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Member and Recipient Service Line: 1-877-685-2415

Provider Support Service Line: 1-855-250-1539

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12465 Results

Internal anastomosis of pancreatic cyst to gastrointestinal tract; direct

Service Code
48520 (CPT) Internal anastomosis of pancreatic cyst to gastrointestinal tract; direct
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

See the Carolina Complete Health site for specific requirements

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health

Internal anastomosis of pancreatic cyst to gastrointestinal tract; Roux-en-Y

Service Code
48540 (CPT) Internal anastomosis of pancreatic cyst to gastrointestinal tract; Roux-en-Y
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

See the Carolina Complete Health site for specific requirements

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health

Pancreatorrhaphy for injury

Service Code
48545 (CPT) Pancreatorrhaphy for injury
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

See the Carolina Complete Health site for specific requirements

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health

Duodenal exclusion with gastrojejunostomy for pancreatic injury

Service Code
48547 (CPT) Duodenal exclusion with gastrojejunostomy for pancreatic injury
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

See the Carolina Complete Health site for specific requirements

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health

Pancreaticojejunostomy, side-to-side anastomosis (Puestow-type operation)

Service Code
48548 (CPT) Pancreaticojejunostomy, side-to-side anastomosis (Puestow-type operation)
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

See the Carolina Complete Health site for specific requirements

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health

Donor pancreatectomy (including cold preservation), with or without duodenal segment for transplantation

Service Code
48550 (CPT) Donor pancreatectomy (including cold preservation), with or without duodenal segment for transplantation
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

See the Carolina Complete Health site for specific requirements

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health

Backbench standard preparation of cadaver donor pancreas allograft prior to transplantation, including dissection of allograft from surrounding soft tissues, splenectomy, duodenotomy, ligation of bile duct, ligation of mesenteric vessels, and Y-graft arte

Service Code
48551 (CPT) Backbench standard preparation of cadaver donor pancreas allograft prior to transplantation, including dissection of allograft from surrounding soft tissues, splenectomy, duodenotomy, ligation of bile duct, ligation of mesenteric vessels, and Y-graft arte
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

See the Carolina Complete Health site for specific requirements

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health

Backbench reconstruction of cadaver donor pancreas allograft prior to transplantation, venous anastomosis, each

Service Code
48552 (CPT) Backbench reconstruction of cadaver donor pancreas allograft prior to transplantation, venous anastomosis, each
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

See the Carolina Complete Health site for specific requirements

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health

Transplantation of pancreatic allograft

Service Code
48554 (CPT) Transplantation of pancreatic allograft
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

See the Carolina Complete Health site for specific requirements

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health

Removal of transplanted pancreatic allograft

Service Code
48556 (CPT) Removal of transplanted pancreatic allograft
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

See the Carolina Complete Health site for specific requirements

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health

Unlisted procedure, pancreas

Service Code
48999 (CPT) Unlisted procedure, pancreas
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

Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure)

Service Code
49000 (CPT) Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Reopening of recent laparotomy

Service Code
49002 (CPT) Reopening of recent laparotomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Exploration, retroperitoneal area with or without biopsy(s) (separate procedure)

Service Code
49010 (CPT) Exploration, retroperitoneal area with or without biopsy(s) (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Preperitoneal pelvic packing for hemorrhage associated with pelvic trauma, including local exploration

Service Code
49013 (CPT) Preperitoneal pelvic packing for hemorrhage associated with pelvic trauma, including local exploration
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Re-exploration of pelvic wound with removal of preperitoneal pelvic packing, including repacking, when performed

Service Code
49014 (CPT) Re-exploration of pelvic wound with removal of preperitoneal pelvic packing, including repacking, when performed
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess, open

Service Code
49020 (CPT) Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess, open
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Drainage of subdiaphragmatic or subphrenic abscess, open

Service Code
49040 (CPT) Drainage of subdiaphragmatic or subphrenic abscess, open
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Drainage of retroperitoneal abscess, open

Service Code
49060 (CPT) Drainage of retroperitoneal abscess, open
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Drainage of extraperitoneal lymphocele to peritoneal cavity, open

Service Code
49062 (CPT) Drainage of extraperitoneal lymphocele to peritoneal cavity, open
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required