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
12437 Results
Transection or avulsion of; infraorbital nerve
Service Code
64734 (CPT) Transection or avulsion of; infraorbital nerve
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Transection or avulsion of; mental nerve
Service Code
64736 (CPT) Transection or avulsion of; mental nerve
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Transection or avulsion of; inferior alveolar nerve by osteotomy
Service Code
64738 (CPT) Transection or avulsion of; inferior alveolar nerve by osteotomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Transection or avulsion of; lingual nerve
Service Code
64740 (CPT) Transection or avulsion of; lingual nerve
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Transection or avulsion of; facial nerve, differential or complete
Service Code
64742 (CPT) Transection or avulsion of; facial nerve, differential or complete
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Transection or avulsion of; greater occipital nerve
Service Code
64744 (CPT) Transection or avulsion of; greater occipital nerve
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Transection or avulsion of; phrenic nerve
Service Code
64746 (CPT) Transection or avulsion of; phrenic nerve
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Transection or avulsion of; vagus nerves limited to proximal stomach (selective proximal vagotomy, proximal gastric vagotomy, parietal cell vagotomy, supra- or highly selective vagotomy)
Service Code
64755 (CPT) Transection or avulsion of; vagus nerves limited to proximal stomach (selective proximal vagotomy, proximal gastric vagotomy, parietal cell vagotomy, supra- or highly selective vagotomy)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Transection or avulsion of; vagus nerve (vagotomy), abdominal
Service Code
64760 (CPT) Transection or avulsion of; vagus nerve (vagotomy), abdominal
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Transection or avulsion of obturator nerve, extrapelvic, with or without adductor tenotomy
Service Code
64763 (CPT) Transection or avulsion of obturator nerve, extrapelvic, with or without adductor tenotomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Transection or avulsion of obturator nerve, intrapelvic, with or without adductor tenotomy
Service Code
64766 (CPT) Transection or avulsion of obturator nerve, intrapelvic, with or without adductor tenotomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Transection or avulsion of other cranial nerve, extradural
Service Code
64771 (CPT) Transection or avulsion of other cranial nerve, extradural
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Transection or avulsion of other spinal nerve, extradural
Service Code
64772 (CPT) Transection or avulsion of other spinal nerve, extradural
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of neuroma; cutaneous nerve, surgically identifiable
Service Code
64774 (CPT) Excision of neuroma; cutaneous nerve, surgically identifiable
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of neuroma; digital nerve, 1 or both, same digit
Service Code
64776 (CPT) Excision of neuroma; digital nerve, 1 or both, same digit
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of neuroma; digital nerve, each additional digit (List separately in addition to code for primary procedure)
Service Code
64778 (CPT) Excision of neuroma; digital nerve, each additional digit (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
Excision of neuroma; hand or foot, except digital nerve
Service Code
64782 (CPT) Excision of neuroma; hand or foot, except digital nerve
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of neuroma; hand or foot, each additional nerve, except same digit (List separately in addition to code for primary procedure)
Service Code
64783 (CPT) Excision of neuroma; hand or foot, each additional nerve, except same digit (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
Excision of neuroma; major peripheral nerve, except sciatic
Service Code
64784 (CPT) Excision of neuroma; major peripheral nerve, except sciatic
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of neuroma; sciatic nerve
Service Code
64786 (CPT) Excision of neuroma; sciatic nerve
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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