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 arteries of shoulder and axilla; axillary-femoral bypass graft
Service Code
01656 (CPT) Anesthesia for procedures on arteries of shoulder and axilla; axillary-femoral bypass graft
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 veins of shoulder and axilla
Service Code
01670 (CPT) Anesthesia for all procedures on veins 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 shoulder cast application, removal or repair, not otherwise specified
Service Code
01680 (CPT) Anesthesia for shoulder cast application, removal or repair, 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 nerves, muscles, tendons, fascia, and bursae of upper arm and elbow; not otherwise specified
Service Code
01710 (CPT) Anesthesia for procedures on nerves, muscles, tendons, fascia, and bursae of upper arm and elbow; 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 nerves, muscles, tendons, fascia, and bursae of upper arm and elbow; tenotomy, elbow to shoulder, open
Service Code
01712 (CPT) Anesthesia for procedures on nerves, muscles, tendons, fascia, and bursae of upper arm and elbow; tenotomy, elbow to shoulder, open
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for procedures on nerves, muscles, tendons, fascia, and bursae of upper arm and elbow; tenoplasty, elbow to shoulder
Service Code
01714 (CPT) Anesthesia for procedures on nerves, muscles, tendons, fascia, and bursae of upper arm and elbow; tenoplasty, elbow to shoulder
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anesthesia for procedures on nerves, muscles, tendons, fascia, and bursae of upper arm and elbow; tenodesis, rupture of long tendon of biceps
Service Code
01716 (CPT) Anesthesia for procedures on nerves, muscles, tendons, fascia, and bursae of upper arm and elbow; tenodesis, rupture of long tendon of biceps
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 humerus and elbow
Service Code
01730 (CPT) Anesthesia for all closed procedures on humerus and elbow
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 elbow joint
Service Code
01732 (CPT) Anesthesia for diagnostic arthroscopic procedures of elbow 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 of the elbow; not otherwise specified
Service Code
01740 (CPT) Anesthesia for open or surgical arthroscopic procedures of the elbow; 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 of the elbow; osteotomy of humerus
Service Code
01742 (CPT) Anesthesia for open or surgical arthroscopic procedures of the elbow; osteotomy of humerus
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 of the elbow; repair of nonunion or malunion of humerus
Service Code
01744 (CPT) Anesthesia for open or surgical arthroscopic procedures of the elbow; repair of nonunion or malunion of humerus
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 of the elbow; radical procedures
Service Code
01756 (CPT) Anesthesia for open or surgical arthroscopic procedures of the elbow; radical procedures
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 of the elbow; excision of cyst or tumor of humerus
Service Code
01758 (CPT) Anesthesia for open or surgical arthroscopic procedures of the elbow; excision of cyst or tumor of humerus
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 of the elbow; total elbow replacement
Service Code
01760 (CPT) Anesthesia for open or surgical arthroscopic procedures of the elbow; total elbow 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 upper arm and elbow; not otherwise specified
Service Code
01770 (CPT) Anesthesia for procedures on arteries of upper arm and elbow; 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 upper arm and elbow; embolectomy
Service Code
01772 (CPT) Anesthesia for procedures on arteries of upper arm and elbow; embolectomy
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 upper arm and elbow; not otherwise specified
Service Code
01780 (CPT) Anesthesia for procedures on veins of upper arm and elbow; 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 upper arm and elbow; phleborrhaphy
Service Code
01782 (CPT) Anesthesia for procedures on veins of upper arm and elbow; phleborrhaphy
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 forearm, wrist, and hand
Service Code
01810 (CPT) Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of forearm, wrist, and hand
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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