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
Implantation of nerve end into bone or muscle (List separately in addition to neuroma excision)
Service Code
64787 (CPT) Implantation of nerve end into bone or muscle (List separately in addition to neuroma excision)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of neurofibroma or neurolemmoma; cutaneous nerve
Service Code
64788 (CPT) Excision of neurofibroma or neurolemmoma; cutaneous nerve
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of neurofibroma or neurolemmoma; major peripheral nerve
Service Code
64790 (CPT) Excision of neurofibroma or neurolemmoma; major peripheral nerve
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of neurofibroma or neurolemmoma; extensive (including malignant type)
Service Code
64792 (CPT) Excision of neurofibroma or neurolemmoma; extensive (including malignant type)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Biopsy of nerve
Service Code
64795 (CPT) Biopsy of nerve
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Sympathectomy, cervical
Service Code
64802 (CPT) Sympathectomy, cervical
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Sympathectomy, cervicothoracic
Service Code
64804 (CPT) Sympathectomy, cervicothoracic
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Sympathectomy, thoracolumbar
Service Code
64809 (CPT) Sympathectomy, thoracolumbar
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Sympathectomy, lumbar
Service Code
64818 (CPT) Sympathectomy, lumbar
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Sympathectomy; digital arteries, each digit
Service Code
64820 (CPT) Sympathectomy; digital arteries, each digit
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Sympathectomy; radial artery
Service Code
64821 (CPT) Sympathectomy; radial artery
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Sympathectomy; ulnar artery
Service Code
64822 (CPT) Sympathectomy; ulnar artery
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Sympathectomy; superficial palmar arch
Service Code
64823 (CPT) Sympathectomy; superficial palmar arch
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Suture of digital nerve, hand or foot; 1 nerve
Service Code
64831 (CPT) Suture of digital nerve, hand or foot; 1 nerve
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Suture of digital nerve, hand or foot; each additional digital nerve (List separately in addition to code for primary procedure)
Service Code
64832 (CPT) Suture of digital nerve, hand or foot; each additional digital nerve (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
Suture of 1 nerve; hand or foot, common sensory nerve
Service Code
64834 (CPT) Suture of 1 nerve; hand or foot, common sensory nerve
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Suture of 1 nerve; median motor thenar
Service Code
64835 (CPT) Suture of 1 nerve; median motor thenar
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Suture of 1 nerve; ulnar motor
Service Code
64836 (CPT) Suture of 1 nerve; ulnar motor
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Suture of each additional nerve, hand or foot (List separately in addition to code for primary procedure)
Service Code
64837 (CPT) Suture of each additional nerve, hand or foot (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
Suture of posterior tibial nerve
Service Code
64840 (CPT) Suture of posterior tibial nerve
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
See something that needs to be updated?
If you find any wrong or out of date information on our pages, we want to know. Please email info@TrilliumNC.org with any corrections.