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
Cystotomy, with insertion of ureteral catheter or stent (separate procedure)
Service Code
51045 (CPT) Cystotomy, with insertion of ureteral catheter or stent (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cystolithotomy, cystotomy with removal of calculus, without vesical neck resection
Service Code
51050 (CPT) Cystolithotomy, cystotomy with removal of calculus, without vesical neck resection
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Transvesical ureterolithotomy
Service Code
51060 (CPT) Transvesical ureterolithotomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cystotomy, with calculus basket extraction and/or ultrasonic or electrohydraulic fragmentation of ureteral calculus
Service Code
51065 (CPT) Cystotomy, with calculus basket extraction and/or ultrasonic or electrohydraulic fragmentation of ureteral calculus
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Drainage of perivesical or prevesical space abscess
Service Code
51080 (CPT) Drainage of perivesical or prevesical space abscess
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Aspiration of bladder; by needle
Service Code
51100 (CPT) Aspiration of bladder; by needle
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Aspiration of bladder; by trocar or intracatheter
Service Code
51101 (CPT) Aspiration of bladder; by trocar or intracatheter
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Aspiration of bladder; with insertion of suprapubic catheter
Service Code
51102 (CPT) Aspiration of bladder; with insertion of suprapubic catheter
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of urachal cyst or sinus, with or without umbilical hernia repair
Service Code
51500 (CPT) Excision of urachal cyst or sinus, with or without umbilical hernia repair
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cystotomy; for simple excision of vesical neck (separate procedure)
Service Code
51520 (CPT) Cystotomy; for simple excision of vesical neck (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cystotomy; for excision of bladder diverticulum, single or multiple (separate procedure)
Service Code
51525 (CPT) Cystotomy; for excision of bladder diverticulum, single or multiple (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cystotomy; for excision of bladder tumor
Service Code
51530 (CPT) Cystotomy; for excision of bladder tumor
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cystotomy for excision, incision, or repair of ureterocele
Service Code
51535 (CPT) Cystotomy for excision, incision, or repair of ureterocele
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cystectomy, partial; simple
Service Code
51550 (CPT) Cystectomy, partial; simple
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cystectomy, partial; complicated (eg, postradiation, previous surgery, difficult location)
Service Code
51555 (CPT) Cystectomy, partial; complicated (eg, postradiation, previous surgery, difficult location)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cystectomy, partial, with reimplantation of ureter(s) into bladder (ureteroneocystostomy)
Service Code
51565 (CPT) Cystectomy, partial, with reimplantation of ureter(s) into bladder (ureteroneocystostomy)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cystectomy, complete; (separate procedure)
Service Code
51570 (CPT) Cystectomy, complete; (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cystectomy, complete; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes
Service Code
51575 (CPT) Cystectomy, complete; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous transplantations;
Service Code
51580 (CPT) Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous transplantations;
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous transplantations; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes
Service Code
51585 (CPT) Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous transplantations; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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