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
Enterectomy, resection of small intestine for congenital atresia, single resection and anastomosis of proximal segment of intestine; each additional resection and anastomosis (List separately in addition to code for primary procedure)
Service Code
44128 (CPT) Enterectomy, resection of small intestine for congenital atresia, single resection and anastomosis of proximal segment of intestine; each additional resection and anastomosis (List separately in addition to code for primary procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Enteroenterostomy, anastomosis of intestine, with or without cutaneous enterostomy (separate procedure)
Service Code
44130 (CPT) Enteroenterostomy, anastomosis of intestine, with or without cutaneous enterostomy (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Donor enterectomy (including cold preservation), open; from cadaver donor
Service Code
44132 (CPT) Donor enterectomy (including cold preservation), open; from cadaver donor
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
Authorization Guidelines
See the Carolina Complete Health site for specific requirements
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
How to Submit
Please submit your request to Carolina Complete Health
Intestinal allotransplantation; from cadaver donor
Service Code
44135 (CPT) Intestinal allotransplantation; from cadaver donor
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
Authorization Guidelines
See the Carolina Complete Health site for specific requirements
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
How to Submit
Please submit your request to Carolina Complete Health
Mobilization (take-down) of splenic flexure performed in conjunction with partial colectomy (List separately in addition to primary procedure)
Service Code
44139 (CPT) Mobilization (take-down) of splenic flexure performed in conjunction with partial colectomy (List separately in addition to primary procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Colectomy, partial; with anastomosis
Service Code
44140 (CPT) Colectomy, partial; with anastomosis
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Colectomy, partial; with skin level cecostomy or colostomy
Service Code
44141 (CPT) Colectomy, partial; with skin level cecostomy or colostomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Colectomy, partial; with end colostomy and closure of distal segment (Hartmann type procedure)
Service Code
44143 (CPT) Colectomy, partial; with end colostomy and closure of distal segment (Hartmann type procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Colectomy, partial; with resection, with colostomy or ileostomy and creation of mucofistula
Service Code
44144 (CPT) Colectomy, partial; with resection, with colostomy or ileostomy and creation of mucofistula
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Colectomy, partial; with coloproctostomy (low pelvic anastomosis)
Service Code
44145 (CPT) Colectomy, partial; with coloproctostomy (low pelvic anastomosis)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Colectomy, partial; with coloproctostomy (low pelvic anastomosis), with colostomy
Service Code
44146 (CPT) Colectomy, partial; with coloproctostomy (low pelvic anastomosis), with colostomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Colectomy, partial; abdominal and transanal approach
Service Code
44147 (CPT) Colectomy, partial; abdominal and transanal approach
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Colectomy, total, abdominal, without proctectomy; with ileostomy or ileoproctostomy
Service Code
44150 (CPT) Colectomy, total, abdominal, without proctectomy; with ileostomy or ileoproctostomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Colectomy, total, abdominal, without proctectomy; with continent ileostomy
Service Code
44151 (CPT) Colectomy, total, abdominal, without proctectomy; with continent ileostomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Colectomy, total, abdominal, with proctectomy; with ileostomy
Service Code
44155 (CPT) Colectomy, total, abdominal, with proctectomy; with ileostomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Colectomy, total, abdominal, with proctectomy; with continent ileostomy
Service Code
44156 (CPT) Colectomy, total, abdominal, with proctectomy; with continent ileostomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosis, includes loop ileostomy, and rectal mucosectomy, when performed
Service Code
44157 (CPT) Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosis, includes loop ileostomy, and rectal mucosectomy, when performed
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosis, creation of ileal reservoir (S or J), includes loop ileostomy, and rectal mucosectomy, when performed
Service Code
44158 (CPT) Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosis, creation of ileal reservoir (S or J), includes loop ileostomy, and rectal mucosectomy, when performed
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Colectomy, partial, with removal of terminal ileum with ileocolostomy
Service Code
44160 (CPT) Colectomy, partial, with removal of terminal ileum with ileocolostomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure)
Service Code
44180 (CPT) Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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