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
Unlisted procedure, rectum
Service Code
45999 (CPT) Unlisted 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
Placement of seton
Service Code
46020 (CPT) Placement of seton
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Removal of anal seton, other marker
Service Code
46030 (CPT) Removal of anal seton, other marker
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Incision and drainage of ischiorectal and/or perirectal abscess (separate procedure)
Service Code
46040 (CPT) Incision and drainage of ischiorectal and/or perirectal abscess (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Incision and drainage of intramural, intramuscular, or submucosal abscess, transanal, under anesthesia
Service Code
46045 (CPT) Incision and drainage of intramural, intramuscular, or submucosal abscess, transanal, under anesthesia
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Incision and drainage, perianal abscess, superficial
Service Code
46050 (CPT) Incision and drainage, perianal abscess, superficial
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Incision and drainage of ischiorectal or intramural abscess, with fistulectomy or fistulotomy, submuscular, with or without placement of seton
Service Code
46060 (CPT) Incision and drainage of ischiorectal or intramural abscess, with fistulectomy or fistulotomy, submuscular, with or without placement of seton
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Incision, anal septum (infant)
Service Code
46070 (CPT) Incision, anal septum (infant)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Sphincterotomy, anal, division of sphincter (separate procedure)
Service Code
46080 (CPT) Sphincterotomy, anal, division of sphincter (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Incision of thrombosed hemorrhoid, external
Service Code
46083 (CPT) Incision of thrombosed hemorrhoid, external
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Fissurectomy, including sphincterotomy, when performed
Service Code
46200 (CPT) Fissurectomy, including sphincterotomy, when performed
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of single external papilla or tag, anus
Service Code
46220 (CPT) Excision of single external papilla or tag, anus
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Hemorrhoidectomy, internal, by rubber band ligation(s)
Service Code
46221 (CPT) Hemorrhoidectomy, internal, by rubber band ligation(s)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of multiple external papillae or tags, anus
Service Code
46230 (CPT) Excision of multiple external papillae or tags, anus
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Hemorrhoidectomy, external, 2 or more columns/groups
Service Code
46250 (CPT) Hemorrhoidectomy, external, 2 or more columns/groups
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Hemorrhoidectomy, internal and external, single column/group;
Service Code
46255 (CPT) Hemorrhoidectomy, internal and external, single column/group;
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Hemorrhoidectomy, internal and external, single column/group; with fissurectomy
Service Code
46257 (CPT) Hemorrhoidectomy, internal and external, single column/group; with fissurectomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Hemorrhoidectomy, internal and external, single column/group; with fistulectomy, including fissurectomy, when performed
Service Code
46258 (CPT) Hemorrhoidectomy, internal and external, single column/group; with fistulectomy, including fissurectomy, when performed
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Hemorrhoidectomy, internal and external, 2 or more columns/groups;
Service Code
46260 (CPT) Hemorrhoidectomy, internal and external, 2 or more columns/groups;
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Hemorrhoidectomy, internal and external, 2 or more columns/groups; with fissurectomy
Service Code
46261 (CPT) Hemorrhoidectomy, internal and external, 2 or more columns/groups; with fissurectomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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