Services Requiring Prior Authorization- Listed by CPT,

HCPC, and REV code. Please Note: Not all codes referenced in this document are covered services for Ohio Medicaid Programs or all sites of service. Please be sure to identify the Medicaid program (e.g. Healthy Families, Healthy Start, ABD, Dual Options MyCare Ohio, or Adult Extension) prior to referencing this document.

  Services, Authorization, Listed, Prior, Requiring, Services requiring prior authorization listed by