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
12465 Results
Drainage of abscess; submaxillary, external
Service Code
42320 (CPT) Drainage of abscess; submaxillary, external
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Sialolithotomy; submandibular (submaxillary), sublingual or parotid, uncomplicated, intraoral
Service Code
42330 (CPT) Sialolithotomy; submandibular (submaxillary), sublingual or parotid, uncomplicated, intraoral
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Sialolithotomy; submandibular (submaxillary), complicated, intraoral
Service Code
42335 (CPT) Sialolithotomy; submandibular (submaxillary), complicated, intraoral
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Sialolithotomy; parotid, extraoral or complicated intraoral
Service Code
42340 (CPT) Sialolithotomy; parotid, extraoral or complicated intraoral
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Biopsy of salivary gland; needle
Service Code
42400 (CPT) Biopsy of salivary gland; needle
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Biopsy of salivary gland; incisional
Service Code
42405 (CPT) Biopsy of salivary gland; incisional
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of sublingual salivary cyst (ranula)
Service Code
42408 (CPT) Excision of sublingual salivary cyst (ranula)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Marsupialization of sublingual salivary cyst (ranula)
Service Code
42409 (CPT) Marsupialization of sublingual salivary cyst (ranula)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of parotid tumor or parotid gland; lateral lobe, without nerve dissection
Service Code
42410 (CPT) Excision of parotid tumor or parotid gland; lateral lobe, without nerve dissection
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of parotid tumor or parotid gland; lateral lobe, with dissection and preservation of facial nerve
Service Code
42415 (CPT) Excision of parotid tumor or parotid gland; lateral lobe, with dissection and preservation of facial nerve
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of parotid tumor or parotid gland; total, with dissection and preservation of facial nerve
Service Code
42420 (CPT) Excision of parotid tumor or parotid gland; total, with dissection and preservation of facial nerve
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of parotid tumor or parotid gland; total, en bloc removal with sacrifice of facial nerve
Service Code
42425 (CPT) Excision of parotid tumor or parotid gland; total, en bloc removal with sacrifice of facial nerve
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of parotid tumor or parotid gland; total, with unilateral radical neck dissection
Service Code
42426 (CPT) Excision of parotid tumor or parotid gland; total, with unilateral radical neck dissection
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of submandibular (submaxillary) gland
Service Code
42440 (CPT) Excision of submandibular (submaxillary) gland
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of sublingual gland
Service Code
42450 (CPT) Excision of sublingual gland
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Plastic repair of salivary duct, sialodochoplasty; primary or simple
Service Code
42500 (CPT) Plastic repair of salivary duct, sialodochoplasty; primary or simple
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Plastic repair of salivary duct, sialodochoplasty; secondary or complicated
Service Code
42505 (CPT) Plastic repair of salivary duct, sialodochoplasty; secondary or complicated
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Parotid duct diversion, bilateral (Wilke type procedure);
Service Code
42507 (CPT) Parotid duct diversion, bilateral (Wilke type procedure);
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Parotid duct diversion, bilateral (Wilke type procedure); with excision of both submandibular glands
Service Code
42509 (CPT) Parotid duct diversion, bilateral (Wilke type procedure); with excision of both submandibular glands
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Parotid duct diversion, bilateral (Wilke type procedure); with ligation of both submandibular (Wharton's) ducts
Service Code
42510 (CPT) Parotid duct diversion, bilateral (Wilke type procedure); with ligation of both submandibular (Wharton's) ducts
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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