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
Ureterolysis for retrocaval ureter, with reanastomosis of upper urinary tract or vena cava
Service Code
50725 (CPT) Ureterolysis for retrocaval ureter, with reanastomosis of upper urinary tract or vena cava
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Revision of urinary-cutaneous anastomosis (any type urostomy);
Service Code
50727 (CPT) Revision of urinary-cutaneous anastomosis (any type urostomy);
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Revision of urinary-cutaneous anastomosis (any type urostomy); with repair of fascial defect and hernia
Service Code
50728 (CPT) Revision of urinary-cutaneous anastomosis (any type urostomy); with repair of fascial defect and hernia
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Ureteropyelostomy, anastomosis of ureter and renal pelvis
Service Code
50740 (CPT) Ureteropyelostomy, anastomosis of ureter and renal pelvis
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Ureterocalycostomy, anastomosis of ureter to renal calyx
Service Code
50750 (CPT) Ureterocalycostomy, anastomosis of ureter to renal calyx
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Ureteroureterostomy
Service Code
50760 (CPT) Ureteroureterostomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Transureteroureterostomy, anastomosis of ureter to contralateral ureter
Service Code
50770 (CPT) Transureteroureterostomy, anastomosis of ureter to contralateral ureter
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Ureteroneocystostomy; anastomosis of single ureter to bladder
Service Code
50780 (CPT) Ureteroneocystostomy; anastomosis of single ureter to bladder
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Ureteroneocystostomy; anastomosis of duplicated ureter to bladder
Service Code
50782 (CPT) Ureteroneocystostomy; anastomosis of duplicated ureter to bladder
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Ureteroneocystostomy; with extensive ureteral tailoring
Service Code
50783 (CPT) Ureteroneocystostomy; with extensive ureteral tailoring
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Ureteroneocystostomy; with vesico-psoas hitch or bladder flap
Service Code
50785 (CPT) Ureteroneocystostomy; with vesico-psoas hitch or bladder flap
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Ureteroenterostomy, direct anastomosis of ureter to intestine
Service Code
50800 (CPT) Ureteroenterostomy, direct anastomosis of ureter to intestine
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Ureterosigmoidostomy, with creation of sigmoid bladder and establishment of abdominal or perineal colostomy, including intestine anastomosis
Service Code
50810 (CPT) Ureterosigmoidostomy, with creation of sigmoid bladder and establishment of abdominal or perineal colostomy, including intestine anastomosis
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Ureterocolon conduit, including intestine anastomosis
Service Code
50815 (CPT) Ureterocolon conduit, including intestine anastomosis
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Ureteroileal conduit (ileal bladder), including intestine anastomosis (Bricker operation)
Service Code
50820 (CPT) Ureteroileal conduit (ileal bladder), including intestine anastomosis (Bricker operation)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Continent diversion, including intestine anastomosis using any segment of small and/or large intestine (Kock pouch or Camey enterocystoplasty)
Service Code
50825 (CPT) Continent diversion, including intestine anastomosis using any segment of small and/or large intestine (Kock pouch or Camey enterocystoplasty)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Urinary undiversion (eg, taking down of ureteroileal conduit, ureterosigmoidostomy or ureteroenterostomy with ureteroureterostomy or ureteroneocystostomy)
Service Code
50830 (CPT) Urinary undiversion (eg, taking down of ureteroileal conduit, ureterosigmoidostomy or ureteroenterostomy with ureteroureterostomy or ureteroneocystostomy)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Replacement of all or part of ureter by intestine segment, including intestine anastomosis
Service Code
50840 (CPT) Replacement of all or part of ureter by intestine segment, including intestine anastomosis
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cutaneous appendico-vesicostomy
Service Code
50845 (CPT) Cutaneous appendico-vesicostomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Ureterostomy, transplantation of ureter to skin
Service Code
50860 (CPT) Ureterostomy, transplantation of ureter to skin
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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