PA Lookup

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Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; sublingual, superficial

Service Code
41005 (CPT) Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; sublingual, superficial
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; sublingual, deep, supramylohyoid

Service Code
41006 (CPT) Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; sublingual, deep, supramylohyoid
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; submental space

Service Code
41007 (CPT) Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; submental space
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; submandibular space

Service Code
41008 (CPT) Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; submandibular space
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; masticator space

Service Code
41009 (CPT) Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; masticator space
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Surgery of the Lingual Frenulum

Service Code
41010 (CPT) Incision of lingual frenum (frenotomy)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Surgery of the lingual frenulum includes incision, excision, or surgical alteration of a short frenum to free the tongue and allow greater range of motion of the tongue.

Limits

Prior approval is required for beneficiaries 2 years of age and older. Surgery of the lingual frenulum is limited to once per lifetime.

Place of Service

Inpatient, Outpatient, Physician’s Office or Dental Office.

How to Submit

N/A - No authorization is required

Resources

Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; sublingual

Service Code
41015 (CPT) Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; sublingual
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; submental

Service Code
41016 (CPT) Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; submental
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; submandibular

Service Code
41017 (CPT) Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; submandibular
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; masticator space

Service Code
41018 (CPT) Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; masticator space
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Placement of needles, catheters, or other device(s) into the head and/or neck region (percutaneous, transoral, or transnasal) for subsequent interstitial radioelement application

Service Code
41019 (CPT) Placement of needles, catheters, or other device(s) into the head and/or neck region (percutaneous, transoral, or transnasal) for subsequent interstitial radioelement application
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Biopsy of tongue; anterior two-thirds

Service Code
41100 (CPT) Biopsy of tongue; anterior two-thirds
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Biopsy of tongue; posterior one-third

Service Code
41105 (CPT) Biopsy of tongue; posterior one-third
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Biopsy of floor of mouth

Service Code
41108 (CPT) Biopsy of floor of mouth
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Excision of lesion of tongue without closure

Service Code
41110 (CPT) Excision of lesion of tongue without closure
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Excision of lesion of tongue with closure; anterior two-thirds

Service Code
41112 (CPT) Excision of lesion of tongue with closure; anterior two-thirds
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Excision of lesion of tongue with closure; posterior one-third

Service Code
41113 (CPT) Excision of lesion of tongue with closure; posterior one-third
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Excision of lesion of tongue with closure; with local tongue flap

Service Code
41114 (CPT) Excision of lesion of tongue with closure; with local tongue flap
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Surgery of the Lingual Frenulum

Service Code
41115 (CPT) Excision of lingual frenum (frenectomy)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Surgery of the lingual frenulum includes incision, excision, or surgical alteration of a short frenum to free the tongue and allow greater range of motion of the tongue.

Limits

Prior approval is required for beneficiaries 2 years of age and older. Surgery of the lingual frenulum is limited to once per lifetime.

Place of Service

Inpatient, Outpatient, Physician’s Office or Dental Office.

How to Submit

N/A - No authorization is required

Resources

Excision, lesion of floor of mouth

Service Code
41116 (CPT) Excision, lesion of floor of mouth
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required