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
Modification of ocular implant with placement or replacement of pegs (eg, drilling receptacle for prosthesis appendage) (separate procedure)
Service Code
65125 (CPT) Modification of ocular implant with placement or replacement of pegs (eg, drilling receptacle for prosthesis appendage) (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Insertion of ocular implant secondary; after evisceration, in scleral shell
Service Code
65130 (CPT) Insertion of ocular implant secondary; after evisceration, in scleral shell
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Insertion of ocular implant secondary; after enucleation, muscles not attached to implant
Service Code
65135 (CPT) Insertion of ocular implant secondary; after enucleation, muscles not attached to implant
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Insertion of ocular implant secondary; after enucleation, muscles attached to implant
Service Code
65140 (CPT) Insertion of ocular implant secondary; after enucleation, muscles attached to implant
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Reinsertion of ocular implant; with or without conjunctival graft
Service Code
65150 (CPT) Reinsertion of ocular implant; with or without conjunctival graft
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Reinsertion of ocular implant; with use of foreign material for reinforcement and/or attachment of muscles to implant
Service Code
65155 (CPT) Reinsertion of ocular implant; with use of foreign material for reinforcement and/or attachment of muscles to implant
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Removal of ocular implant
Service Code
65175 (CPT) Removal of ocular implant
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Removal of foreign body, external eye; conjunctival superficial
Service Code
65205 (CPT) Removal of foreign body, external eye; conjunctival superficial
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Removal of foreign body, external eye; conjunctival embedded (includes concretions), subconjunctival, or scleral nonperforating
Service Code
65210 (CPT) Removal of foreign body, external eye; conjunctival embedded (includes concretions), subconjunctival, or scleral nonperforating
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Removal of foreign body, external eye; corneal, without slit lamp
Service Code
65220 (CPT) Removal of foreign body, external eye; corneal, without slit lamp
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Removal of foreign body, external eye; corneal, with slit lamp
Service Code
65222 (CPT) Removal of foreign body, external eye; corneal, with slit lamp
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Removal of foreign body, intraocular; from anterior chamber of eye or lens
Service Code
65235 (CPT) Removal of foreign body, intraocular; from anterior chamber of eye or lens
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Removal of foreign body, intraocular; from posterior segment, magnetic extraction, anterior or posterior route
Service Code
65260 (CPT) Removal of foreign body, intraocular; from posterior segment, magnetic extraction, anterior or posterior route
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Removal of foreign body, intraocular; from posterior segment, nonmagnetic extraction
Service Code
65265 (CPT) Removal of foreign body, intraocular; from posterior segment, nonmagnetic extraction
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Repair of laceration; conjunctiva, with or without nonperforating laceration sclera, direct closure
Service Code
65270 (CPT) Repair of laceration; conjunctiva, with or without nonperforating laceration sclera, direct closure
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Repair of laceration; conjunctiva, by mobilization and rearrangement, without hospitalization
Service Code
65272 (CPT) Repair of laceration; conjunctiva, by mobilization and rearrangement, without hospitalization
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Repair of laceration; conjunctiva, by mobilization and rearrangement, with hospitalization
Service Code
65273 (CPT) Repair of laceration; conjunctiva, by mobilization and rearrangement, with hospitalization
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Repair of laceration; cornea, nonperforating, with or without removal foreign body
Service Code
65275 (CPT) Repair of laceration; cornea, nonperforating, with or without removal foreign body
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Repair of laceration; cornea and/or sclera, perforating, not involving uveal tissue
Service Code
65280 (CPT) Repair of laceration; cornea and/or sclera, perforating, not involving uveal tissue
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Repair of laceration; cornea and/or sclera, perforating, with reposition or resection of uveal tissue
Service Code
65285 (CPT) Repair of laceration; cornea and/or sclera, perforating, with reposition or resection of uveal tissue
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.