Procedure Code Table - continued

CPT or HCPCS Procedure Code : 99215

Short Description: Office/outpatient visit est

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 99241

Short Description: Office consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99242

Short Description: Office consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99243

Short Description: Office consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99244

Short Description: Office consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99245

Short Description: Office consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99251

Short Description: Inpatient consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99252

Short Description: Inpatient consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99253

Short Description: Inpatient consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99254

Short Description: Inpatient consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : 99255

Short Description: Inpatient consultation

Covered Benefit :No

Prior Authorization Needed: -

CPT or HCPCS Procedure Code : L7510

Short Description: Prosthetic device repair rep

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8515
Short Description: Gel cap app device for trach

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8615
Short Description: Headpiece for cochlear implant

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8616
Short Description: Microphone for cochlear implant

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8617
Short Description: Transmit coil cochlear implant

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8618
Short Description: Transmit cable cochlear impl

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8619
Short Description: Coch imp ext proc/contr rplc

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8621
Short Description: Zinc air battery cochlear impl

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8622
Short Description: Alkaline battery cochlear imp

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8623
Short Description: Lith ion batt CID, non-ear lvl

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8624
Short Description: Lith ion batt CID, ear level

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : L8691
Short Description: Auditory osseointegrated device, external sound processor, replacement

Covered Benefit :Yes

Prior Authorization Needed: Yes

CPT or HCPCS Procedure Code : L8692
Short Description: Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment

Covered Benefit :Yes

Prior Authorization Needed: Yes

CPT or HCPCS Procedure Code : S0618
Short Description: Audiometry for hearing aid evaluation to determine the level and degree of hearing loss

Covered Benefit :Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : S9152
Short Description: Speech therapy, re-eval

Covered Benefit :No

Prior Authorization Needed: -