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

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12437 Results

Lithium

Service Code
80178 (CPT) Lithium
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Mycophenolate (mycophenolic acid)

Service Code
80180 (CPT) Mycophenolate (mycophenolic acid)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Flecainide

Service Code
80181 (CPT) Flecainide
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Oxcarbazepine

Service Code
80183 (CPT) Oxcarbazepine
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

80184 - PHENOBARBITAL

Service Code
80184 (CPT) 80184 - PHENOBARBITAL
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Phenytoin; total

Service Code
80185 (CPT) Phenytoin; total
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Phenytoin; free

Service Code
80186 (CPT) Phenytoin; free
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Posaconazole

Service Code
80187 (CPT) Posaconazole
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Primidone

Service Code
80188 (CPT) Primidone
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Procainamide;

Service Code
80190 (CPT) Procainamide;
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Procainamide; with metabolites (eg, n-acetyl procainamide)

Service Code
80192 (CPT) Procainamide; with metabolites (eg, n-acetyl procainamide)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Quinidine

Service Code
80194 (CPT) Quinidine
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Sirolimus

Service Code
80195 (CPT) Sirolimus
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Tacrolimus

Service Code
80197 (CPT) Tacrolimus
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Theophylline

Service Code
80198 (CPT) Theophylline
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Tiagabine

Service Code
80199 (CPT) Tiagabine
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Tobramycin

Service Code
80200 (CPT) Tobramycin
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Topiramate

Service Code
80201 (CPT) Topiramate
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Vancomycin

Service Code
80202 (CPT) Vancomycin
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Zonisamide

Service Code
80203 (CPT) Zonisamide
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required