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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

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12465 Results

Vulvectomy, radical, complete;

Service Code
56633 (CPT) Vulvectomy, radical, complete;
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Vulvectomy, radical, complete; with unilateral inguinofemoral lymphadenectomy

Service Code
56634 (CPT) Vulvectomy, radical, complete; with unilateral inguinofemoral lymphadenectomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Vulvectomy, radical, complete; with bilateral inguinofemoral lymphadenectomy

Service Code
56637 (CPT) Vulvectomy, radical, complete; with bilateral inguinofemoral lymphadenectomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Vulvectomy, radical, complete, with inguinofemoral, iliac, and pelvic lymphadenectomy

Service Code
56640 (CPT) Vulvectomy, radical, complete, with inguinofemoral, iliac, and pelvic lymphadenectomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Partial hymenectomy or revision of hymenal ring

Service Code
56700 (CPT) Partial hymenectomy or revision of hymenal ring
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Excision of Bartholin's gland or cyst

Service Code
56740 (CPT) Excision of Bartholin's gland or cyst
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Plastic repair of introitus

Service Code
56800 (CPT) Plastic repair of introitus
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.

Conditional Requirements

Pre-authorization required for all providers when billed with a Gender Reassignment Dx. For all others, auth is required for non-participating providers only.

How to Submit

If applicable, please submit your request to Trillium.

Clitoroplasty for intersex state

Service Code
56805 (CPT) Clitoroplasty for intersex state
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.

Conditional Requirements

Pre-authorization required for all providers when billed with a Gender Reassignment Dx. For all others, auth is required for non-participating providers only.

How to Submit

If applicable, please submit your request to Trillium.

Perineoplasty, repair of perineum, nonobstetrical (separate procedure)

Service Code
56810 (CPT) Perineoplasty, repair of perineum, nonobstetrical (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Colposcopy of the vulva;

Service Code
56820 (CPT) Colposcopy of the vulva;
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Colposcopy of the vulva; with biopsy(s)

Service Code
56821 (CPT) Colposcopy of the vulva; with biopsy(s)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Colpotomy; with exploration

Service Code
57000 (CPT) Colpotomy; with exploration
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Colpotomy; with drainage of pelvic abscess

Service Code
57010 (CPT) Colpotomy; with drainage of pelvic abscess
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Colpocentesis (separate procedure)

Service Code
57020 (CPT) Colpocentesis (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Incision and drainage of vaginal hematoma; obstetrical/postpartum

Service Code
57022 (CPT) Incision and drainage of vaginal hematoma; obstetrical/postpartum
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Incision and drainage of vaginal hematoma; non-obstetrical (eg, post-trauma, spontaneous bleeding)

Service Code
57023 (CPT) Incision and drainage of vaginal hematoma; non-obstetrical (eg, post-trauma, spontaneous bleeding)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Destruction of vaginal lesion(s); simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)

Service Code
57061 (CPT) Destruction of vaginal lesion(s); simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Destruction of vaginal lesion(s); extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)

Service Code
57065 (CPT) Destruction of vaginal lesion(s); extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Biopsy of vaginal mucosa; simple (separate procedure)

Service Code
57100 (CPT) Biopsy of vaginal mucosa; simple (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Biopsy of vaginal mucosa; extensive, requiring suture (including cysts)

Service Code
57105 (CPT) Biopsy of vaginal mucosa; extensive, requiring suture (including cysts)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required