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
Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); corneovitreal adhesions
Service Code
65880 (CPT) Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); corneovitreal adhesions
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Removal of epithelial downgrowth, anterior chamber of eye
Service Code
65900 (CPT) Removal of epithelial downgrowth, anterior chamber of eye
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Removal of implanted material, anterior segment of eye
Service Code
65920 (CPT) Removal of implanted material, anterior segment of eye
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Removal of blood clot, anterior segment of eye
Service Code
65930 (CPT) Removal of blood clot, anterior segment of eye
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Injection, anterior chamber of eye (separate procedure); air or liquid
Service Code
66020 (CPT) Injection, anterior chamber of eye (separate procedure); air or liquid
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Injection, anterior chamber of eye (separate procedure); medication
Service Code
66030 (CPT) Injection, anterior chamber of eye (separate procedure); medication
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of lesion, sclera
Service Code
66130 (CPT) Excision of lesion, sclera
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Fistulization of sclera for glaucoma; trephination with iridectomy
Service Code
66150 (CPT) Fistulization of sclera for glaucoma; trephination with iridectomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Fistulization of sclera for glaucoma; thermocauterization with iridectomy
Service Code
66155 (CPT) Fistulization of sclera for glaucoma; thermocauterization with iridectomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Fistulization of sclera for glaucoma; sclerectomy with punch or scissors, with iridectomy
Service Code
66160 (CPT) Fistulization of sclera for glaucoma; sclerectomy with punch or scissors, with iridectomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Fistulization of sclera for glaucoma; trabeculectomy ab externo in absence of previous surgery
Service Code
66170 (CPT) Fistulization of sclera for glaucoma; trabeculectomy ab externo in absence of previous surgery
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma (includes injection of antifibrotic agents)
Service Code
66172 (CPT) Fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma (includes injection of antifibrotic agents)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Transluminal dilation of aqueous outflow canal; without retention of device or stent
Service Code
66174 (CPT) Transluminal dilation of aqueous outflow canal; without retention of device or stent
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Transluminal dilation of aqueous outflow canal; with retention of device or stent
Service Code
66175 (CPT) Transluminal dilation of aqueous outflow canal; with retention of device or stent
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft
Service Code
66179 (CPT) Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Aqueous shunt to extraocular equatorial plate reservoir, external approach; with graft
Service Code
66180 (CPT) Aqueous shunt to extraocular equatorial plate reservoir, external approach; with graft
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach
Service Code
66183 (CPT) Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft
Service Code
66184 (CPT) Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Revision of aqueous shunt to extraocular equatorial plate reservoir; with graft
Service Code
66185 (CPT) Revision of aqueous shunt to extraocular equatorial plate reservoir; with graft
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Repair of scleral staphyloma; with graft
Service Code
66225 (CPT) Repair of scleral staphyloma; with 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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