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
Anoplasty, plastic operation for stricture; adult
Service Code
46700 (CPT) Anoplasty, plastic operation for stricture; adult
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anoplasty, plastic operation for stricture; infant
Service Code
46705 (CPT) Anoplasty, plastic operation for stricture; infant
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Repair of anal fistula with fibrin glue
Service Code
46706 (CPT) Repair of anal fistula with fibrin glue
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Repair of anorectal fistula with plug (eg, porcine small intestine submucosa [SIS])
Service Code
46707 (CPT) Repair of anorectal fistula with plug (eg, porcine small intestine submucosa [SIS])
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Repair of ileoanal pouch fistula/sinus (eg, perineal or vaginal), pouch advancement; transperineal approach
Service Code
46710 (CPT) Repair of ileoanal pouch fistula/sinus (eg, perineal or vaginal), pouch advancement; transperineal approach
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Repair of ileoanal pouch fistula/sinus (eg, perineal or vaginal), pouch advancement; combined transperineal and transabdominal approach
Service Code
46712 (CPT) Repair of ileoanal pouch fistula/sinus (eg, perineal or vaginal), pouch advancement; combined transperineal and transabdominal approach
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Repair of low imperforate anus; with anoperineal fistula (cut-back procedure)
Service Code
46715 (CPT) Repair of low imperforate anus; with anoperineal fistula (cut-back procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Repair of low imperforate anus; with transposition of anoperineal or anovestibular fistula
Service Code
46716 (CPT) Repair of low imperforate anus; with transposition of anoperineal or anovestibular fistula
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Repair of high imperforate anus without fistula; perineal or sacroperineal approach
Service Code
46730 (CPT) Repair of high imperforate anus without fistula; perineal or sacroperineal approach
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Repair of high imperforate anus without fistula; combined transabdominal and sacroperineal approaches
Service Code
46735 (CPT) Repair of high imperforate anus without fistula; combined transabdominal and sacroperineal approaches
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Repair of high imperforate anus with rectourethral or rectovaginal fistula; perineal or sacroperineal approach
Service Code
46740 (CPT) Repair of high imperforate anus with rectourethral or rectovaginal fistula; perineal or sacroperineal approach
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Repair of high imperforate anus with rectourethral or rectovaginal fistula; combined transabdominal and sacroperineal approaches
Service Code
46742 (CPT) Repair of high imperforate anus with rectourethral or rectovaginal fistula; combined transabdominal and sacroperineal approaches
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Repair of cloacal anomaly by anorectovaginoplasty and urethroplasty, sacroperineal approach
Service Code
46744 (CPT) Repair of cloacal anomaly by anorectovaginoplasty and urethroplasty, sacroperineal approach
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Repair of cloacal anomaly by anorectovaginoplasty and urethroplasty, combined abdominal and sacroperineal approach;
Service Code
46746 (CPT) Repair of cloacal anomaly by anorectovaginoplasty and urethroplasty, combined abdominal and sacroperineal approach;
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Repair of cloacal anomaly by anorectovaginoplasty and urethroplasty, combined abdominal and sacroperineal approach; with vaginal lengthening by intestinal graft or pedicle flaps
Service Code
46748 (CPT) Repair of cloacal anomaly by anorectovaginoplasty and urethroplasty, combined abdominal and sacroperineal approach; with vaginal lengthening by intestinal graft or pedicle flaps
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Sphincteroplasty, anal, for incontinence or prolapse; adult
Service Code
46750 (CPT) Sphincteroplasty, anal, for incontinence or prolapse; adult
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Sphincteroplasty, anal, for incontinence or prolapse; child
Service Code
46751 (CPT) Sphincteroplasty, anal, for incontinence or prolapse; child
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Graft (Thiersch operation) for rectal incontinence and/or prolapse
Service Code
46753 (CPT) Graft (Thiersch operation) for rectal incontinence and/or prolapse
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Removal of Thiersch wire or suture, anal canal
Service Code
46754 (CPT) Removal of Thiersch wire or suture, anal canal
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Sphincteroplasty, anal, for incontinence, adult; muscle transplant
Service Code
46760 (CPT) Sphincteroplasty, anal, for incontinence, adult; muscle transplant
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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