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
Anesthesia for body cast application or revision
Service Code
01130 (CPT) Anesthesia for body cast application or revision
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for interpelviabdominal (hindquarter) amputation
Service Code
01140 (CPT) Anesthesia for interpelviabdominal (hindquarter) amputation
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for radical procedures for tumor of pelvis, except hindquarter amputation
Service Code
01150 (CPT) Anesthesia for radical procedures for tumor of pelvis, except hindquarter amputation
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for closed procedures involving symphysis pubis or sacroiliac joint
Service Code
01160 (CPT) Anesthesia for closed procedures involving symphysis pubis or sacroiliac joint
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for open procedures involving symphysis pubis or sacroiliac joint
Service Code
01170 (CPT) Anesthesia for open procedures involving symphysis pubis or sacroiliac joint
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for open repair of fracture disruption of pelvis or column fracture involving acetabulum
Service Code
01173 (CPT) Anesthesia for open repair of fracture disruption of pelvis or column fracture involving acetabulum
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for all closed procedures involving hip joint
Service Code
01200 (CPT) Anesthesia for all closed procedures involving hip joint
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for arthroscopic procedures of hip joint
Service Code
01202 (CPT) Anesthesia for arthroscopic procedures of hip joint
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for open procedures involving hip joint; not otherwise specified
Service Code
01210 (CPT) Anesthesia for open procedures involving hip joint; not otherwise specified
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for open procedures involving hip joint; hip disarticulation
Service Code
01212 (CPT) Anesthesia for open procedures involving hip joint; hip disarticulation
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for open procedures involving hip joint; total hip arthroplasty
Service Code
01214 (CPT) Anesthesia for open procedures involving hip joint; total hip arthroplasty
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for open procedures involving hip joint; revision of total hip arthroplasty
Service Code
01215 (CPT) Anesthesia for open procedures involving hip joint; revision of total hip arthroplasty
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for all closed procedures involving upper two-thirds of femur
Service Code
01220 (CPT) Anesthesia for all closed procedures involving upper two-thirds of femur
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for open procedures involving upper two-thirds of femur; not otherwise specified
Service Code
01230 (CPT) Anesthesia for open procedures involving upper two-thirds of femur; not otherwise specified
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for open procedures involving upper two-thirds of femur; amputation
Service Code
01232 (CPT) Anesthesia for open procedures involving upper two-thirds of femur; amputation
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for open procedures involving upper two-thirds of femur; radical resection
Service Code
01234 (CPT) Anesthesia for open procedures involving upper two-thirds of femur; radical resection
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of upper leg
Service Code
01250 (CPT) Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of upper leg
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for procedures involving arteries of upper leg, including bypass graft; not otherwise specified
Service Code
01270 (CPT) Anesthesia for procedures involving arteries of upper leg, including bypass graft; not otherwise specified
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for procedures involving arteries of upper leg, including bypass graft; femoral artery ligation
Service Code
01272 (CPT) Anesthesia for procedures involving arteries of upper leg, including bypass graft; femoral artery ligation
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for procedures involving arteries of upper leg, including bypass graft; femoral artery embolectomy
Service Code
01274 (CPT) Anesthesia for procedures involving arteries of upper leg, including bypass graft; femoral artery embolectomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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