PA Lookup
If you have questions about prior authorizations, please call:
Member and Recipient Service Line: 1-877-685-2415
Provider Support Service Line: 1-855-250-1539
Ascending aorta graft, with cardiopulmonary bypass, includes valve suspension, when performed; for aortic disease other than dissection (eg, aneurysm)
Authorization Guidelines
If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Conditional Requirements
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
How to Submit
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
Ascending aorta graft, with cardiopulmonary bypass, with aortic root replacement using valved conduit and coronary reconstruction (eg, Bentall)
Authorization Guidelines
If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Conditional Requirements
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
How to Submit
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
Ascending aorta graft, with cardiopulmonary bypass with valve suspension, with coronary reconstruction and valve-sparing aortic root remodeling (eg, David Procedure, Yacoub Procedure)
Authorization Guidelines
If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Conditional Requirements
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
How to Submit
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
Aortic hemiarch graft including isolation and control of the arch vessels, beveled open distal aortic anastomosis extending under one or more of the arch vessels, and total circulatory arrest or isolated cerebral perfusion (List separately in addition to
Authorization Guidelines
If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Conditional Requirements
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
How to Submit
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
Transverse aortic arch graft, with cardiopulmonary bypass, with profound hypothermia, total circulatory arrest and isolated cerebral perfusion with reimplantation of arch vessel(s) (eg, island pedicle or individual arch vessel reimplantation)
Authorization Guidelines
If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Conditional Requirements
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
How to Submit
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
Descending thoracic aorta graft, with or without bypass
Authorization Guidelines
If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Conditional Requirements
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
How to Submit
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
Repair of thoracoabdominal aortic aneurysm with graft, with or without cardiopulmonary bypass
Authorization Guidelines
If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Conditional Requirements
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
How to Submit
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
Endovascular Repair of Aortic Aneurysm
Aortic aneurysms can develop anywhere along the length of the aorta, but three-fourths of aneurysms are located in the abdominal aorta. Thoracic aortic aneurysms, including those that extend from the descending thoracic aorta into the upper abdomen, account for one-fourth of aortic aneurysms.
Endovascular stent grafting of the vascular system has emerged as a therapeutic modality for aortic aneurysms. Their safety and efficacy has been explored in the treatment of thoracic aortic aneurysms, abdominal aortic aneurysms, and peripheral arterial aneurysms.
Endovascular graft repair is performed under general, spinal or regional anesthesia. During the procedure, a prosthetic endograft is introduced with radiographic guidance through the femoral artery, iliac artery or the abdominal aorta. The device is advanced to the aneurysm site, deployed, and attached to the normal aorta with a self-expandable stent system. While both thoracic and abdominal aneurysms can be surgically repaired using stents and grafts, these open procedures are associated with considerable morbidity and mortality. Endovascular repair was developed to provide a minimally invasive approach, using a catheter inserted through a small groin incision to place the stent/graft across the aneurysm site. Patients requiring aortic aneurysm artery repair often have very significant co-morbid conditions including cardiac, pulmonary, and renal disease or insufficiency, and the comorbidities significantly increase the risk for major perioperative complications following open surgical repair.
A thoracic aortic aneurysm (TAA) is a potentially life-threatening disorder involving a structural weakness of the aortic wall. Progressive arterial dilation and possible rupture may occur.
Standard treatment for thoracic aortic aneurysms is an open surgical resection and replacement of the diseased aorta with a graft.
An abdominal aortic aneurysm (AAA) is usually asymptomatic until it expands or ruptures.
Presence of a pulsatile abdominal mass is virtually diagnostic but is found in less than half of cases. Rupture is uncommon if aneurysms are less than 5 cm in diameter, but ruptures are dramatically more common for aneurysms greater than 6 cm in diameter. Without prompt intervention, ruptured aneurysms are often fatal.
Endovascular stent grafting for the repair of descending thoracic aorta (DTA) and AAA is an option for treatment of aneurysms and may be covered for patients who meet the required criteria.
Authorization Guidelines
See the Turning Point site for specific requirements
Reauthorization Guidelines
See the Turning Point site for specific requirements
Limits
Medicaid only covers one procedure per date of service
Exclusions
Do not report 33881, 33883 when extension placement converts repair to cover left subclavian origin. Use only 33880.
Do not report 33886 in conjunction with 33880, 33881.
Report 33886 once, regardless of number of modules deployed.
Do not report 33889 in conjunction with 35694.
Do not report 33891 in conjunction with 35509, 35601.
Report CPT codes 34812, 34820, 34833, 34844, as appropriate.
Do not report 34833 in addition to 34820.
Place of Service
Inpatient hospital, Outpatient hospital, Office
Additional Service Specifics
Codes 33880 through 33891 represent a family of procedures to report placement of an endovascular graft for repair of the aorta. These codes include all device introduction, manipulation, positioning and deployment. All balloon angioplasty and/or stent deployment within the target treatment zone for the endoprosthesis, either before or after endograft deployment, are not reported separately.
Other Information
The following procedure codes, when applicable, are reported separately: 34812, 34820, 34833 through 34834, 35226, 35286, 36140, 36200 through 36218, 36245 through 36248
How to Submit
Please submit your request to Turning Point
Resources
Endovascular Repair of Aortic Aneurysm
Aortic aneurysms can develop anywhere along the length of the aorta, but three-fourths of aneurysms are located in the abdominal aorta. Thoracic aortic aneurysms, including those that extend from the descending thoracic aorta into the upper abdomen, account for one-fourth of aortic aneurysms.
Endovascular stent grafting of the vascular system has emerged as a therapeutic modality for aortic aneurysms. Their safety and efficacy has been explored in the treatment of thoracic aortic aneurysms, abdominal aortic aneurysms, and peripheral arterial aneurysms.
Endovascular graft repair is performed under general, spinal or regional anesthesia. During the procedure, a prosthetic endograft is introduced with radiographic guidance through the femoral artery, iliac artery or the abdominal aorta. The device is advanced to the aneurysm site, deployed, and attached to the normal aorta with a self-expandable stent system. While both thoracic and abdominal aneurysms can be surgically repaired using stents and grafts, these open procedures are associated with considerable morbidity and mortality. Endovascular repair was developed to provide a minimally invasive approach, using a catheter inserted through a small groin incision to place the stent/graft across the aneurysm site. Patients requiring aortic aneurysm artery repair often have very significant co-morbid conditions including cardiac, pulmonary, and renal disease or insufficiency, and the comorbidities significantly increase the risk for major perioperative complications following open surgical repair.
A thoracic aortic aneurysm (TAA) is a potentially life-threatening disorder involving a structural weakness of the aortic wall. Progressive arterial dilation and possible rupture may occur.
Standard treatment for thoracic aortic aneurysms is an open surgical resection and replacement of the diseased aorta with a graft.
An abdominal aortic aneurysm (AAA) is usually asymptomatic until it expands or ruptures.
Presence of a pulsatile abdominal mass is virtually diagnostic but is found in less than half of cases. Rupture is uncommon if aneurysms are less than 5 cm in diameter, but ruptures are dramatically more common for aneurysms greater than 6 cm in diameter. Without prompt intervention, ruptured aneurysms are often fatal.
Endovascular stent grafting for the repair of descending thoracic aorta (DTA) and AAA is an option for treatment of aneurysms and may be covered for patients who meet the required criteria.
Authorization Guidelines
See the Turning Point site for specific requirements
Reauthorization Guidelines
See the Turning Point site for specific requirements
Limits
Medicaid only covers one procedure per date of service
Exclusions
Do not report 33881, 33883 when extension placement converts repair to cover left subclavian origin. Use only 33880.
Do not report 33886 in conjunction with 33880, 33881.
Report 33886 once, regardless of number of modules deployed.
Do not report 33889 in conjunction with 35694.
Do not report 33891 in conjunction with 35509, 35601.
Report CPT codes 34812, 34820, 34833, 34844, as appropriate.
Do not report 34833 in addition to 34820.
Place of Service
Inpatient hospital, Outpatient hospital, Office
Additional Service Specifics
Codes 33880 through 33891 represent a family of procedures to report placement of an endovascular graft for repair of the aorta. These codes include all device introduction, manipulation, positioning and deployment. All balloon angioplasty and/or stent deployment within the target treatment zone for the endoprosthesis, either before or after endograft deployment, are not reported separately.
Other Information
The following procedure codes, when applicable, are reported separately: 34812, 34820, 34833 through 34834, 35226, 35286, 36140, 36200 through 36218, 36245 through 36248
How to Submit
Please submit your request to Turning Point
Resources
Endovascular Repair of Aortic Aneurysm
Aortic aneurysms can develop anywhere along the length of the aorta, but three-fourths of aneurysms are located in the abdominal aorta. Thoracic aortic aneurysms, including those that extend from the descending thoracic aorta into the upper abdomen, account for one-fourth of aortic aneurysms.
Endovascular stent grafting of the vascular system has emerged as a therapeutic modality for aortic aneurysms. Their safety and efficacy has been explored in the treatment of thoracic aortic aneurysms, abdominal aortic aneurysms, and peripheral arterial aneurysms.
Endovascular graft repair is performed under general, spinal or regional anesthesia. During the procedure, a prosthetic endograft is introduced with radiographic guidance through the femoral artery, iliac artery or the abdominal aorta. The device is advanced to the aneurysm site, deployed, and attached to the normal aorta with a self-expandable stent system. While both thoracic and abdominal aneurysms can be surgically repaired using stents and grafts, these open procedures are associated with considerable morbidity and mortality. Endovascular repair was developed to provide a minimally invasive approach, using a catheter inserted through a small groin incision to place the stent/graft across the aneurysm site. Patients requiring aortic aneurysm artery repair often have very significant co-morbid conditions including cardiac, pulmonary, and renal disease or insufficiency, and the comorbidities significantly increase the risk for major perioperative complications following open surgical repair.
A thoracic aortic aneurysm (TAA) is a potentially life-threatening disorder involving a structural weakness of the aortic wall. Progressive arterial dilation and possible rupture may occur.
Standard treatment for thoracic aortic aneurysms is an open surgical resection and replacement of the diseased aorta with a graft.
An abdominal aortic aneurysm (AAA) is usually asymptomatic until it expands or ruptures.
Presence of a pulsatile abdominal mass is virtually diagnostic but is found in less than half of cases. Rupture is uncommon if aneurysms are less than 5 cm in diameter, but ruptures are dramatically more common for aneurysms greater than 6 cm in diameter. Without prompt intervention, ruptured aneurysms are often fatal.
Endovascular stent grafting for the repair of descending thoracic aorta (DTA) and AAA is an option for treatment of aneurysms and may be covered for patients who meet the required criteria.
Limits
Medicaid only covers one procedure per date of service
Exclusions
Do not report 33881, 33883 when extension placement converts repair to cover left subclavian origin. Use only 33880.
Do not report 33886 in conjunction with 33880, 33881.
Report 33886 once, regardless of number of modules deployed.
Do not report 33889 in conjunction with 35694.
Do not report 33891 in conjunction with 35509, 35601.
Report CPT codes 34812, 34820, 34833, 34844, as appropriate.
Do not report 34833 in addition to 34820.
Place of Service
Inpatient hospital, Outpatient hospital, Office
Additional Service Specifics
Codes 33880 through 33891 represent a family of procedures to report placement of an endovascular graft for repair of the aorta. These codes include all device introduction, manipulation, positioning and deployment. All balloon angioplasty and/or stent deployment within the target treatment zone for the endoprosthesis, either before or after endograft deployment, are not reported separately.
Other Information
The following procedure codes, when applicable, are reported separately: 34812, 34820, 34833 through 34834, 35226, 35286, 36140, 36200 through 36218, 36245 through 36248
How to Submit
N/A - No authorization is required
Resources
Endovascular Repair of Aortic Aneurysm
Aortic aneurysms can develop anywhere along the length of the aorta, but three-fourths of aneurysms are located in the abdominal aorta. Thoracic aortic aneurysms, including those that extend from the descending thoracic aorta into the upper abdomen, account for one-fourth of aortic aneurysms.
Endovascular stent grafting of the vascular system has emerged as a therapeutic modality for aortic aneurysms. Their safety and efficacy has been explored in the treatment of thoracic aortic aneurysms, abdominal aortic aneurysms, and peripheral arterial aneurysms.
Endovascular graft repair is performed under general, spinal or regional anesthesia. During the procedure, a prosthetic endograft is introduced with radiographic guidance through the femoral artery, iliac artery or the abdominal aorta. The device is advanced to the aneurysm site, deployed, and attached to the normal aorta with a self-expandable stent system. While both thoracic and abdominal aneurysms can be surgically repaired using stents and grafts, these open procedures are associated with considerable morbidity and mortality. Endovascular repair was developed to provide a minimally invasive approach, using a catheter inserted through a small groin incision to place the stent/graft across the aneurysm site. Patients requiring aortic aneurysm artery repair often have very significant co-morbid conditions including cardiac, pulmonary, and renal disease or insufficiency, and the comorbidities significantly increase the risk for major perioperative complications following open surgical repair.
A thoracic aortic aneurysm (TAA) is a potentially life-threatening disorder involving a structural weakness of the aortic wall. Progressive arterial dilation and possible rupture may occur.
Standard treatment for thoracic aortic aneurysms is an open surgical resection and replacement of the diseased aorta with a graft.
An abdominal aortic aneurysm (AAA) is usually asymptomatic until it expands or ruptures.
Presence of a pulsatile abdominal mass is virtually diagnostic but is found in less than half of cases. Rupture is uncommon if aneurysms are less than 5 cm in diameter, but ruptures are dramatically more common for aneurysms greater than 6 cm in diameter. Without prompt intervention, ruptured aneurysms are often fatal.
Endovascular stent grafting for the repair of descending thoracic aorta (DTA) and AAA is an option for treatment of aneurysms and may be covered for patients who meet the required criteria.
Authorization Guidelines
See the Turning Point site for specific requirements
Reauthorization Guidelines
See the Turning Point site for specific requirements
Limits
Medicaid only covers one procedure per date of service
Exclusions
Do not report 33881, 33883 when extension placement converts repair to cover left subclavian origin. Use only 33880.
Do not report 33886 in conjunction with 33880, 33881.
Report 33886 once, regardless of number of modules deployed.
Do not report 33889 in conjunction with 35694.
Do not report 33891 in conjunction with 35509, 35601.
Report CPT codes 34812, 34820, 34833, 34844, as appropriate.
Do not report 34833 in addition to 34820.
Place of Service
Inpatient hospital, Outpatient hospital, Office
Additional Service Specifics
Codes 33880 through 33891 represent a family of procedures to report placement of an endovascular graft for repair of the aorta. These codes include all device introduction, manipulation, positioning and deployment. All balloon angioplasty and/or stent deployment within the target treatment zone for the endoprosthesis, either before or after endograft deployment, are not reported separately.
Other Information
The following procedure codes, when applicable, are reported separately: 34812, 34820, 34833 through 34834, 35226, 35286, 36140, 36200 through 36218, 36245 through 36248
How to Submit
Please submit your request to Turning Point
Resources
Endovascular Repair of Aortic Aneurysm
Aortic aneurysms can develop anywhere along the length of the aorta, but three-fourths of aneurysms are located in the abdominal aorta. Thoracic aortic aneurysms, including those that extend from the descending thoracic aorta into the upper abdomen, account for one-fourth of aortic aneurysms.
Endovascular stent grafting of the vascular system has emerged as a therapeutic modality for aortic aneurysms. Their safety and efficacy has been explored in the treatment of thoracic aortic aneurysms, abdominal aortic aneurysms, and peripheral arterial aneurysms.
Endovascular graft repair is performed under general, spinal or regional anesthesia. During the procedure, a prosthetic endograft is introduced with radiographic guidance through the femoral artery, iliac artery or the abdominal aorta. The device is advanced to the aneurysm site, deployed, and attached to the normal aorta with a self-expandable stent system. While both thoracic and abdominal aneurysms can be surgically repaired using stents and grafts, these open procedures are associated with considerable morbidity and mortality. Endovascular repair was developed to provide a minimally invasive approach, using a catheter inserted through a small groin incision to place the stent/graft across the aneurysm site. Patients requiring aortic aneurysm artery repair often have very significant co-morbid conditions including cardiac, pulmonary, and renal disease or insufficiency, and the comorbidities significantly increase the risk for major perioperative complications following open surgical repair.
A thoracic aortic aneurysm (TAA) is a potentially life-threatening disorder involving a structural weakness of the aortic wall. Progressive arterial dilation and possible rupture may occur.
Standard treatment for thoracic aortic aneurysms is an open surgical resection and replacement of the diseased aorta with a graft.
An abdominal aortic aneurysm (AAA) is usually asymptomatic until it expands or ruptures.
Presence of a pulsatile abdominal mass is virtually diagnostic but is found in less than half of cases. Rupture is uncommon if aneurysms are less than 5 cm in diameter, but ruptures are dramatically more common for aneurysms greater than 6 cm in diameter. Without prompt intervention, ruptured aneurysms are often fatal.
Endovascular stent grafting for the repair of descending thoracic aorta (DTA) and AAA is an option for treatment of aneurysms and may be covered for patients who meet the required criteria.
Authorization Guidelines
See the Turning Point site for specific requirements
Reauthorization Guidelines
See the Turning Point site for specific requirements
Limits
Medicaid only covers one procedure per date of service
Exclusions
Do not report 33881, 33883 when extension placement converts repair to cover left subclavian origin. Use only 33880.
Do not report 33886 in conjunction with 33880, 33881.
Report 33886 once, regardless of number of modules deployed.
Do not report 33889 in conjunction with 35694.
Do not report 33891 in conjunction with 35509, 35601.
Report CPT codes 34812, 34820, 34833, 34844, as appropriate.
Do not report 34833 in addition to 34820.
Place of Service
Inpatient hospital, Outpatient hospital, Office
Additional Service Specifics
Codes 33880 through 33891 represent a family of procedures to report placement of an endovascular graft for repair of the aorta. These codes include all device introduction, manipulation, positioning and deployment. All balloon angioplasty and/or stent deployment within the target treatment zone for the endoprosthesis, either before or after endograft deployment, are not reported separately.
Other Information
The following procedure codes, when applicable, are reported separately: 34812, 34820, 34833 through 34834, 35226, 35286, 36140, 36200 through 36218, 36245 through 36248
How to Submit
Please submit your request to Turning Point
Resources
Endovascular stent repair of coarctation of the ascending, transverse, or descending thoracic or abdominal aorta, involving stent placement; across major side branches
Authorization Guidelines
If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Conditional Requirements
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
How to Submit
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
Endovascular stent repair of coarctation of the ascending, transverse, or descending thoracic or abdominal aorta, involving stent placement; not crossing major side branches
Authorization Guidelines
If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Conditional Requirements
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
How to Submit
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
Percutaneous transluminal angioplasty of native or recurrent coarctation of the aorta
Authorization Guidelines
If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Conditional Requirements
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
How to Submit
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
Percutaneous pulmonary artery revascularization by stent placement, initial; normal native connections, unilateral
Authorization Guidelines
If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Conditional Requirements
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
How to Submit
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
Percutaneous pulmonary artery revascularization by stent placement, initial; normal native connections, bilateral
Authorization Guidelines
If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Conditional Requirements
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
How to Submit
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
Percutaneous pulmonary artery revascularization by stent placement, initial; abnormal connections, unilateral
Authorization Guidelines
If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Conditional Requirements
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
How to Submit
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
Percutaneous pulmonary artery revascularization by stent placement, initial; abnormal connections, bilateral
Authorization Guidelines
If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Conditional Requirements
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
How to Submit
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
Percutaneous pulmonary artery revascularization by stent placement, each additional vessel or separate lesion, normal or abnormal connections (List separately in addition to code for primary procedure)
Authorization Guidelines
If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Conditional Requirements
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
How to Submit
If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.
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