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
Thymectomy, partial or total; sternal split or transthoracic approach, with radical mediastinal dissection (separate procedure)
Service Code
60522 (CPT) Thymectomy, partial or total; sternal split or transthoracic approach, with radical mediastinal dissection (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal (separate procedure);
Service Code
60540 (CPT) Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal (separate procedure);
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal (separate procedure); with excision of adjacent retroperitoneal tumor
Service Code
60545 (CPT) Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal (separate procedure); with excision of adjacent retroperitoneal tumor
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of carotid body tumor; without excision of carotid artery
Service Code
60600 (CPT) Excision of carotid body tumor; without excision of carotid artery
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of carotid body tumor; with excision of carotid artery
Service Code
60605 (CPT) Excision of carotid body tumor; with excision of carotid artery
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Laparoscopy, surgical, with adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal
Service Code
60650 (CPT) Laparoscopy, surgical, with adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Unlisted laparoscopy procedure, endocrine system
Service Code
60659 (CPT) Unlisted laparoscopy procedure, endocrine system
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.
How to Submit
Please submit your request to Trillium Health Resources
Unlisted procedure, endocrine system
Service Code
60699 (CPT) Unlisted procedure, endocrine system
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.
How to Submit
Please submit your request to Trillium Health Resources
Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; initial
Service Code
61000 (CPT) Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; initial
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; subsequent taps
Service Code
61001 (CPT) Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; subsequent taps
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; without injection
Service Code
61020 (CPT) Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; without injection
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; with injection of medication or other substance for diagnosis or treatment
Service Code
61026 (CPT) Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; with injection of medication or other substance for diagnosis or treatment
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cisternal or lateral cervical (C1-C2) puncture; without injection (separate procedure)
Service Code
61050 (CPT) Cisternal or lateral cervical (C1-C2) puncture; without injection (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cisternal or lateral cervical (C1-C2) puncture; with injection of medication or other substance for diagnosis or treatment
Service Code
61055 (CPT) Cisternal or lateral cervical (C1-C2) puncture; with injection of medication or other substance for diagnosis or treatment
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Puncture of shunt tubing or reservoir for aspiration or injection procedure
Service Code
61070 (CPT) Puncture of shunt tubing or reservoir for aspiration or injection procedure
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Twist drill hole for subdural or ventricular puncture
Service Code
61105 (CPT) Twist drill hole for subdural or ventricular puncture
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Twist drill hole(s) for subdural, intracerebral, or ventricular puncture; for implanting ventricular catheter, pressure recording device, or other intracerebral monitoring device
Service Code
61107 (CPT) Twist drill hole(s) for subdural, intracerebral, or ventricular puncture; for implanting ventricular catheter, pressure recording device, or other intracerebral monitoring device
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Twist drill hole(s) for subdural, intracerebral, or ventricular puncture; for evacuation and/or drainage of subdural hematoma
Service Code
61108 (CPT) Twist drill hole(s) for subdural, intracerebral, or ventricular puncture; for evacuation and/or drainage of subdural hematoma
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Burr hole(s) for ventricular puncture (including injection of gas, contrast media, dye, or radioactive material)
Service Code
61120 (CPT) Burr hole(s) for ventricular puncture (including injection of gas, contrast media, dye, or radioactive material)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Burr hole(s) or trephine; with biopsy of brain or intracranial lesion
Service Code
61140 (CPT) Burr hole(s) or trephine; with biopsy of brain or intracranial lesion
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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