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Provider Reference

Materials for Providers

To view a document and then save it: Click on the link in the document list to view the document in your browser. From the menu at the top of the browser, select FILE - SAVE AS to navigate to the folder in which you wish to save the document. Then save it.

To save the document without opening it:
 Right-click the link in the document list and select "Save target as". Navigate to the folder in which you wish to save the document. Then save it.

CPT Codes Requiring Prior Authorization

All CPT Codes in Numerical Order

Dr. Holmes Supplemental Dental and Oral Surgery Codes

Dr. Orta Supplemental Dental and Oral Surgery Codes

General Dental Oral Surgery CPT Codes 

Dental Codes Requiring Prior Authorization

Dental Guidelines

DME/Prosthetics/Orthotics Requiring Prior Authorization

DME Prosthetics Orthotics CPT Codes

Prosthetics/Orthotics Guidelines

Home Health Codes Requiring Prior Authorization

Home Health CPT Codes

Inpatient Service Codes Requiring Authorization

Hysterectomy Surgery CPT Codes

Joint Replacement Surgery CPT Codes

Neck & Back Surgery CPT Code

Pain Management Codes Requiring Prior Authorization

Pain Management CPT Codes

Pain Management Guidelines

Specialist Referrals Codes Requiring Prior Authorization
  1. Referrals to specialty providers must be completed by the client’s PCP
  2. All visits to specialists must have a current prior authorization
Moffitt Dx Codes

HCHCP MOFFITT DX Codes

Moffitt Announcement and Referral Processing

Healthy Living Referral Process

Healthy Living Referral Process Provider Instructions

FAX forms

General HCHCP Fax Form

HCHCP-Recon-Fax-Form

HELP

Acentra Health's training materials are available in various file formats, requiring specific tools to enable you to view them. The file types and links to the associated tools which you may need to download and install are listed below:

  • For file type .pdf use the Adobe Acrobat Reader.
  • For file types .ppt and .pptx use the Microsoft PowerPoint viewer if you do not have Microsoft PowerPoint.
  • For file type .avi use this codec: http://www.compression.ru/video/ls-codec/msu-sc-codec.exe
Chiropractic Provider Instruction

Provider Instructions for Chiropractic Referral

Provider Checklists

Want to avoid hold-ups caused by missing information in service requests?

Check out our Provider Checklists. These handy reference lists will help you determine at a glance all the information required for each service type. Don't be stuck retrieving information twice!

Use the checklists for once-and-done submission!

Dental

Currently, there are no materials available for this category. Please check back later.

DME

DME – Power Wheelchairs

BiPAP Questionnaire

CPAP Questionnaire

Insulin Pump 

Inpatient Services

Currently, there are no materials available for this category. Please check back later.

Outpatient Services

Blepharoplasty

Provider Checklist Outpatient Breast Reconstruction

Provider Checklist Outpatient Breast Reduction Mammoplasty

Provider Checklist Outpatient Rehab OT Initial

Provider Checklist Outpatient Rehab PT Initial

Provider Checklist Outpatient Rehab-ST Initial

Provider Checklist Outpatient Rehab Cardiac Post Eval

Provider Checklist Outpatient Rehab-Pulmonary Post Eval

Provider Checklist Outpatient Cystoscopy Cystourethroscopy

Provider Checklist Outpatient Prostratic RF Thermotx

Provider Checklist Outpatient Varicose Veins

Provider Checklist Outpatient Wound Care Hyperbaric Oxygen Therapy (HBO2)

HCHCP_MRICTCervicalSpineQuestionnaire 2025

HCHCP_MRICTLumbarSpineQuestionnaire 2025

Outpatient Imaging

Computed Tomography (CT) Abdomen

Computed Tomography (CT) Abdomen and Pelvis

Computed Tomography (CT) Brain

Computed Tomography (CT) Cervical

Computed Tomography (CT) Chest-Cardiac

Computed Tomography (CT) Colon

Computed Tomography (CT) Extremity

Computed Tomography (CT) Kidney

Computed Tomography (CT) Lumbar Spine

Computed Tomography (CT) Neck

Computed Tomography (CT)Orbit

Computed Tomography (CT) Sinuses

Computed Tomography Angiogram (CTA) Coronaries

Magnetic Resonance Angiogram (MRA) Brain

Magnetic Resonance Cholangiopancreatography (MRCP)

Magnetic Resonance Imaging (MRI) Abdomen

Magnetic Resonance Imaging (MRI) Ankle

Magnetic Resonance Imaging (MRI) Brain

Magnetic Resonance Imaging (MRI) Breast

Magnetic Resonance Imaging (MRI) Cervical Spine

Magnetic Resonance Imaging (MRI) Elbow

Magnetic Resonance Imaging (MRI)Foot

Magnetic Resonance Imaging (MRI) Hip

Magnetic Resonance Imaging (MRI) Knee

Magnetic Resonance Imaging (MRI) Lumbar Spine

Magnetic Resonance Imaging (MRI) Neck

Magnetic Resonance Imaging (MRI) Orbit

Magnetic Resonance Imaging (MRI) Pelvis

Magnetic Resonance Imaging (MRI) Pituitary

Magnetic Resonance Imaging (MRI) Shoulder

Magnetic Resonance Imaging (MRI) Thoracic Spine

Magnetic Resonance Imaging (MRI) Wrist

Nuclear Stress Test-Thallium-Technetium-Sestamibi

Positron Emission Tomography (PET) Whole Body

Ultrasound (US) Abdomen

Ultrasound (US) Pelvis

Ultrasound (US) Scrotum

Provider Checklist Outpatient Imaging-Ultrasound Transrectal

Pain Management

Acute Pain Cervical Spine

Acute Pain of Lumbar Spine

Hip Pain & Sacro-Iliac (SI) Joint Pain

Shoulder Pain

Specialty Physician Visit for Pain Management

Help

Acentra Health's training materials are available in various file formats which may require specific tools to enable you to view them. The file types and links to the associated tools which you may need to download and install are listed below:

  • For file type .pdf use the Adobe Acrobat Reader.
  • For file types .ppt and .pptx use the Microsoft PowerPoint viewer if you do not have Microsoft PowerPoint.
  • For file type .avi use this codec: http://www.compression.ru/video/ls-codec/msu-sc-codec.exe
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