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
Excision of lesion, conjunctiva; with adjacent sclera
Service Code
68130 (CPT) Excision of lesion, conjunctiva; with adjacent sclera
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Destruction of lesion, conjunctiva
Service Code
68135 (CPT) Destruction of lesion, conjunctiva
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Subconjunctival injection
Service Code
68200 (CPT) Subconjunctival injection
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Conjunctivoplasty; with conjunctival graft or extensive rearrangement
Service Code
68320 (CPT) Conjunctivoplasty; with conjunctival graft or extensive rearrangement
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Conjunctivoplasty; with buccal mucous membrane graft (includes obtaining graft)
Service Code
68325 (CPT) Conjunctivoplasty; with buccal mucous membrane graft (includes obtaining graft)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Conjunctivoplasty, reconstruction cul-de-sac; with conjunctival graft or extensive rearrangement
Service Code
68326 (CPT) Conjunctivoplasty, reconstruction cul-de-sac; with conjunctival graft or extensive rearrangement
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Conjunctivoplasty, reconstruction cul-de-sac; with buccal mucous membrane graft (includes obtaining graft)
Service Code
68328 (CPT) Conjunctivoplasty, reconstruction cul-de-sac; with buccal mucous membrane graft (includes obtaining graft)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Repair of symblepharon; conjunctivoplasty, without graft
Service Code
68330 (CPT) Repair of symblepharon; conjunctivoplasty, without graft
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Repair of symblepharon; with free graft conjunctiva or buccal mucous membrane (includes obtaining graft)
Service Code
68335 (CPT) Repair of symblepharon; with free graft conjunctiva or buccal mucous membrane (includes obtaining graft)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Repair of symblepharon; division of symblepharon, with or without insertion of conformer or contact lens
Service Code
68340 (CPT) Repair of symblepharon; division of symblepharon, with or without insertion of conformer or contact lens
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Conjunctival flap; bridge or partial (separate procedure)
Service Code
68360 (CPT) Conjunctival flap; bridge or partial (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Conjunctival flap; total (such as Gunderson thin flap or purse string flap)
Service Code
68362 (CPT) Conjunctival flap; total (such as Gunderson thin flap or purse string flap)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Harvesting conjunctival allograft, living donor
Service Code
68371 (CPT) Harvesting conjunctival allograft, living donor
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Unlisted procedure, conjunctiva
Service Code
68399 (CPT) Unlisted procedure, conjunctiva
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
How to Submit
Please submit your request to Trillium Health Resources
Incision, drainage of lacrimal gland
Service Code
68400 (CPT) Incision, drainage of lacrimal gland
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Incision, drainage of lacrimal sac (dacryocystotomy or dacryocystostomy)
Service Code
68420 (CPT) Incision, drainage of lacrimal sac (dacryocystotomy or dacryocystostomy)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Snip incision of lacrimal punctum
Service Code
68440 (CPT) Snip incision of lacrimal punctum
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of lacrimal gland (dacryoadenectomy), except for tumor; total
Service Code
68500 (CPT) Excision of lacrimal gland (dacryoadenectomy), except for tumor; total
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of lacrimal gland (dacryoadenectomy), except for tumor; partial
Service Code
68505 (CPT) Excision of lacrimal gland (dacryoadenectomy), except for tumor; partial
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Biopsy of lacrimal gland
Service Code
68510 (CPT) Biopsy of lacrimal gland
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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