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
Cholecystectomy with exploration of common duct;
Service Code
47610 (CPT) Cholecystectomy with exploration of common duct;
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cholecystectomy with exploration of common duct; with choledochoenterostomy
Service Code
47612 (CPT) Cholecystectomy with exploration of common duct; with choledochoenterostomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cholecystectomy with exploration of common duct; with transduodenal sphincterotomy or sphincteroplasty, with or without cholangiography
Service Code
47620 (CPT) Cholecystectomy with exploration of common duct; with transduodenal sphincterotomy or sphincteroplasty, with or without cholangiography
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Exploration for congenital atresia of bile ducts, without repair, with or without liver biopsy, with or without cholangiography
Service Code
47700 (CPT) Exploration for congenital atresia of bile ducts, without repair, with or without liver biopsy, with or without cholangiography
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Portoenterostomy (eg, Kasai procedure)
Service Code
47701 (CPT) Portoenterostomy (eg, Kasai procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of bile duct tumor, with or without primary repair of bile duct; extrahepatic
Service Code
47711 (CPT) Excision of bile duct tumor, with or without primary repair of bile duct; extrahepatic
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of bile duct tumor, with or without primary repair of bile duct; intrahepatic
Service Code
47712 (CPT) Excision of bile duct tumor, with or without primary repair of bile duct; intrahepatic
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of choledochal cyst
Service Code
47715 (CPT) Excision of choledochal cyst
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cholecystoenterostomy; direct
Service Code
47720 (CPT) Cholecystoenterostomy; direct
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cholecystoenterostomy; with gastroenterostomy
Service Code
47721 (CPT) Cholecystoenterostomy; with gastroenterostomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cholecystoenterostomy; Roux-en-Y
Service Code
47740 (CPT) Cholecystoenterostomy; Roux-en-Y
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cholecystoenterostomy; Roux-en-Y with gastroenterostomy
Service Code
47741 (CPT) Cholecystoenterostomy; Roux-en-Y with gastroenterostomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anastomosis, of extrahepatic biliary ducts and gastrointestinal tract
Service Code
47760 (CPT) Anastomosis, of extrahepatic biliary ducts and gastrointestinal tract
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anastomosis, of intrahepatic ducts and gastrointestinal tract
Service Code
47765 (CPT) Anastomosis, of intrahepatic ducts and gastrointestinal tract
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anastomosis, Roux-en-Y, of extrahepatic biliary ducts and gastrointestinal tract
Service Code
47780 (CPT) Anastomosis, Roux-en-Y, of extrahepatic biliary ducts and gastrointestinal tract
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anastomosis, Roux-en-Y, of intrahepatic biliary ducts and gastrointestinal tract
Service Code
47785 (CPT) Anastomosis, Roux-en-Y, of intrahepatic biliary ducts and gastrointestinal tract
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Reconstruction, plastic, of extrahepatic biliary ducts with end-to-end anastomosis
Service Code
47800 (CPT) Reconstruction, plastic, of extrahepatic biliary ducts with end-to-end anastomosis
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Placement of choledochal stent
Service Code
47801 (CPT) Placement of choledochal stent
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Suture of extrahepatic biliary duct for pre-existing injury (separate procedure)
Service Code
47900 (CPT) Suture of extrahepatic biliary duct for pre-existing injury (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Unlisted procedure, biliary tract
Service Code
47999 (CPT) Unlisted procedure, biliary tract
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
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