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 all procedures on nerves, muscles, tendons, fascia, and bursae of knee and/or popliteal area
Service Code
01320 (CPT) Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of knee and/or popliteal area
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 on lower one-third of femur
Service Code
01340 (CPT) Anesthesia for all closed procedures on lower one-third of femur
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for all open procedures on lower one-third of femur
Service Code
01360 (CPT) Anesthesia for all open procedures on lower one-third of femur
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 on knee joint
Service Code
01380 (CPT) Anesthesia for all closed procedures on knee joint
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for diagnostic arthroscopic procedures of knee joint
Service Code
01382 (CPT) Anesthesia for diagnostic arthroscopic procedures of knee joint
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 on upper ends of tibia, fibula, and/or patella
Service Code
01390 (CPT) Anesthesia for all closed procedures on upper ends of tibia, fibula, and/or patella
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for all open procedures on upper ends of tibia, fibula, and/or patella
Service Code
01392 (CPT) Anesthesia for all open procedures on upper ends of tibia, fibula, and/or patella
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for open or surgical arthroscopic procedures on knee joint; not otherwise specified
Service Code
01400 (CPT) Anesthesia for open or surgical arthroscopic procedures on knee 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 or surgical arthroscopic procedures on knee joint; total knee arthroplasty
Service Code
01402 (CPT) Anesthesia for open or surgical arthroscopic procedures on knee joint; total knee arthroplasty
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for open or surgical arthroscopic procedures on knee joint; disarticulation at knee
Service Code
01404 (CPT) Anesthesia for open or surgical arthroscopic procedures on knee joint; disarticulation at knee
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for all cast applications, removal, or repair involving knee joint
Service Code
01420 (CPT) Anesthesia for all cast applications, removal, or repair involving knee joint
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for procedures on veins of knee and popliteal area; not otherwise specified
Service Code
01430 (CPT) Anesthesia for procedures on veins of knee and popliteal area; 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 on veins of knee and popliteal area; arteriovenous fistula
Service Code
01432 (CPT) Anesthesia for procedures on veins of knee and popliteal area; arteriovenous fistula
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for procedures on arteries of knee and popliteal area; not otherwise specified
Service Code
01440 (CPT) Anesthesia for procedures on arteries of knee and popliteal area; 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 on arteries of knee and popliteal area; popliteal thromboendarterectomy, with or without patch graft
Service Code
01442 (CPT) Anesthesia for procedures on arteries of knee and popliteal area; popliteal thromboendarterectomy, with or without patch graft
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for procedures on arteries of knee and popliteal area; popliteal excision and graft or repair for occlusion or aneurysm
Service Code
01444 (CPT) Anesthesia for procedures on arteries of knee and popliteal area; popliteal excision and graft or repair for occlusion or aneurysm
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 on lower leg, ankle, and foot
Service Code
01462 (CPT) Anesthesia for all closed procedures on lower leg, ankle, and foot
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 ankle and/or foot
Service Code
01464 (CPT) Anesthesia for arthroscopic procedures of ankle and/or foot
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; not otherwise specified
Service Code
01470 (CPT) Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; 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 on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; repair of ruptured Achilles tendon, with or without graft
Service Code
01472 (CPT) Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; repair of ruptured Achilles tendon, with or without graft
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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