5 NA NA 9246 9246 Carrier L 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E1028 Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other 4 0 47.55 0 4 NA NA 9247 9247 Carrier L 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E2510 Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access 4 1 5.08 0 4 NA NA 9248 9248 Carrier L 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A6550 Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories 3 1 9.97 0 3 NA NA 9249 9249 Carrier L 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with nondurable medical equipment interstitial continuous glucose monitoring system (CGM), one unit = 1 day supply 2 0 62.85 0 2 NA NA 9250 9250 Carrier L 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC A9277 Transmitter; external, for use with nondurable medical equipment interstitial continuous glucose monitoring system (CGM) 2 0 62.85 0 2 NA NA 9251 9251 Carrier L 2024 DME Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0486 Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment 2 0.5 20.4 0 2 NA NA 9252 9252 Carrier L 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC S1040 Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) 5 1 37.98 0 5 NA NA 9253 9253 Carrier L 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2510 Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access 4 1 5.08 0 4 NA NA 9254 9254 Carrier L 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A6550 Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories 3 1 9.97 0 3 NA NA 9255 9255 Carrier L 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0760 Osteogenesis stimulator, low intensity ultrasound, non-invasive 2 1 14.85 0 2 NA NA 9256 9256 Carrier L 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E1399 Durable medical equipment, miscellaneous 2 1 25.4 0 2 NA NA 9257 9257 Carrier L 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2512 Accessory for speech generating device, mounting system 2 1 5.9 0 2 NA NA 9258 9258 Carrier L 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E2599 Accessory for speech generating device, not otherwise classified 2 1 5.9 0 2 NA NA 9259 9259 Carrier L 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A4238 Supply allowance for adjunctive, nonimplanted continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service 1 1 61 0 1 NA NA 9260 9260 Carrier L 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC A7000 Canister, disposable, used with suction pump, each 1 1 7.3 0 1 NA NA 9261 9261 Carrier L 2024 DME Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0471 Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 1 1 14.8 0 1 NA NA 9262 9262 Carrier L 2024 Diabetes Supplies and Equip Codes with the highest total number of prior authorization requests during the previous plan year HCPC E0784 External ambulatory infusion pump, insulin 14 1 12.16 0 1 NA NA 9263 9263 Carrier L 2024 Diabetes Supplies and Equip Codes with the highest percentage of approved prior authorization requests during the previous plan year HCPC E0784 External ambulatory infusion pump, insulin 14 1 12.16 0 1 NA NA 9264 9264 Carrier K 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 431 0.77 13 45 0 53 378 0 SEMAGLUTIDE (WEIGHT MNGMT) SOLN AUTO-INJECTOR 0.25 MG/0.5ML WEGOVY 9265 9265 Carrier K 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 430 0.65 19 39 0 50 380 0 TIRZEPATIDE (WEIGHT MNGMT) SOLN AUTO-INJECTOR 2.5 MG/0.5ML ZEPBOUND 9266 9266 Carrier K 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 172 0.44 14 44 0 33 139 0 SEMAGLUTIDE SOLN PEN-INJ 0.25 OR 0.5 MG/DOSE (2 MG/3ML) OZEMPIC 9267 9267 Carrier K 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 153 0.59 13 62 0 42 111 0 RIMEGEPANT SULFATE TAB DISINT 75 MG NURTEC 9268 9268 Carrier K 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 121 0.74 32 59 0 19 102 0 SEMAGLUTIDE (WEIGHT MNGMT) SOLN AUTO-INJECTOR 0.5 MG/0.5ML WEGOVY 9269 9269 Carrier K 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 115 0.88 0 39 0 9 106 0 SEMAGLUTIDE (WEIGHT MNGMT) SOLN AUTO-INJECTOR 2.4 MG/0.75ML WEGOVY 9270 9270 Carrier K 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 91 0.71 11 42 0 12 79 0 SEMAGLUTIDE (WEIGHT MNGMT) SOLN AUTO-INJECTOR 1 MG/0.5ML WEGOVY 9271 9271 Carrier K 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 86 0.28 12 56 0 16 70 0 TIRZEPATIDE SOLN PEN-INJECTOR 2.5 MG/0.5ML MOUNJARO 9272 9272 Carrier K 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 77 0.74 1 20 0 17 60 0 *CONTINUOUS GLUCOSE SYSTEM SENSOR*** DEXCOM G7 SENSOR 9273 9273 Carrier K 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 69 0.75 15 21 0 9 60 0 RUXOLITINIB PHOSPHATE CREAM 1.5% OPZELURA 9274 9274 Carrier K 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 14 1 1 2 0 9 5 0 OFATUMUMAB SOLN AUTO-INJECTOR 20 MG/0.4ML KESIMPTA 9275 9275 Carrier K 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 12 1 0 11 0 0 12 0 *INSULIN INFUSION DISPOSABLE PUMP RESERVOIR*** OMNIPOD 5 DEXCOM G7G6 PODS (GEN 5) 9276 9276 Carrier K 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 2 10 0 3 5 0 OMALIZUMAB SUBCUTANEOUS SOLN PREFILLED SYRINGE 150 MG/ML XOLAIR 9277 9277 Carrier K 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 0 0 0 4 4 0 BELIMUMAB SUBCUTANEOUS SOLUTION AUTO-INJECTOR 200 MG/ML BENLYSTA 9278 9278 Carrier K 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 0 18 0 3 5 0 RELUGOLIX-ESTRADIOL-NORETHINDRONE ACETATE TAB 40-1-0.5 MG MYFEMBREE 9279 9279 Carrier K 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 0 13 0 0 8 0 DROSPIRENONE TAB 4 MG SLYND 9280 9280 Carrier K 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 0 1 0 2 5 0 METHYLPHENIDATE HCL CAP DELAYED ER 24HR 40 MG (PM) JORNAY PM 9281 9281 Carrier K 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 0 0 0 2 5 0 METHYLPHENIDATE HCL CAP DELAYED ER 24HR 20 MG (PM) JORNAY PM 9282 9282 Carrier K 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 0 0 0 3 4 0 TOFACITINIB CITRATE TAB ER 24HR 11 MG (BASE EQUIVALENT) XELJANZ XR 9283 9283 Carrier K 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 7 1 1 0 0 7 0 0 LEUPROLIDE ACETATE INJ KIT 1 MG/0.2ML (5 MG/ML) LEUPROLIDE ACETATE 9284 9284 Carrier K 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 51 0.16 43.44 67.68 8 43 n/a WEGOVY 9285 9285 Carrier K 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 20 0.06 21.84 82.56 1 19 n/a ZEPBOUND 9286 9286 Carrier K 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 13 0.12 45.6 107.9 3 10 n/a DUPIXENT 9287 9287 Carrier K 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 15 0.07 0 134.64 0 15 n/a OZEMPIC 9288 9288 Carrier K 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 12 0.1 27.36 136.8 3 9 n/a SKYRIZI PEN 9289 9289 Carrier K 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 12 0.11 44.4 38.16 11 1 n/a STELARA 9290 9290 Carrier K 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 10 0.11 36.48 182.88 5 5 n/a HUMIRA PEN 9291 9291 Carrier K 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 9 0.04 0 137.52 0 9 n/a MOUNJARO 9292 9292 Carrier K 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 8 0.07 82.56 96.96 1 7 n/a NURTEC 9293 9293 Carrier K 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 7 0.03 40.56 268.8 4 3 n/a REPATHA SURECLICK 9294 9294 Carrier L 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 406 0.12 36 62 0 15 391 0 SEMAGLUTIDE (WEIGHT MNGMT) SOLN AUTO-INJECTOR 0.25 MG/0.5ML WEGOVY 9295 9295 Carrier L 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 351 0.49 14 64 0 52 299 0 SEMAGLUTIDE SOLN PEN-INJ 0.25 OR 0.5 MG/DOSE (2 MG/3ML) OZEMPIC 9296 9296 Carrier L 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 266 0.1 6 41 0 6 260 0 TIRZEPATIDE (WEIGHT MNGMT) SOLN AUTO-INJECTOR 2.5 MG/0.5ML ZEPBOUND 9297 9297 Carrier L 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 168 0.32 23 50 0 16 152 0 TIRZEPATIDE SOLN PEN-INJECTOR 2.5 MG/0.5ML MOUNJARO 9298 9298 Carrier L 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 128 0.64 7 68 0 30 98 0 RIMEGEPANT SULFATE TAB DISINT 75 MG NURTEC 9299 9299 Carrier L 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 115 0.76 16 53 0 34 81 0 SEMAGLUTIDE SOLN PEN-INJ 1 MG/DOSE (4 MG/3ML) OZEMPIC 9300 9300 Carrier L 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 100 0.58 3 44 0 24 76 0 *CONTINUOUS GLUCOSE SYSTEM SENSOR*** DEXCOM G7 SENSOR 9301 9301 Carrier L 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 77 0.75 5 56 0 12 65 0 SEMAGLUTIDE SOLN PEN-INJ 2 MG/DOSE (8 MG/3ML) OZEMPIC 9302 9302 Carrier L 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 76 0.86 24 21 0 17 59 0 ADALIMUMAB PEN-INJECTOR KIT 40 MG/0.4ML HUMIRA PEN 9303 9303 Carrier L 2024 Prescription Drugs Codes with the highest total number of prior authorization requests during the previous plan year GPI10 NA NA 76 0.72 7 28 0 9 67 0 RISANKIZUMAB-RZAA SOLN AUTO-INJECTOR 150 MG/ML SKYRIZI PEN 9304 9304 Carrier L 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 36 1 1 5 0 12 24 0 ADALIMUMAB AUTO-INJECTOR KIT 40 MG/0.4ML HUMIRA PEN 9305 9305 Carrier L 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 16 1 0 0 0 1 15 0 LUBIPROSTONE CAP 24 MCG LUBIPROSTONE 9306 9306 Carrier L 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 13 1 0 1 0 6 7 0 DEXTROMETHORPHAN HBR-BUPROPION HCL TAB ER 45-105 MG AUVELITY 9307 9307 Carrier L 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 10 1 0 1 0 2 8 0 TOFACITINIB CITRATE TAB ER 24HR 11 MG (BASE EQUIVALENT) XELJANZ XR 9308 9308 Carrier L 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 0 0 0 2 6 0 CALCIUM, MAG, POTASSIUM, & SOD OXYBATES ORAL SOLN 500 MG/ML XYWAV 9309 9309 Carrier L 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 6 13 0 5 3 0 MORPHINE SULFATE TAB ER 15 MG MORPHINE SULFATE ER 9310 9310 Carrier L 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 0 1 0 1 7 0 DULAGLUTIDE SOLN PEN-INJECTOR 4.5 MG/0.5ML TRULICITY 9311 9311 Carrier L 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 8 1 1 0 0 4 4 0 SUVOREXANT TAB 10 MG BELSOMRA 9312 9312 Carrier L 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 6 1 1 1 0 1 5 0 DULAGLUTIDE SOLN PEN-INJECTOR 3 MG/0.5ML TRULICITY 9313 9313 Carrier L 2024 Prescription Drugs Codes with the highest percentage of approved prior authorization requests during the previous plan year GPI10 NA NA 6 1 0 0 0 0 6 0 UPADACITINIB TAB ER 24HR 30 MG RINVOQ 9314 9314 Carrier L 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 69 0.02 29.76 64.8 5 64 n/a WEGOVY 9315 9315 Carrier L 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 17 0.1 47.04 125.28 3 14 n/a OZEMPIC 9316 9316 Carrier L 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 16 0.11 42.96 97.44 6 10 n/a SKYRIZI PEN 9317 9317 Carrier L 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 15 0 29.76 62.4 2 13 n/a ZEPBOUND 9318 9318 Carrier L 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 13 0.05 37.92 179.28 1 12 n/a MOUNJARO 9319 9319 Carrier L 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 13 0.12 43.92 167.76 7 6 n/a STELARA 9320 9320 Carrier L 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 9 0.08 29.28 143.76 3 6 n/a DUPIXENT 9321 9321 Carrier L 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 4 0.04 37.2 131.28 1 3 n/a Entresto 9322 9322 Carrier L 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 4 0.02 38.4 57.36 2 2 n/a Taltz 9323 9323 Carrier L 2024 Prescription Drugs Codes with the highest percentage of prior authorization requests that were initially denied and then subsequently approved on appeal GPI10 NA NA 4 0.02 48.24 18.24 3 1 n/a Xolair