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
Diverticulectomy of hypopharynx or esophagus, with or without myotomy; cervical approach
Service Code
43130 (CPT) Diverticulectomy of hypopharynx or esophagus, with or without myotomy; cervical approach
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Diverticulectomy of hypopharynx or esophagus, with or without myotomy; thoracic approach
Service Code
43135 (CPT) Diverticulectomy of hypopharynx or esophagus, with or without myotomy; thoracic approach
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus (eg, Zenker's diverticulum), with cricopharyngeal myotomy, includes use of telescope or operating microscope and repair, when performed
Service Code
43180 (CPT) Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus (eg, Zenker's diverticulum), with cricopharyngeal myotomy, includes use of telescope or operating microscope and repair, when performed
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Esophagoscopy, rigid, transoral; diagnostic, including collection of specimen(s) by brushing or washing when performed (separate procedure)
Service Code
43191 (CPT) Esophagoscopy, rigid, transoral; diagnostic, including collection of specimen(s) by brushing or washing when performed (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Esophagoscopy, rigid, transoral; with directed submucosal injection(s), any substance
Service Code
43192 (CPT) Esophagoscopy, rigid, transoral; with directed submucosal injection(s), any substance
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Esophagoscopy, rigid, transoral; with biopsy, single or multiple
Service Code
43193 (CPT) Esophagoscopy, rigid, transoral; with biopsy, single or multiple
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Esophagoscopy, rigid, transoral; with removal of foreign body(s)
Service Code
43194 (CPT) Esophagoscopy, rigid, transoral; with removal of foreign body(s)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Esophagoscopy, rigid, transoral; with balloon dilation (less than 30 mm diameter)
Service Code
43195 (CPT) Esophagoscopy, rigid, transoral; with balloon dilation (less than 30 mm diameter)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Esophagoscopy, rigid, transoral; with insertion of guide wire followed by dilation over guide wire
Service Code
43196 (CPT) Esophagoscopy, rigid, transoral; with insertion of guide wire followed by dilation over guide wire
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Esophagoscopy, flexible, transnasal; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
Service Code
43197 (CPT) Esophagoscopy, flexible, transnasal; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Esophagoscopy, flexible, transnasal; with biopsy, single or multiple
Service Code
43198 (CPT) Esophagoscopy, flexible, transnasal; with biopsy, single or multiple
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
Service Code
43200 (CPT) Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Esophagoscopy, flexible, transoral; with directed submucosal injection(s), any substance
Service Code
43201 (CPT) Esophagoscopy, flexible, transoral; with directed submucosal injection(s), any substance
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Esophagoscopy, flexible, transoral; with biopsy, single or multiple
Service Code
43202 (CPT) Esophagoscopy, flexible, transoral; with biopsy, single or multiple
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Esophagoscopy, flexible, transoral; with injection sclerosis of esophageal varices
Service Code
43204 (CPT) Esophagoscopy, flexible, transoral; with injection sclerosis of esophageal varices
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Esophagoscopy, flexible, transoral; with band ligation of esophageal varices
Service Code
43205 (CPT) Esophagoscopy, flexible, transoral; with band ligation of esophageal varices
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Esophagoscopy, flexible, transoral; with optical endomicroscopy
Service Code
43206 (CPT) Esophagoscopy, flexible, transoral; with optical endomicroscopy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Esophagogastroduodenoscopy, flexible, transoral; with esophagogastric fundoplasty, partial or complete, includes duodenoscopy when performed
Service Code
43210 (CPT) Esophagogastroduodenoscopy, flexible, transoral; with esophagogastric fundoplasty, partial or complete, includes duodenoscopy when performed
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Esophagoscopy, flexible, transoral; with endoscopic mucosal resection
Service Code
43211 (CPT) Esophagoscopy, flexible, transoral; with endoscopic mucosal resection
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Esophagoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)
Service Code
43212 (CPT) Esophagoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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