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 procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; gastrocnemius recession (eg, Strayer procedure)
Service Code
01474 (CPT) Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; gastrocnemius recession (eg, Strayer procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for open procedures on bones of lower leg, ankle, and foot; not otherwise specified
Service Code
01480 (CPT) Anesthesia for open procedures on bones 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 open procedures on bones of lower leg, ankle, and foot; radical resection (including below knee amputation)
Service Code
01482 (CPT) Anesthesia for open procedures on bones of lower leg, ankle, and foot; radical resection (including below knee 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 on bones of lower leg, ankle, and foot; osteotomy or osteoplasty of tibia and/or fibula
Service Code
01484 (CPT) Anesthesia for open procedures on bones of lower leg, ankle, and foot; osteotomy or osteoplasty of tibia and/or fibula
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for open procedures on bones of lower leg, ankle, and foot; total ankle replacement
Service Code
01486 (CPT) Anesthesia for open procedures on bones of lower leg, ankle, and foot; total ankle replacement
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for lower leg cast application, removal, or repair
Service Code
01490 (CPT) Anesthesia for lower leg cast application, removal, or repair
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 lower leg, including bypass graft; not otherwise specified
Service Code
01500 (CPT) Anesthesia for procedures on arteries of lower 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 on arteries of lower leg, including bypass graft; embolectomy, direct or with catheter
Service Code
01502 (CPT) Anesthesia for procedures on arteries of lower leg, including bypass graft; embolectomy, direct or with catheter
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 lower leg; not otherwise specified
Service Code
01520 (CPT) Anesthesia for procedures on veins of lower leg; 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 lower leg; venous thrombectomy, direct or with catheter
Service Code
01522 (CPT) Anesthesia for procedures on veins of lower leg; venous thrombectomy, direct or with catheter
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 shoulder and axilla
Service Code
01610 (CPT) Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of shoulder and axilla
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 humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint
Service Code
01620 (CPT) Anesthesia for all closed procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder 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 shoulder joint
Service Code
01622 (CPT) Anesthesia for diagnostic arthroscopic procedures of shoulder joint
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 humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; not otherwise specified
Service Code
01630 (CPT) Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder 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 humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; shoulder disarticulation
Service Code
01634 (CPT) Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; shoulder disarticulation
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 humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; interthoracoscapular (forequarter) amputation
Service Code
01636 (CPT) Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; interthoracoscapular (forequarter) amputation
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 humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; total shoulder replacement
Service Code
01638 (CPT) Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; total shoulder replacement
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 shoulder and axilla; not otherwise specified
Service Code
01650 (CPT) Anesthesia for procedures on arteries of shoulder and axilla; 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 shoulder and axilla; axillary-brachial aneurysm
Service Code
01652 (CPT) Anesthesia for procedures on arteries of shoulder and axilla; axillary-brachial aneurysm
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 shoulder and axilla; bypass graft
Service Code
01654 (CPT) Anesthesia for procedures on arteries of shoulder and axilla; bypass 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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