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
Somatomedin
Service Code
84305 (CPT) Somatomedin
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Somatostatin
Service Code
84307 (CPT) Somatostatin
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Spectrophotometry, analyte not elsewhere specified
Service Code
84311 (CPT) Spectrophotometry, analyte not elsewhere specified
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Specific gravity (except urine)
Service Code
84315 (CPT) Specific gravity (except urine)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Sugars, chromatographic, TLC or paper chromatography
Service Code
84375 (CPT) Sugars, chromatographic, TLC or paper chromatography
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Sugars (mono-, di-, and oligosaccharides); single qualitative, each specimen
Service Code
84376 (CPT) Sugars (mono-, di-, and oligosaccharides); single qualitative, each specimen
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Sugars (mono-, di-, and oligosaccharides); multiple qualitative, each specimen
Service Code
84377 (CPT) Sugars (mono-, di-, and oligosaccharides); multiple qualitative, each specimen
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Sugars (mono-, di-, and oligosaccharides); single quantitative, each specimen
Service Code
84378 (CPT) Sugars (mono-, di-, and oligosaccharides); single quantitative, each specimen
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Sugars (mono-, di-, and oligosaccharides); multiple quantitative, each specimen
Service Code
84379 (CPT) Sugars (mono-, di-, and oligosaccharides); multiple quantitative, each specimen
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Sulfate, urine
Service Code
84392 (CPT) Sulfate, urine
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Testosterone; free
Service Code
84402 (CPT) Testosterone; free
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Testosterone; total
Service Code
84403 (CPT) Testosterone; total
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Testosterone; bioavailable, direct measurement (eg, differential precipitation)
Service Code
84410 (CPT) Testosterone; bioavailable, direct measurement (eg, differential precipitation)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Thiamine (Vitamin B-1)
Service Code
84425 (CPT) Thiamine (Vitamin B-1)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Thiocyanate
Service Code
84430 (CPT) Thiocyanate
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Thromboxane metabolite(s), including thromboxane if performed, urine
Service Code
84431 (CPT) Thromboxane metabolite(s), including thromboxane if performed, urine
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Thyroglobulin
Service Code
84432 (CPT) Thyroglobulin
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Thyroxine; total
Service Code
84436 (CPT) Thyroxine; total
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Thyroxine; requiring elution (eg, neonatal)
Service Code
84437 (CPT) Thyroxine; requiring elution (eg, neonatal)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Thyroxine; free
Service Code
84439 (CPT) Thyroxine; free
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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