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
Laparoscopy, surgical; jejunostomy (eg, for decompression or feeding)
Service Code
44186 (CPT) Laparoscopy, surgical; jejunostomy (eg, for decompression or feeding)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Laparoscopy, surgical; ileostomy or jejunostomy, non-tube
Service Code
44187 (CPT) Laparoscopy, surgical; ileostomy or jejunostomy, non-tube
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Laparoscopy, surgical, colostomy or skin level cecostomy
Service Code
44188 (CPT) Laparoscopy, surgical, colostomy or skin level cecostomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Laparoscopy, surgical; enterectomy, resection of small intestine, single resection and anastomosis
Service Code
44202 (CPT) Laparoscopy, surgical; enterectomy, resection of small intestine, single resection and anastomosis
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Laparoscopy, surgical; each additional small intestine resection and anastomosis (List separately in addition to code for primary procedure)
Service Code
44203 (CPT) Laparoscopy, surgical; each additional small intestine 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
Laparoscopy, surgical; colectomy, partial, with anastomosis
Service Code
44204 (CPT) Laparoscopy, surgical; colectomy, partial, with anastomosis
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Laparoscopy, surgical; colectomy, partial, with removal of terminal ileum with ileocolostomy
Service Code
44205 (CPT) Laparoscopy, surgical; 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; colectomy, partial, with end colostomy and closure of distal segment (Hartmann type procedure)
Service Code
44206 (CPT) Laparoscopy, surgical; 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
Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis)
Service Code
44207 (CPT) Laparoscopy, surgical; colectomy, partial, with anastomosis, 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
Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) with colostomy
Service Code
44208 (CPT) Laparoscopy, surgical; colectomy, partial, with anastomosis, 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
Laparoscopy, surgical; colectomy, total, abdominal, without proctectomy, with ileostomy or ileoproctostomy
Service Code
44210 (CPT) Laparoscopy, surgical; 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
Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileoanal anastomosis, creation of ileal reservoir (S or J), with loop ileostomy, includes rectal mucosectomy, when performed
Service Code
44211 (CPT) Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileoanal anastomosis, creation of ileal reservoir (S or J), with loop ileostomy, includes rectal mucosectomy, when performed
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileostomy
Service Code
44212 (CPT) Laparoscopy, surgical; 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
Laparoscopy, surgical, mobilization (take-down) of splenic flexure performed in conjunction with partial colectomy (List separately in addition to primary procedure)
Service Code
44213 (CPT) Laparoscopy, surgical, 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
Laparoscopy, surgical, closure of enterostomy, large or small intestine, with resection and anastomosis
Service Code
44227 (CPT) Laparoscopy, surgical, closure of enterostomy, large or small intestine, with resection and anastomosis
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Unlisted laparoscopy procedure, intestine (except rectum)
Service Code
44238 (CPT) Unlisted laparoscopy procedure, intestine (except rectum)
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
How to Submit
Please submit your request to Trillium Health Resources
Placement, enterostomy or cecostomy, tube open (eg, for feeding or decompression) (separate procedure)
Service Code
44300 (CPT) Placement, enterostomy or cecostomy, tube open (eg, for feeding or decompression) (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Ileostomy or jejunostomy, non-tube
Service Code
44310 (CPT) Ileostomy or jejunostomy, non-tube
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Revision of ileostomy; simple (release of superficial scar) (separate procedure)
Service Code
44312 (CPT) Revision of ileostomy; simple (release of superficial scar) (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Revision of ileostomy; complicated (reconstruction in-depth) (separate procedure)
Service Code
44314 (CPT) Revision of ileostomy; complicated (reconstruction in-depth) (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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