Search procedures, labs & medications

Type a procedure, lab test, or medication name. Pick your medical insurer or Rx carrier (PBM, specialty pharmacy, or retail pharmacy) to see the associated coverage and prior-authorization criteria.

Educational only — not a coverage decision. Confirm details with your health plan.

All seeded codes124 matches

99213Office VisitPrior auth: not commonly required

Established patient office visit, 20–29 minutes

A visit with a clinician you have seen before, lasting roughly 20–29 minutes of total provider time on the day of the visit, or involving low-complexity medical decision-making.

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99214Office VisitPrior auth: not commonly required

Established patient office visit, 30–39 minutes

A visit with a clinician you have seen before, lasting roughly 30–39 minutes of total provider time, or involving moderate-complexity medical decision-making.

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99204Office VisitPrior auth: not commonly required

New patient office visit, 45–59 minutes

A first visit with a clinician you have not seen recently, lasting about 45–59 minutes of total provider time or involving moderate-complexity decision-making.

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99203Office VisitPrior auth: not commonly required

New patient office visit, 30–44 minutes

A first visit with a clinician, lasting about 30–44 minutes of total time or involving low-complexity decision-making.

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G0439PreventivePrior auth: not commonly required

Medicare annual wellness visit, subsequent

A yearly Medicare visit focused on prevention — a health risk assessment, screening planning, and a personalized prevention plan. G0439 is used after the first AWV (G0438 is used only once).

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77067Preventive ImagingPrior auth: not commonly required

Screening mammogram, bilateral

A routine breast X-ray used to screen for breast cancer in people without symptoms, including computer-aided detection when used.

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36415LaboratoryPrior auth: not commonly required

Routine venipuncture (blood draw)

The act of drawing a blood sample from a vein for laboratory testing.

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80053LaboratoryPrior auth: not commonly required

Comprehensive metabolic panel (CMP)

A panel of 14 blood tests that measure kidney function, liver function, blood sugar, and electrolytes.

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85025LaboratoryPrior auth: not commonly required

Complete blood count (CBC) with automated differential

A blood test that measures red cells, white cells (with a breakdown by type), and platelets.

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