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 lacrimal sac (dacryocystectomy)
Service Code
68520 (CPT) Excision of lacrimal sac (dacryocystectomy)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Biopsy of lacrimal sac
Service Code
68525 (CPT) Biopsy of lacrimal sac
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Removal of foreign body or dacryolith, lacrimal passages
Service Code
68530 (CPT) Removal of foreign body or dacryolith, lacrimal passages
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of lacrimal gland tumor; frontal approach
Service Code
68540 (CPT) Excision of lacrimal gland tumor; frontal approach
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Excision of lacrimal gland tumor; involving osteotomy
Service Code
68550 (CPT) Excision of lacrimal gland tumor; involving osteotomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Plastic repair of canaliculi
Service Code
68700 (CPT) Plastic repair of canaliculi
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Correction of everted punctum, cautery
Service Code
68705 (CPT) Correction of everted punctum, cautery
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Dacryocystorhinostomy (fistulization of lacrimal sac to nasal cavity)
Service Code
68720 (CPT) Dacryocystorhinostomy (fistulization of lacrimal sac to nasal cavity)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); without tube
Service Code
68745 (CPT) Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); without tube
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); with insertion of tube or stent
Service Code
68750 (CPT) Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); with insertion of tube or stent
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Closure of the lacrimal punctum; by thermocauterization, ligation, or laser surgery
Service Code
68760 (CPT) Closure of the lacrimal punctum; by thermocauterization, ligation, or laser surgery
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Closure of the lacrimal punctum; by plug, each
Service Code
68761 (CPT) Closure of the lacrimal punctum; by plug, each
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Closure of lacrimal fistula (separate procedure)
Service Code
68770 (CPT) Closure of lacrimal fistula (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Dilation of lacrimal punctum, with or without irrigation
Service Code
68801 (CPT) Dilation of lacrimal punctum, with or without irrigation
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Probing of nasolacrimal duct, with or without irrigation;
Service Code
68810 (CPT) Probing of nasolacrimal duct, with or without irrigation;
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Probing of nasolacrimal duct, with or without irrigation; requiring general anesthesia
Service Code
68811 (CPT) Probing of nasolacrimal duct, with or without irrigation; requiring general anesthesia
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Probing of nasolacrimal duct, with or without irrigation; with insertion of tube or stent
Service Code
68815 (CPT) Probing of nasolacrimal duct, with or without irrigation; with insertion of tube or stent
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Probing of nasolacrimal duct, with or without irrigation; with transluminal balloon catheter dilation
Service Code
68816 (CPT) Probing of nasolacrimal duct, with or without irrigation; with transluminal balloon catheter dilation
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Probing of lacrimal canaliculi, with or without irrigation
Service Code
68840 (CPT) Probing of lacrimal canaliculi, with or without irrigation
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Insertion of drug-eluting implant, including punctal dilation when performed, into lacrimal canaliculus, each
Service Code
68841 (CPT) Insertion of drug-eluting implant, including punctal dilation when performed, into lacrimal canaliculus, each
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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