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

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12465 Results

Unlisted procedure, small intestine

Service Code
44799 (CPT) Unlisted procedure, small intestine
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

Excision of Meckel's diverticulum (diverticulectomy) or omphalomesenteric duct

Service Code
44800 (CPT) Excision of Meckel's diverticulum (diverticulectomy) or omphalomesenteric duct
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Excision of lesion of mesentery (separate procedure)

Service Code
44820 (CPT) Excision of lesion of mesentery (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Suture of mesentery (separate procedure)

Service Code
44850 (CPT) Suture of mesentery (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Unlisted procedure, Meckel's diverticulum and the mesentery

Service Code
44899 (CPT) Unlisted procedure, Meckel's diverticulum and the mesentery
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

Incision and drainage of appendiceal abscess, open

Service Code
44900 (CPT) Incision and drainage of appendiceal abscess, open
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Appendectomy;

Service Code
44950 (CPT) Appendectomy;
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Appendectomy; when done for indicated purpose at time of other major procedure (not as separate procedure) (List separately in addition to code for primary procedure)

Service Code
44955 (CPT) Appendectomy; when done for indicated purpose at time of other major procedure (not as separate procedure) (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

Appendectomy; for ruptured appendix with abscess or generalized peritonitis

Service Code
44960 (CPT) Appendectomy; for ruptured appendix with abscess or generalized peritonitis
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Laparoscopy, surgical, appendectomy

Service Code
44970 (CPT) Laparoscopy, surgical, appendectomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Unlisted laparoscopy procedure, appendix

Service Code
44979 (CPT) Unlisted laparoscopy procedure, appendix
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

Transrectal drainage of pelvic abscess

Service Code
45000 (CPT) Transrectal drainage of pelvic abscess
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Incision and drainage of submucosal abscess, rectum

Service Code
45005 (CPT) Incision and drainage of submucosal abscess, rectum
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Incision and drainage of deep supralevator, pelvirectal, or retrorectal abscess

Service Code
45020 (CPT) Incision and drainage of deep supralevator, pelvirectal, or retrorectal abscess
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Biopsy of anorectal wall, anal approach (eg, congenital megacolon)

Service Code
45100 (CPT) Biopsy of anorectal wall, anal approach (eg, congenital megacolon)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Anorectal myomectomy

Service Code
45108 (CPT) Anorectal myomectomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Proctectomy; complete, combined abdominoperineal, with colostomy

Service Code
45110 (CPT) Proctectomy; complete, combined abdominoperineal, with colostomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Proctectomy; partial resection of rectum, transabdominal approach

Service Code
45111 (CPT) Proctectomy; partial resection of rectum, transabdominal approach
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Proctectomy, combined abdominoperineal, pull-through procedure (eg, colo-anal anastomosis)

Service Code
45112 (CPT) Proctectomy, combined abdominoperineal, pull-through procedure (eg, colo-anal anastomosis)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Proctectomy, partial, with rectal mucosectomy, ileoanal anastomosis, creation of ileal reservoir (S or J), with or without loop ileostomy

Service Code
45113 (CPT) Proctectomy, partial, with rectal mucosectomy, ileoanal anastomosis, creation of ileal reservoir (S or J), with or without loop ileostomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required