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; proctopexy (for prolapse), with sigmoid resection
Service Code
45402 (CPT) Laparoscopy, surgical; proctopexy (for prolapse), with sigmoid resection
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Unlisted laparoscopy procedure, rectum
Service Code
45499 (CPT) Unlisted laparoscopy procedure, 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
Proctoplasty; for stenosis
Service Code
45500 (CPT) Proctoplasty; for stenosis
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Proctoplasty; for prolapse of mucous membrane
Service Code
45505 (CPT) Proctoplasty; for prolapse of mucous membrane
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Perirectal injection of sclerosing solution for prolapse
Service Code
45520 (CPT) Perirectal injection of sclerosing solution for prolapse
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Proctopexy (eg, for prolapse); abdominal approach
Service Code
45540 (CPT) Proctopexy (eg, for prolapse); abdominal approach
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Proctopexy (eg, for prolapse); perineal approach
Service Code
45541 (CPT) Proctopexy (eg, for prolapse); perineal approach
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Proctopexy (eg, for prolapse); with sigmoid resection, abdominal approach
Service Code
45550 (CPT) Proctopexy (eg, for prolapse); with sigmoid resection, abdominal approach
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Repair of rectocele (separate procedure)
Service Code
45560 (CPT) Repair of rectocele (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Exploration, repair, and presacral drainage for rectal injury;
Service Code
45562 (CPT) Exploration, repair, and presacral drainage for rectal injury;
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Exploration, repair, and presacral drainage for rectal injury; with colostomy
Service Code
45563 (CPT) Exploration, repair, and presacral drainage for rectal injury; with colostomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Closure of rectovesical fistula;
Service Code
45800 (CPT) Closure of rectovesical fistula;
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Closure of rectovesical fistula; with colostomy
Service Code
45805 (CPT) Closure of rectovesical fistula; with colostomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Closure of rectourethral fistula;
Service Code
45820 (CPT) Closure of rectourethral fistula;
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Closure of rectourethral fistula; with colostomy
Service Code
45825 (CPT) Closure of rectourethral fistula; with colostomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Reduction of procidentia (separate procedure) under anesthesia
Service Code
45900 (CPT) Reduction of procidentia (separate procedure) under anesthesia
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Dilation of anal sphincter (separate procedure) under anesthesia other than local
Service Code
45905 (CPT) Dilation of anal sphincter (separate procedure) under anesthesia other than local
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Dilation of rectal stricture (separate procedure) under anesthesia other than local
Service Code
45910 (CPT) Dilation of rectal stricture (separate procedure) under anesthesia other than local
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Removal of fecal impaction or foreign body (separate procedure) under anesthesia
Service Code
45915 (CPT) Removal of fecal impaction or foreign body (separate procedure) under anesthesia
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anorectal exam, surgical, requiring anesthesia (general, spinal, or epidural), diagnostic
Service Code
45990 (CPT) Anorectal exam, surgical, requiring anesthesia (general, spinal, or epidural), diagnostic
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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