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
0762 Observation room
Service Code
0762 (Revenue) 0762 Observation room
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
0769 Other treatment room
Service Code
0769 (Revenue) 0769 Other treatment room
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for all procedures on major abdominal blood vessels
Service Code
00770 (CPT) Anesthesia for all procedures on major abdominal blood vessels
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
0771 Vaccine administration
Service Code
0771 (Revenue) 0771 Vaccine administration
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
0779 Other preventive care services
Service Code
0779 (Revenue) 0779 Other preventive care services
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
0780 Telemedicine
Service Code
0780 (Revenue) 0780 Telemedicine
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
0789 Other telemedicine
Service Code
0789 (Revenue) 0789 Other telemedicine
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified
Service Code
00790 (CPT) Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; partial hepatectomy or management of liver hemorrhage (excluding liver biopsy)
Service Code
00792 (CPT) Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; partial hepatectomy or management of liver hemorrhage (excluding liver biopsy)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; pancreatectomy, partial or total (eg, Whipple procedure)
Service Code
00794 (CPT) Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; pancreatectomy, partial or total (eg, Whipple procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; liver transplant (recipient)
Service Code
00796 (CPT) Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; liver transplant (recipient)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; gastric restrictive procedure for morbid obesity
Service Code
00797 (CPT) Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; gastric restrictive procedure for morbid obesity
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
0799 Other ESWT
Service Code
0799 (Revenue) 0799 Other ESWT
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for procedures on lower anterior abdominal wall; not otherwise specified
Service Code
00800 (CPT) Anesthesia for procedures on lower anterior abdominal wall; not otherwise specified
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
0801 Inpatient hemodialysis
Service Code
0801 (Revenue) 0801 Inpatient hemodialysis
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for procedures on lower anterior abdominal wall; panniculectomy
Service Code
00802 (CPT) Anesthesia for procedures on lower anterior abdominal wall; panniculectomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
0803 Inpatient continuous ambulatory peritoneal dialysis (CAPD)
Service Code
0803 (Revenue) 0803 Inpatient continuous ambulatory peritoneal dialysis (CAPD)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
0804 Inpatient continuous cycling peritoneal dialysis (CCPD)
Service Code
0804 (Revenue) 0804 Inpatient continuous cycling peritoneal dialysis (CCPD)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
0809 Other inpatient dialysis
Service Code
0809 (Revenue) 0809 Other inpatient dialysis
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
0810 General
Service Code
0810 (Revenue) 0810 General
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
See something that needs to be updated?
If you find any wrong or out of date information on our pages, we want to know. Please email info@TrilliumNC.org with any corrections.