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
Computer-aided mapping of cervix uteri during colposcopy, including optical dynamic spectral imaging and algorithmic quantification of the acetowhitening effect (List separately in addition to code for primary procedure)
Service Code
57465 (CPT) Computer-aided mapping of cervix uteri during colposcopy, including optical dynamic spectral imaging and algorithmic quantification of the acetowhitening effect (List separately in addition to code for primary procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Biopsy of cervix, single or multiple, or local excision of lesion, with or without fulguration (separate procedure)
Service Code
57500 (CPT) Biopsy of cervix, single or multiple, or local excision of lesion, with or without fulguration (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Endocervical curettage (not done as part of a dilation and curettage)
Service Code
57505 (CPT) Endocervical curettage (not done as part of a dilation and curettage)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cautery of cervix; electro or thermal
Service Code
57510 (CPT) Cautery of cervix; electro or thermal
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cautery of cervix; cryocautery, initial or repeat
Service Code
57511 (CPT) Cautery of cervix; cryocautery, initial or repeat
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cautery of cervix; laser ablation
Service Code
57513 (CPT) Cautery of cervix; laser ablation
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser
Service Code
57520 (CPT) Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; loop electrode excision
Service Code
57522 (CPT) Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; loop electrode excision
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Trachelectomy (cervicectomy), amputation of cervix (separate procedure)
Service Code
57530 (CPT) Trachelectomy (cervicectomy), amputation of cervix (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Radical trachelectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling biopsy, with or without removal of tube(s), with or without removal of ovary(s)
Service Code
57531 (CPT) Radical trachelectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling biopsy, with or without removal of tube(s), with or without removal of ovary(s)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of cervical stump, abdominal approach;
Service Code
57540 (CPT) Excision of cervical stump, abdominal approach;
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of cervical stump, abdominal approach; with pelvic floor repair
Service Code
57545 (CPT) Excision of cervical stump, abdominal approach; with pelvic floor repair
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of cervical stump, vaginal approach;
Service Code
57550 (CPT) Excision of cervical stump, vaginal approach;
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of cervical stump, vaginal approach; with anterior and/or posterior repair
Service Code
57555 (CPT) Excision of cervical stump, vaginal approach; with anterior and/or posterior repair
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of cervical stump, vaginal approach; with repair of enterocele
Service Code
57556 (CPT) Excision of cervical stump, vaginal approach; with repair of enterocele
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Dilation and curettage of cervical stump
Service Code
57558 (CPT) Dilation and curettage of cervical stump
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cerclage of uterine cervix, nonobstetrical
Service Code
57700 (CPT) Cerclage of uterine cervix, nonobstetrical
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Trachelorrhaphy, plastic repair of uterine cervix, vaginal approach
Service Code
57720 (CPT) Trachelorrhaphy, plastic repair of uterine cervix, vaginal approach
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Dilation of cervical canal, instrumental (separate procedure)
Service Code
57800 (CPT) Dilation of cervical canal, instrumental (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure)
Service Code
58100 (CPT) Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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