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
Folic acid; RBC
Service Code
82747 (CPT) Folic acid; RBC
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Fructose, semen
Service Code
82757 (CPT) Fructose, semen
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Galactokinase, RBC
Service Code
82759 (CPT) Galactokinase, RBC
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Galactose
Service Code
82760 (CPT) Galactose
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Galactose-1-phosphate uridyl transferase; quantitative
Service Code
82775 (CPT) Galactose-1-phosphate uridyl transferase; quantitative
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Galactose-1-phosphate uridyl transferase; screen
Service Code
82776 (CPT) Galactose-1-phosphate uridyl transferase; screen
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Galectin-3
Service Code
82777 (CPT) Galectin-3
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Gammaglobulin (immunoglobulin); IgA, IgD, IgG, IgM, each
Service Code
82784 (CPT) Gammaglobulin (immunoglobulin); IgA, IgD, IgG, IgM, each
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Gammaglobulin (immunoglobulin); IgE
Service Code
82785 (CPT) Gammaglobulin (immunoglobulin); IgE
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Gammaglobulin (immunoglobulin); immunoglobulin subclasses (eg, IgG1, 2, 3, or 4), each
Service Code
82787 (CPT) Gammaglobulin (immunoglobulin); immunoglobulin subclasses (eg, IgG1, 2, 3, or 4), each
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Gases, blood, pH only
Service Code
82800 (CPT) Gases, blood, pH only
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation);
Service Code
82803 (CPT) Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation);
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation); with O2 saturation, by direct measurement, except pulse oximetry
Service Code
82805 (CPT) Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation); with O2 saturation, by direct measurement, except pulse oximetry
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Gases, blood, O2 saturation only, by direct measurement, except pulse oximetry
Service Code
82810 (CPT) Gases, blood, O2 saturation only, by direct measurement, except pulse oximetry
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Hemoglobin-oxygen affinity (pO2 for 50% hemoglobin saturation with oxygen)
Service Code
82820 (CPT) Hemoglobin-oxygen affinity (pO2 for 50% hemoglobin saturation with oxygen)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Gastric acid analysis, includes pH if performed, each specimen
Service Code
82930 (CPT) Gastric acid analysis, includes pH if performed, each specimen
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Gastrin after secretin stimulation
Service Code
82938 (CPT) Gastrin after secretin stimulation
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Gastrin
Service Code
82941 (CPT) Gastrin
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Glucagon
Service Code
82943 (CPT) Glucagon
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Glucose, body fluid, other than blood
Service Code
82945 (CPT) Glucose, body fluid, other than blood
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
See something that needs to be updated?
If you find any wrong or out of date information on our pages, we want to know. Please email info@TrilliumNC.org with any corrections.