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
Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; adrenalectomy
Service Code
00866 (CPT) Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; adrenalectomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; renal transplant (recipient)
Service Code
00868 (CPT) Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; renal transplant (recipient)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; cystolithotomy
Service Code
00870 (CPT) Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; cystolithotomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
CELL/GENE THERAPY GENERAL
Service Code
0870 (Revenue) CELL/GENE THERAPY GENERAL
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Harvesting blood-derived T cell
Service Code
0871 (Revenue) Harvesting blood-derived T cell
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for lithotripsy, extracorporeal shock wave; with water bath
Service Code
00872 (CPT) Anesthesia for lithotripsy, extracorporeal shock wave; with water bath
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for lithotripsy, extracorporeal shock wave; without water bath
Service Code
00873 (CPT) Anesthesia for lithotripsy, extracorporeal shock wave; without water bath
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cell administration infusion
Service Code
0874 (Revenue) Cell administration infusion
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for procedures on major lower abdominal vessels; not otherwise specified
Service Code
00880 (CPT) Anesthesia for procedures on major lower abdominal vessels; not otherwise specified
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
0881 Ultrafiltration
Service Code
0881 (Revenue) 0881 Ultrafiltration
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for procedures on major lower abdominal vessels; inferior vena cava ligation
Service Code
00882 (CPT) Anesthesia for procedures on major lower abdominal vessels; inferior vena cava ligation
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
0882 Home dialysis aid visit
Service Code
0882 (Revenue) 0882 Home dialysis aid visit
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
0900 General - Psych Treatment
Service Code
0900 (Revenue) 0900 General - Psych Treatment
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
0901 Electroshock Treatment
Service Code
0901 (Revenue) 0901 Electroshock Treatment
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for; anorectal procedure
Service Code
00902 (CPT) Anesthesia for; anorectal procedure
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
0903 Play therapy
Service Code
0903 (Revenue) 0903 Play therapy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for; radical perineal procedure
Service Code
00904 (CPT) Anesthesia for; radical perineal procedure
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
0905 Intensive Outpatient Services Psychiatric
Service Code
0905 (Revenue) 0905 Intensive Outpatient Services Psychiatric
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for; vulvectomy
Service Code
00906 (CPT) Anesthesia for; vulvectomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
0907 Community behavioral health program (day treatment)
Service Code
0907 (Revenue) 0907 Community behavioral health program (day treatment)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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