Medicare Prior Authorization - 2023
Date: 11/18/22
List effective January 1, 2023
Sunflower Health Plan requires prior authorization (PA) as a condition of payment for many services. This notice contains information regarding such prior authorization requirements and is applicable to all Medicare products offered by Sunflower Health Plan.
Sunflower is committed to delivering cost-effective quality care to our members. This effort requires us to ensure that our members receive only treatment that is medically necessary according to current standards of practice. Prior authorization is a process initiated by the physician in which we verify the medical necessity of a treatment in advance using independent objective medical criteria and/or in network utilization, where applicable.
It is the ordering/prescribing provider’s responsibility to determine which specific codes require prior authorization.
Please verify eligibility and benefits prior to rendering services for all members. Payment, regardless of authorization, is contingent on the member’s eligibility at the time service is rendered. NON-PAR PROVIDERS & FACILITIES REQUIRE AUTHORIZATION FOR ALL HMO SERVICES EXCEPT WHERE INDICATED.
For complete CPT/HCPCS code listing, please see Online Prior Authorization Tool.
Effective January 1, 2023, the following are changes to prior authorization requirements:
| Service Category | PA Rule | Services | Procedure Codes |
|---|---|---|---|
| Anesthesia | No PA Required | Anesthesia for nerve blocks | 01991, 01992 |
| Audiology | PA Required | Hearing aid | V5256, V5258, V5261 |
| No PA Required | Speech audiometry threshold | 0210T | |
| Behavioral Health | PA Required | Behavior assessments | 97151, 97152 |
| Adaptive behavior treatment | 97153, 97154, 97155, 97156 | ||
| No PA Required | Psychotherapy, training & education | 90832, 90834, 90837, 90846, 90847, 90853, G0177 | |
| Hypnotherapy | 90880 | ||
| Brief behavior assessment | 96127 | ||
| Breast reconstruction | PA Required except with breast cancer diagnosis | Breast reconstruction | 19367, 19368, 19369 |
| Cardiovascular | PA Required | Artificial heart | 33927 |
| Pulmonary artery pressure sensor | C2624 | ||
| Unlisted procedures | 37501 | ||
| No PA Required | Operative ablation | 33261 | |
| Exclusion left atrial appendage | 33267, 33268, 33269 | ||
| Artificial heart removal/replacement | 33928, 33929 | ||
| Extracorporeal membrane oxygenation (ECMO) | 33953, 33954, 33955, 33956, 33957, 33958, 33959 | ||
| External circulatory support | 92971, G0166 | ||
| Carotid intima media thickness study | 93895 | ||
| Carotid sinus baroreflex activation device | 0269T | ||
| Devices and monitoring | 0497T, 0498T, 0650T | ||
| Blinded procedure for NYHA Class III/IV heart failure | C9758 | ||
| Cochlear and other auditory implants | PA Required | Auditory implant and device | L8619, L8690, L8691 |
| No PA Required | Replacement Headset/headpiece | L8615 | |
| Cosmetic and reconstructive | PA Required | Lipectomy | 15876, 15878 |
| Reconstruction head/face | 21175, 21179, 21180, 21181, 21182, 21183, 21184, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21275 | ||
| Excision or surgical planing for rhinophyma | 30120 | ||
| No PA Required | Reduction forehead | 21137, 21138, 21139 | |
| Otoplasty | 69300 | ||
| Dental | No PA Required | Application of topical fluoride varnish | 99188 |
| Dermatology | PA Required | Chemodenervation of eccrine glands | 64650, 64653 |
| No PA Required | Autografts | 15131, 15135, 15136, 15150, 15152, 15155, 15156, 15157 | |
| Laser treatments | 17106, 0491T, 0492T | ||
| Cryotherapy | 17340 | ||
| Incision and drainage, deep abscess | 22010, 22015 | ||
| Cell therapy for scleroderma | 0489T, 0490T | ||
| Autologous platelet rich plasma | G0465 | ||
| Diagnostic imaging | PA Required | Magnetic resonance image guided high intensity focused ultrasound | 0398T |
| No PA Required | Ablation, cryosurgical, of fibroadenoma | 19105 | |
| Discography | 72285, 72295 | ||
| Ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac) | 76979 | ||
| Fluoroscopic guidance | 77002, 77003 | ||
| Unlisted imaging procedures | 78199, 78399, 75899, 78799 | ||
| Salivary gland imaging and function study | 78230, 78231, 78232 | ||
| Gastrointestinal system imaging | 78261, 78282, 78299 | ||
| Nervous system imaging | 78610, 78635, 78660, 78699 | ||
| CAD for lesion detection | 0174T, 0175T | ||
| Myocardial imaging | 0331T, 0332T | ||
| Radiostereometric analysis (RSA) | 0348T, 0349T, 0350T | ||
| Optical coherence tomography (OCT) | 0351T, 0352T, 0353T, 0354T, 0443T, 0485T, 0486T, 0606T | ||
| Biomechanical mapping | 0487T | ||
| Spectroscopy studies | 0493T, 0641T, 0642T, 0658T | ||
| Cardiac magnetic resonance imaging for morphology and function | C9762, C9763 | ||
| Set-up portable x-ray equipment | Q0092 | ||
| DME & Supplies | PA Required | Walker, heavy-duty | E0147 |
| Hospital beds and accessories | E0181, E0184, E0185, E0186, E0193, E0196, E0197, E0199, E0250, E0251, E0255, E0256, E0260, E0261, E0271, E0272, E0277, E0280, E0293, E0294, E0295, E0301, E0303, E0304, E0305, E0310, E0329, E0371, E0373 | ||
| Respiratory devices | E0434, E0439, E0445, E0465, E0466, E0470, E0471, E0482, E0483, E0486, E1390, E1399 | ||
| Patient lifts | E0630, E0635, E0636, E0640 | ||
| Pneumatic compressor devices | E0650, E0651, E0652, E0656, E0660, E0667, E0668, E0671, E0673, E0675, E0676 | ||
| Nerve stimulators | E0720, E0730, E0731, E0740, E0745, E0747, E0748, E0760, E0766 | ||
| Diabetic devices & supplies | E0784, K0554 | ||
| Continuous passive motion device | E0935 | ||
| Wheelchairs, power operated vehicles, and accessories | E0953, E0954, E0956, E0957, E0973, E0981, E0982, E0990, E1002, E1007, E1008, E1010, E1016, E1028, E1031, E1035, E1038, E1050, E1060, E1088, E1150, E1161, E1195, E1226, E1230, E1236, E1238, E1240, E2209, E2210, E2228, E2300, E2310, E2312, E2313, E2322, E2325, E2330, E2331, E2359, E2361, E2363, E2365, E2366, E2367, E2370, E2373, E2374, E2375, E2376, E2377, E2378, E2381, E2382, E2383, E2386, E2387, E2388, E2389, E2390, E2391, E2392, E2394, E2395, E2396, E2397, E2603, E2604, E2605, E2606, E2607, E2608, E2609, E2613, E2615, E2616, E2617, E2620, E2621, E2622, E2623, E2624, E2626, E2627, K0003, K0004, K0005, K0006, K0007, K0010, K0017, K0018, K0019, K0037, K0042, K0043, K0044, K0045, K0047, K0051, K0052, K0053, K0069, K0070, K0071, K0072, K0077, K0108, K0195, K0733, K0739, K0800, K0801, K0806, K0808, K0813, K0816, K0820, K0821, K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0835, K0836, K0837, K0838, K0839, K0841, K0842, K0843, K0848, K0849, K0856, K0857, K0858, K0859, K0861, K0862, K0863 | ||
| Upper & lower limb bracing devices | E1800, E1801, E1805, E1810, E1811, E1815, E1825 | ||
| Speech generating device/accessory | E2508, E2510, E2512 | ||
| No PA Required | Skin protection supplies | E0188, E0190, E0191, A4640 | |
| Pump or water circulating pad | E0236 | ||
| Respiratory equipment | E0550, E0555, E0560, E0565, E0600, E0615, E0621, E0700, E0781, E0791, K0730 | ||
| Traction equipment, trapeze bars, extremity belt/harness | E0849, E0855, E0870, E0910, E0911, E0912, E0940, E0945 | ||
| Wheelchairs and accessories | E0950, E0951, E0952, E0955, E0960, E0978, E0995, E1020, E2202, E2203, E2204, E2311, E2321, E2323, E2326, E2342, E2601, E2602, E2611, E2612, E2619, K0002, K0038, K0039, K0040, K0041, K0056, K0073 | ||
| Infusion pumps and supplies | A4220, A4222, A4602, B9004, K0455, K0552, K0553, K0603 | ||
| Helmet | A8003 | ||
| Miscellaneous DME supplies | A4465, A5102, A7048, A9999 | ||
| Surgical supplies | C1761, C1823, L8612, L8684 | ||
| Endocrinology | PA Required | Unlisted laparoscopy procedure | 60659 |
| No PA Required | Ambulatory continuous glucose monitoring | 95250 | |
| Creation of subcutaneous pocket/removal implantable interstitial glucose sensor | 0446T, 0447T, 0448T | ||
| Enteral & Parenteral nutrition | PA Required | In-line cartridge digestive enzyme | B4105 |
| No PA Required | Nutrition | B4103, B4104, B4149, B4150, B4152, B4153, B4154, B4155, B4160, B4161, B4185 | |
| Home therapy | S9340, S9341, S9342, S9343 | ||
| Gastroenterology | PA Required | Unlisted laparoscopy, spleen | 38129 |
| Transoral lower esophageal myotomy | 43497 | ||
| No PA Required | Esophagogastroduodenoscopy | 43235, 43236, 43237, 43238, 43239, 43240, 43241, 43242, 43245, 43247, 43248, 43249, 43250, 43251, 43253, 43254, 43255, 43259 | |
| Gastric/gastrointestinal systems surgery/procedures | 43651, 43652, 43882, 44139, 44899, 45499, 47570, 0184T | ||
| General surgery | No PA Required | Hernia repair | 49495, 49496, 49505, 49525, 49550, 49570, 49585, 49650, 49651 |
| Adrenalectomy | 60545 | ||
| Genetic counseling | No PA Required | Genetic counseling services | 96040 |
| Gynecology | No PA Required | Vulvectomy | 56632, 56637, 56640 |
| Stress incontinence treatment, revision/removal of vaginal graft | 57288, 57289, 57296 | ||
| Hysteroscopy | 58558, 58565, 58579 | ||
| Laparoscopy | 58672, 58673, 58674, 58679 | ||
| Resection initial/tumor debulking | 58950, 58958 | ||
| Hysterectomy after cesarean | 59525 | ||
| Uterine fibroids(s) ablation | 0404T | ||
| Home care | No PA Required | Home visit | 99501, 99502, 99503, 99505, 99506, 99507, 99511 |
| Infertility | PA Required | Artificial insemination | 58321, 58322, 58323, 58345 |
| Embryo transfer | 58970, 58974, 58976 | ||
| Infusion services | No PA Required | Infusion and home infusion therapy | 96371, 96422, 96425, 96440, 96549 S9346, S9348, S9364, S9366, S9367, S9494, S9500 |
| Injectable medications | Step therapy | Injectables | J2777, J3299, Q2056, Q5124, Q5125 |
| PA Required | Injectables | C9047, J0135, J0180, J0221, J0565, J0596, J0630, J0725, J0745, J1170, J1290, J1322, J1560, J1600, J1620, J1726, J1729, J1744, J1750, J1756, J1830, J2358, J2440, J2502, J2504, J3060, J3355, J7175, J7179, J7189, J7196, J7201, J7209, Q0138, Q0139, Q0221, Q2026 | |
| No PA Required | Injectables | 0481T, C9257, C9290, J0122, J0130, J0200, J0205, J0210, J0215, J0288, J0289, J0300, J0348, J0380, J0390, J0395, J0401, J0470, J0475, J0480, J0485, J0520, J0583, J0600, J0620, J0637, J0714, J0740, J0742, J0770, J0834, J0841, J0875, J0878, J0887, J0895, J1071, J1162, J1180, J1201, J1250, J1265, J1270, J1320, J1325, J1327, J1436, J1440, J1451, J1452, J1571, J1573, J1640, J1645, J1652, J1655, J1730, J1738, J1833, J1835, J1890, J1945, J1950, J1960, J1990, J2248, J2260, J2265, J2270, J2274, J2278, J2315, J2320, J2407, J2425, J2426, J2513, J2547, J2670, J2724, J2725, J2730, J2770, J2788, J2792, J2810, J2910, J2916, J2995, J3070, J3090, J3095, J3145, J3265, J3280, J3320, J3350, J3364, J3365, J3400, J7168, J7316, Q5105, S0020, S0028, S0030, S0032, S0073, S0077, S0078, S0164, S0171 | |
| Laboratory | PA Required | DMD (Dystrophin) | 81161 |
| Multianalyte assay tests | 0014M, 0017M | ||
| Proprietary Laboratory Analysis (PLA) Codes | 0002U, 0003U, 0027U, 0037U, 0040U, 0062U, 0063U, 0092U, 0093U, 0105U, 0108U, 0112U, 0117U, 0163U, 0169U, 0170U, 0171U, 0174U, 0177U, 0180U, 0181U, 0182U, 0183U, 0184U, 0185U, 0186U, 0187U, 0188U, 0189U, 0190U, 0191U, 0192U, 0193U, 0194U, 0195U, 0196U, 0197U, 0198U, 0199U, 0200U, 0201U, 0242U, 0243U, 0244U, 0245U, 0246U, 0247U, 0250U, 0254U, 0329U | ||
| Quantitative drug testing | G0481, G0482, G0483 | ||
| No PA Required | Drug tests | 80184, 80368, 83992, G0480, G0659 | |
| Unlisted lab procedures | 81099, 85999, 86849, 87999, 88099, 88749, 89240 | ||
| Human leukocyte antigen (HLA) Typing | 81370, 81371, 81372, 81373, 81374, 81375, 81376, 81377, 81378, 81379, 81380, 81381, 81382, 81383, 86812, 86813, 86816, 86817, 86825, 86826 86828, 86829, 86830, 86831, 86832, 86833, 86834, 86835 | ||
| Genetic and multianalyte assay tests | 81341, 81420, 81506, 81507, 82784, 87483, 88239 | ||
| Proprietary Laboratory Analysis (PLA) Codes | 0140U, 0141U, 0142U, 0152U, 0206U, 0207U, 0210U, 0226U, 0251U, 0323U, 0330U, 0500T | ||
| Medication | PA Required | Buprenorphine/naloxone | J0574 |
| Dexamethasone, ophthalmic insert | J1096 | ||
| Ganciclovir 4.5 mg long-acting implant | J7310 | ||
| Lymphocyte immune globulin | J7511 | ||
| Treprostinil inhalation solution | J7686 | ||
| Iloprost inhalation solution | Q4074 | ||
| Dextroamphetamine sulfate 5mg | S0160 | ||
| No PA Required | Bupivacaine collagen-matrix implant 1 mg | C9089 | |
| Cinacalcet oral 1mg for (ESRD on dialysis) | J0604 | ||
| Phenylephrine & Ketorolac Ophthalmic | J1097 | ||
| Insulin for administration through DME | J1817 | ||
| Topical for actinic keratosis | J7308, J7309 | ||
| Capsaicin patch | J7335, J7336 | ||
| Parenteral solutions | J7501, J7503, J7505, J7508, J7516, J7518, J7520, J7525, J7599 | ||
| Inhalation solutions | J2062, J7604, J7622, J7624, J7627, J7628, J7629, J7632, J7633, J7634, J7635, J7636, J7640, J7641, J7647, J7648, J7649, J7650, J7658, J7659, J7660, J7667, J7668, J7669, J7670, J7680, J7681, J7683, J7684, J7685, J7699 | ||
| Non-inhalation drug for DME | J7799 | ||
| Unlisted chemo drug | J7999 | ||
| Antiemetics | J8498, J8597, Q0167, Q0174, S0183 | ||
| Leuprolide acetate per 1mg | J9218 | ||
| Drug or biological, part b drug competitive acquisition program (CAP) | Q4082 | ||
| Drugs for opioid use disorder | S0106, S0109 | ||
| Calcitrol | S0169 | ||
| Neonatal care | PA Required | Unlisted fetal invasive procedure | 59897 |
| No PA Required | Initiation of hypothermia in neonate | 99184 | |
| Neurology | PA Required | Creation of lesion by stereotactic method | 61790, 61791 |
| No PA Required | Graft for facial nerve paralysis | 15840, 15841, 15842, 15845 | |
| Injection for myelogram/CT | 62284, 62294 | ||
| Removal of implanted catheter | 62355 | ||
| Quantitative sensory testing (QST) | 0106T, 0107T, 0108T, 0109T, 0110T | ||
| Neurostimulators | PA Required | Insertion/replacement neurostimulator | 0425T, 0426T |
| No PA Required | Electronic analysis of neurostimulator | 95970, 95971, 95972, 95980, 95981, 95982 | |
| Removal of neurostimulators system | 0428T | ||
| Nutritional counseling | No PA Required | Nutritional counseling, dietitian visit | S9470 |
| Ophthalmology | PA Required | Prosthetic eye, scleral cover shell | V2623, V2627, V2629 |
| No PA Required | Keratoplasty, keratoprosthesis | 65730, 65750, 65755, 65756, 65757, 65770 | |
| Glaucoma treatments | 65855, 66170, 66172, 66183 | ||
| Cataract procedures | 66820, 66821, 66825, 66830, 66840, 66850, 66852, 66940, 66982, 66983, 66984, 66985, 66986, 66987, 66988, 66989, 66991 | ||
| Treatment of extensive/progressive retinopathy, scleral reinforcement | 67228, 67255 | ||
| Unlisted ophthalmology procedure | 67399, 92499 | ||
| Orbitotomy without bone flap | 67405 | ||
| Canthotomy | 67715 | ||
| Eyelid procedures | 67912, 67938, 67961, 67966, 67999 | ||
| Conjunctiva procedures | 68325, 68340, 68360, 68371, 68399 | ||
| Lacrimal procedures | 68761, 68899 | ||
| Retinal prosthesis | 0100T | ||
| Ocular monitoring and screening | 0198T, 0329T, 0330T, 0333T, 0378T, 0379T | ||
| Scleral lenses | V2531 | ||
| Orthopedic | PA Required | Computer-assisted surgical navigation | 0054T, 0055T |
| No PA Required | Procedures upper extremities | 23450, 23462, 23465, 23490, 24346, 25240, 25449, 25830, 26497, 26530, 26531, 26535, 26536 | |
| Open treatment of iliac spine(s) | 27215 | ||
| Procedures lower extremities | 27330, 27455, 27457, 27538, 27540, 27830, 28302, 28302, 28510, 28705, 28715, 28725, 28730, 28735, 28737, 28740 | ||
| Arthroscopy | 29800, 29830, 29835, 29847, 29900, 29902, 29904, 29905, 29906 | ||
| Device placement for radiostereometric analysis | 0347T | ||
| SI Joint injection | G0259 | ||
| Orthotics and Prosthetics | PA Required | Prosthesis (penile) | C1813, C2622 |
| Spinal orthotics | L0456, L0457, L0462, L0464, L0482, L0486, L0491, L0631, L0636, L0637, L0648, L0650, L0999, L1005, L1499 | ||
| Lower extremity orthotics | L1685, L1686, L1832, L1833, L1834, L1843, L1844, L1845, L1846, L1907, L1932, L1940, L1945, L1950, L1951, L1960, L1970, L1971, L1990, L2020, L2036, L2037, L2108, L2250, L2280, L2330, L2340, L2350, L2510, L2520, L2861, L2999, L3030, L3230, L3730, L3763, L3901, L3999, L4631 | ||
| Lower extremity prosthetics | L5000, L5020, L5050, L5100, L5210, L5220, L5301, L5312, L5321, L5331, L5530, L5540, L5580, L5590, L5611, L5617, L5626, L5631, L5643, L5645, L5646, L5647, L5648, L5649, L5650, L5651, L5652, L5653, L5665, L5671, L5673, L5677, L5679, L5681, L5683, L5700, L5701, L5703, L5704, L5705, L5706, L5707, L5781, L5782, L5785, L5790, L5811, L5812, L5814, L5816, L5822, L5828, L5840, L5845, L5848, L5856, L5857, L5920, L5940, L5950, L5960, L5961, L5962, L5964, L5968, L5973, L5975, L5976, L5979, L5980, L5981, L5984, L5986, L5987, L5988, L5999 | ||
| Upper extremity prosthetics | L6055, L6100, L6110, L6120, L6500, L6550, L6621, L6624, L6686, L6687, L6689, L6693, L6694, L6695, L6696, L6698, L6708, L6709, L6721, L6722, L6880, L6881, L6882, L6884, L6935, L6955, L7007, L7009, L7040, L7180, L7404, L7499, L8699, L8701, L9900 | ||
| No PA Required | Impression and prosthetic preparation | 21076, 21079, 21080, 21081, 21082, 21083, 21085 | |
| Cervical collar | L0200 | ||
| Orthotics | L0460, L0635, L1848, L2112, L2114, L2116, L3760, L3905, L3915, L3916, L3960, L4205, L5450, L5460 | ||
| Battery charger(s) | L7366, L7368 | ||
| Custom breast prosthesis | L8035 | ||
| Artificial larynx | L8500 | ||
| Ocular implant | L8610, L8670 | ||
| Osteopathy | No PA Required | Osteopathic manipulative treatment | 98925, 98926, 98927, 98928, 98929 |
| Otolaryngology | No PA Required | Surgical procedures of nasal/sinus and ears | 31050, 31051, 31075, 31080, 31081, 31084, 31086, 31087, 31090, 31201, 31290, 31291, 31294, 31611, 69717, 69979 |
| Pain management | PA Required | Injection, anesthetic agent or steroid | 64400, 64408, 64415, 64416, 64417, 64418, 64420, 64421, 64430, 64445, 64446, 64447, 64448, 64449, 64454, 64480, 64484, 64491, 64492, 64494, 64495 |
| Implant of hypoglossal neurostimulator | 64582 | ||
| Destruction by neurolytic agent | 64634, 64636, 64640 | ||
| No PA Required | Injection, anesthetic agent | 64505, 64517, 64530 | |
| Destruction by neurolytic agent | 64620, 64630, 64632, 64680, 64681 | ||
| Preventive | No PA Required | Unlisted preventative medicine service | 99429, 0358T |
| Preventive behavior change program | 0403T, 0488T | ||
| Professional services | No PA Required | Physician or other qualified health care professional supervision | 99380, G0068, G0128, G2082, G0039 |
| Pulmonology | PA Required | Drug Induced Sleep Endoscopy (DISE) | 42975 |
| No PA Required | Bronchoscopy | C9751 | |
| Skin substitute | PA Required | Skin substitute products | Q4107, Q4108, Q4114, Q4123, Q4127, Q4130, Q4140, Q4141, Q4142, Q4143, Q4146, Q4147, Q4149, Q4150, Q4152, Q4156, Q4157, Q4164, Q4173, Q4175, Q4184, Q4185, Q4188, Q4189, Q4190, Q4191, Q4192, Q4193, Q4194, Q4198, Q4200, Q4201, Q4202, Q4203, Q4204, Q4249, Q4250, Q4254, Q4255, Q4112, Q4113 |
| No PA Required | Dermal and epidermal substitute | J7340 | |
| Therapy service | PA Required | Activity therapy | G0176 |
| No PA Required | Extracorporeal shock wave | 0101T, 0102T | |
| Transplant services | No PA Required | Surgical preparation | 0494T, 0495T, 0496T |
| Transportation | No PA Required | Ambulance services | A0426, A0428, A0431, A0436, A0999 |
| Unlisted misc. procedures | PA Required | Unlisted procedure mediastinum, diaphragm, mouth | 39499, 39599, 40899 |
| No PA Required | Unlisted procedure, immunology | 95199 | |
| Urology | PA Required | Unlisted laparoscopy, renal | 50549 |
| No PA Required | Lithotripsy, extracorporeal shock wave | 50590 | |
| Closure of vesicouterine fistula | 51925 | ||
| Cystourethroscopy | 52005, 52007, 52204, 52224, 52234, 52235, 52240, 52276, 52287, 52300, 52320, 52325, 52330, 52332, 52341, 52344, 52351, 52352, 52353, 52354, 52356, 52402, C9740, C9761, C9769 | ||
| Insertion of tandem cuff | 53444 | ||
| Transurethral radiofrequency micro-remodeling of female bladder neck and proximal | 53860 | ||
| Destruction of penial lesion(s) | 54060 | ||
| Unlisted laparoscopy, testis | 54699 | ||
| Biopsy, prostate; needle or punch | 55700 | ||
| Vaccines | No PA Required | Immunizations/administration SARS-CoV-2 | 90376, 90620, 91311, 0112A |