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
Reduction of craniomegalic skull (eg, treated hydrocephalus); not requiring bone grafts or cranioplasty
Service Code
62115 (CPT) Reduction of craniomegalic skull (eg, treated hydrocephalus); not requiring bone grafts or cranioplasty
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Reduction of craniomegalic skull (eg, treated hydrocephalus); requiring craniotomy and reconstruction with or without bone graft (includes obtaining grafts)
Service Code
62117 (CPT) Reduction of craniomegalic skull (eg, treated hydrocephalus); requiring craniotomy and reconstruction with or without bone graft (includes obtaining grafts)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Repair of encephalocele, skull vault, including cranioplasty
Service Code
62120 (CPT) Repair of encephalocele, skull vault, including cranioplasty
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Craniotomy for repair of encephalocele, skull base
Service Code
62121 (CPT) Craniotomy for repair of encephalocele, skull base
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cranioplasty for skull defect; up to 5 cm diameter
Service Code
62140 (CPT) Cranioplasty for skull defect; up to 5 cm diameter
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cranioplasty for skull defect; larger than 5 cm diameter
Service Code
62141 (CPT) Cranioplasty for skull defect; larger than 5 cm diameter
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Removal of bone flap or prosthetic plate of skull
Service Code
62142 (CPT) Removal of bone flap or prosthetic plate of skull
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Replacement of bone flap or prosthetic plate of skull
Service Code
62143 (CPT) Replacement of bone flap or prosthetic plate of skull
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cranioplasty for skull defect with reparative brain surgery
Service Code
62145 (CPT) Cranioplasty for skull defect with reparative brain surgery
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cranioplasty with autograft (includes obtaining bone grafts); up to 5 cm diameter
Service Code
62146 (CPT) Cranioplasty with autograft (includes obtaining bone grafts); up to 5 cm diameter
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cranioplasty with autograft (includes obtaining bone grafts); larger than 5 cm diameter
Service Code
62147 (CPT) Cranioplasty with autograft (includes obtaining bone grafts); larger than 5 cm diameter
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Incision and retrieval of subcutaneous cranial bone graft for cranioplasty (List separately in addition to code for primary procedure)
Service Code
62148 (CPT) Incision and retrieval of subcutaneous cranial bone graft for cranioplasty (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
Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)
Service Code
62160 (CPT) Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (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
Neuroendoscopy, intracranial; with dissection of adhesions, fenestration of septum pellucidum or intraventricular cysts (including placement, replacement, or removal of ventricular catheter)
Service Code
62161 (CPT) Neuroendoscopy, intracranial; with dissection of adhesions, fenestration of septum pellucidum or intraventricular cysts (including placement, replacement, or removal of ventricular catheter)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Neuroendoscopy, intracranial; with fenestration or excision of colloid cyst, including placement of external ventricular catheter for drainage
Service Code
62162 (CPT) Neuroendoscopy, intracranial; with fenestration or excision of colloid cyst, including placement of external ventricular catheter for drainage
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Neuroendoscopy, intracranial; with excision of brain tumor, including placement of external ventricular catheter for drainage
Service Code
62164 (CPT) Neuroendoscopy, intracranial; with excision of brain tumor, including placement of external ventricular catheter for drainage
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Neuroendoscopy, intracranial; with excision of pituitary tumor, transnasal or trans-sphenoidal approach
Service Code
62165 (CPT) Neuroendoscopy, intracranial; with excision of pituitary tumor, transnasal or trans-sphenoidal approach
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Ventriculocisternostomy (Torkildsen type operation)
Service Code
62180 (CPT) Ventriculocisternostomy (Torkildsen type operation)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Creation of shunt; subarachnoid/subdural-atrial, -jugular, -auricular
Service Code
62190 (CPT) Creation of shunt; subarachnoid/subdural-atrial, -jugular, -auricular
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Creation of shunt; subarachnoid/subdural-peritoneal, -pleural, other terminus
Service Code
62192 (CPT) Creation of shunt; subarachnoid/subdural-peritoneal, -pleural, other terminus
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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