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
Burr hole(s) or trephine; with drainage of brain abscess or cyst
Service Code
61150 (CPT) Burr hole(s) or trephine; with drainage of brain abscess or cyst
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 subsequent tapping (aspiration) of intracranial abscess or cyst
Service Code
61151 (CPT) Burr hole(s) or trephine; with subsequent tapping (aspiration) of intracranial abscess or cyst
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Burr hole(s) with evacuation and/or drainage of hematoma, extradural or subdural
Service Code
61154 (CPT) Burr hole(s) with evacuation and/or drainage of hematoma, extradural or subdural
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Burr hole(s); with aspiration of hematoma or cyst, intracerebral
Service Code
61156 (CPT) Burr hole(s); with aspiration of hematoma or cyst, intracerebral
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Burr hole(s); for implanting ventricular catheter, reservoir, EEG electrode(s), pressure recording device, or other cerebral monitoring device (separate procedure)
Service Code
61210 (CPT) Burr hole(s); for implanting ventricular catheter, reservoir, EEG electrode(s), pressure recording device, or other cerebral monitoring device (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Insertion of subcutaneous reservoir, pump or continuous infusion system for connection to ventricular catheter
Service Code
61215 (CPT) Insertion of subcutaneous reservoir, pump or continuous infusion system for connection to ventricular catheter
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, supratentorial, exploratory, not followed by other surgery
Service Code
61250 (CPT) Burr hole(s) or trephine, supratentorial, exploratory, not followed by other surgery
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, infratentorial, unilateral or bilateral
Service Code
61253 (CPT) Burr hole(s) or trephine, infratentorial, unilateral or bilateral
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Craniectomy or craniotomy, exploratory; supratentorial
Service Code
61304 (CPT) Craniectomy or craniotomy, exploratory; supratentorial
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Craniectomy or craniotomy, exploratory; infratentorial (posterior fossa)
Service Code
61305 (CPT) Craniectomy or craniotomy, exploratory; infratentorial (posterior fossa)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural
Service Code
61312 (CPT) Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Craniectomy or craniotomy for evacuation of hematoma, supratentorial; intracerebral
Service Code
61313 (CPT) Craniectomy or craniotomy for evacuation of hematoma, supratentorial; intracerebral
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Craniectomy or craniotomy for evacuation of hematoma, infratentorial; extradural or subdural
Service Code
61314 (CPT) Craniectomy or craniotomy for evacuation of hematoma, infratentorial; extradural or subdural
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Craniectomy or craniotomy for evacuation of hematoma, infratentorial; intracerebellar
Service Code
61315 (CPT) Craniectomy or craniotomy for evacuation of hematoma, infratentorial; intracerebellar
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Incision and subcutaneous placement of cranial bone graft (List separately in addition to code for primary procedure)
Service Code
61316 (CPT) Incision and subcutaneous placement of cranial bone graft (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
Craniectomy or craniotomy, drainage of intracranial abscess; supratentorial
Service Code
61320 (CPT) Craniectomy or craniotomy, drainage of intracranial abscess; supratentorial
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Craniectomy or craniotomy, drainage of intracranial abscess; infratentorial
Service Code
61321 (CPT) Craniectomy or craniotomy, drainage of intracranial abscess; infratentorial
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma; without lobectomy
Service Code
61322 (CPT) Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma; without lobectomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma; with lobectomy
Service Code
61323 (CPT) Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma; with lobectomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Decompression of orbit only, transcranial approach
Service Code
61330 (CPT) Decompression of orbit only, transcranial approach
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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