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

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12465 Results

PSYCH/3&4 BED

Service Code
0134 (Revenue) PSYCH/3&4 BED
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health, Mental Health

Authorization Guidelines

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100

Conditional Requirements

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100, with the exception of 0160: Servicses Rendered in an IMD. For Behavioral Health, prior authorization is not required for the first 72 hours of service. For Physical Health, no prior authorization is required.

How to Submit

Please submit your request to Trillium Health Resources

0135-ROOM & BOARD-SEMI-PRIV THREE OR FOUR BEDS HOSPICE

Service Code
0135 (Revenue) 0135-ROOM & BOARD-SEMI-PRIV THREE OR FOUR BEDS HOSPICE
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health, Mental Health

Authorization Guidelines

See the Carolina Complete Health site for specific requirements

Conditional Requirements

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100, with the exception of 0160: Servicses Rendered in an IMD. For Behavioral Health, prior authorization is not required for the first 72 hours of service. For Physical Health, no prior authorization is required.

How to Submit

Please submit your request to Carolina Complete Health

DETOX/2BED

Service Code
0136 (Revenue) DETOX/2BED
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health, Mental Health

Authorization Guidelines

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100

Conditional Requirements

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100, with the exception of 0160: Servicses Rendered in an IMD. For Behavioral Health, prior authorization is not required for the first 72 hours of service. For Physical Health, no prior authorization is required.

How to Submit

Please submit your request to Trillium Health Resources

0137-ROOM & BOARD-SEMI-PRIV THREE OR FOUR BEDS ONCOLOGY

Service Code
0137 (Revenue) 0137-ROOM & BOARD-SEMI-PRIV THREE OR FOUR BEDS ONCOLOGY
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health, Mental Health

Authorization Guidelines

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100

Conditional Requirements

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100, with the exception of 0160: Servicses Rendered in an IMD. For Behavioral Health, prior authorization is not required for the first 72 hours of service. For Physical Health, no prior authorization is required.

How to Submit

N/A - No authorization is required

0138-ROOM & BOARD-SEMI-PRIV-THREE OR FOUR BEDS REHAB

Service Code
0138 (Revenue) 0138-ROOM & BOARD-SEMI-PRIV-THREE OR FOUR BEDS REHAB
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health, Mental Health

Authorization Guidelines

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100

Conditional Requirements

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100, with the exception of 0160: Servicses Rendered in an IMD. For Behavioral Health, prior authorization is not required for the first 72 hours of service. For Physical Health, no prior authorization is required.

How to Submit

Please submit your request to Trillium Health Resources

0139-ROOM & BOARD-SEMI-PRIV THREE OR FOUR BEDS OTHER

Service Code
0139 (Revenue) 0139-ROOM & BOARD-SEMI-PRIV THREE OR FOUR BEDS OTHER
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health, Mental Health

Authorization Guidelines

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100

Conditional Requirements

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100, with the exception of 0160: Servicses Rendered in an IMD. For Behavioral Health, prior authorization is not required for the first 72 hours of service. For Physical Health, no prior authorization is required.

How to Submit

N/A - No authorization is required

Anesthesia for procedures on eye; not otherwise specified

Service Code
00140 (CPT) Anesthesia for procedures on eye; not otherwise specified
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0140-ROOM & BOARD-PRIVATE DELUXE GEN CLASS

Service Code
0140 (Revenue) 0140-ROOM & BOARD-PRIVATE DELUXE GEN CLASS
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health, Mental Health

Authorization Guidelines

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100

Conditional Requirements

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100, with the exception of 0160: Servicses Rendered in an IMD. For Behavioral Health, prior authorization is not required for the first 72 hours of service. For Physical Health, no prior authorization is required.

How to Submit

N/A - No authorization is required

0141-ROOM & BOARD-PRIVATE DELUXE MED/SURG/GYN

Service Code
0141 (Revenue) 0141-ROOM & BOARD-PRIVATE DELUXE MED/SURG/GYN
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health, Mental Health

Authorization Guidelines

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100

Conditional Requirements

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100, with the exception of 0160: Servicses Rendered in an IMD. For Behavioral Health, prior authorization is not required for the first 72 hours of service. For Physical Health, no prior authorization is required.

How to Submit

N/A - No authorization is required

Anesthesia for procedures on eye; lens surgery

Service Code
00142 (CPT) Anesthesia for procedures on eye; lens surgery
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0142-ROOM & BOARD-PRIVATE DELUXE OB

Service Code
0142 (Revenue) 0142-ROOM & BOARD-PRIVATE DELUXE OB
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health, Mental Health

Authorization Guidelines

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100

Conditional Requirements

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100, with the exception of 0160: Servicses Rendered in an IMD. For Behavioral Health, prior authorization is not required for the first 72 hours of service. For Physical Health, no prior authorization is required.

How to Submit

Please submit your request to Trillium Health Resources

0143-ROOM & BOARD-PRIVATE DELUXE PEDIATRIC

Service Code
0143 (Revenue) 0143-ROOM & BOARD-PRIVATE DELUXE PEDIATRIC
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health, Mental Health

Authorization Guidelines

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100

Conditional Requirements

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100, with the exception of 0160: Servicses Rendered in an IMD. For Behavioral Health, prior authorization is not required for the first 72 hours of service. For Physical Health, no prior authorization is required.

How to Submit

N/A - No authorization is required

Anesthesia for procedures on eye; corneal transplant

Service Code
00144 (CPT) Anesthesia for procedures on eye; corneal transplant
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

PSYCH/PVT/DLX

Service Code
0144 (Revenue) PSYCH/PVT/DLX
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health, Mental Health

Authorization Guidelines

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100

Conditional Requirements

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100, with the exception of 0160: Servicses Rendered in an IMD. For Behavioral Health, prior authorization is not required for the first 72 hours of service. For Physical Health, no prior authorization is required.

How to Submit

Please submit your request to Trillium Health Resources

Anesthesia for procedures on eye; vitreoretinal surgery

Service Code
00145 (CPT) Anesthesia for procedures on eye; vitreoretinal surgery
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0145-ROOM & BOARD-PRIVATE DELUXE HOSPICE

Service Code
0145 (Revenue) 0145-ROOM & BOARD-PRIVATE DELUXE HOSPICE
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health, Mental Health

Authorization Guidelines

See the Carolina Complete Health site for specific requirements

Conditional Requirements

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100, with the exception of 0160: Servicses Rendered in an IMD. For Behavioral Health, prior authorization is not required for the first 72 hours of service. For Physical Health, no prior authorization is required.

How to Submit

Please submit your request to Carolina Complete Health

DETOX/PVT/DLX

Service Code
0146 (Revenue) DETOX/PVT/DLX
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health, Mental Health

Authorization Guidelines

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100

Conditional Requirements

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100, with the exception of 0160: Servicses Rendered in an IMD. For Behavioral Health, prior authorization is not required for the first 72 hours of service. For Physical Health, no prior authorization is required.

How to Submit

Please submit your request to Trillium Health Resources

Anesthesia for procedures on eye; iridectomy

Service Code
00147 (CPT) Anesthesia for procedures on eye; iridectomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0147-ROOM & BOARD-PRIVATE DELUXE ONCOLOGY

Service Code
0147 (Revenue) 0147-ROOM & BOARD-PRIVATE DELUXE ONCOLOGY
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health, Mental Health

Authorization Guidelines

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100

Conditional Requirements

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100, with the exception of 0160: Servicses Rendered in an IMD. For Behavioral Health, prior authorization is not required for the first 72 hours of service. For Physical Health, no prior authorization is required.

How to Submit

N/A - No authorization is required

Anesthesia for procedures on eye; ophthalmoscopy

Service Code
00148 (CPT) Anesthesia for procedures on eye; ophthalmoscopy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required