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
Radiologic examination, mandible; partial, less than 4 views
Service Code
70100 (CPT) Radiologic examination, mandible; partial, less than 4 views
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Radiologic examination, mandible; complete, minimum of 4 views
Service Code
70110 (CPT) Radiologic examination, mandible; complete, minimum of 4 views
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Radiologic examination, mastoids; less than 3 views per side
Service Code
70120 (CPT) Radiologic examination, mastoids; less than 3 views per side
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Radiologic examination, mastoids; complete, minimum of 3 views per side
Service Code
70130 (CPT) Radiologic examination, mastoids; complete, minimum of 3 views per side
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Radiologic examination, internal auditory meati, complete
Service Code
70134 (CPT) Radiologic examination, internal auditory meati, complete
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Radiologic examination, facial bones; less than 3 views
Service Code
70140 (CPT) Radiologic examination, facial bones; less than 3 views
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Radiologic examination, facial bones; complete, minimum of 3 views
Service Code
70150 (CPT) Radiologic examination, facial bones; complete, minimum of 3 views
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Radiologic examination, nasal bones, complete, minimum of 3 views
Service Code
70160 (CPT) Radiologic examination, nasal bones, complete, minimum of 3 views
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Dacryocystography, nasolacrimal duct, radiological supervision and interpretation
Service Code
70170 (CPT) Dacryocystography, nasolacrimal duct, radiological supervision and interpretation
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Radiologic examination; optic foramina
Service Code
70190 (CPT) Radiologic examination; optic foramina
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Radiologic examination; orbits, complete, minimum of 4 views
Service Code
70200 (CPT) Radiologic examination; orbits, complete, minimum of 4 views
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Radiologic examination, sinuses, paranasal, less than 3 views
Service Code
70210 (CPT) Radiologic examination, sinuses, paranasal, less than 3 views
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Radiologic examination, sinuses, paranasal, complete, minimum of 3 views
Service Code
70220 (CPT) Radiologic examination, sinuses, paranasal, complete, minimum of 3 views
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Radiologic examination, sella turcica
Service Code
70240 (CPT) Radiologic examination, sella turcica
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
X-ray of skull, fewer than 4 views
Service Code
70250 (CPT) X-ray of skull, fewer than 4 views
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Radiologic examination, skull; complete, minimum of 4 views
Service Code
70260 (CPT) Radiologic examination, skull; complete, minimum of 4 views
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Radiologic examination, teeth; single view
Service Code
70300 (CPT) Radiologic examination, teeth; single view
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Radiologic examination, teeth; partial examination, less than full mouth
Service Code
70310 (CPT) Radiologic examination, teeth; partial examination, less than full mouth
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Radiologic examination, teeth; complete, full mouth
Service Code
70320 (CPT) Radiologic examination, teeth; complete, full mouth
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Radiologic examination, temporomandibular joint, open and closed mouth; unilateral
Service Code
70328 (CPT) Radiologic examination, temporomandibular joint, open and closed mouth; unilateral
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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