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
Clotting; factor IX (PTC or Christmas)
Service Code
85250 (CPT) Clotting; factor IX (PTC or Christmas)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Clotting; factor X (Stuart-Prower)
Service Code
85260 (CPT) Clotting; factor X (Stuart-Prower)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Clotting; factor XI (PTA)
Service Code
85270 (CPT) Clotting; factor XI (PTA)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Clotting; factor XII (Hageman)
Service Code
85280 (CPT) Clotting; factor XII (Hageman)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Clotting; factor XIII (fibrin stabilizing)
Service Code
85290 (CPT) Clotting; factor XIII (fibrin stabilizing)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Clotting; factor XIII (fibrin stabilizing), screen solubility
Service Code
85291 (CPT) Clotting; factor XIII (fibrin stabilizing), screen solubility
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Clotting; prekallikrein assay (Fletcher factor assay)
Service Code
85292 (CPT) Clotting; prekallikrein assay (Fletcher factor assay)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Clotting; high molecular weight kininogen assay (Fitzgerald factor assay)
Service Code
85293 (CPT) Clotting; high molecular weight kininogen assay (Fitzgerald factor assay)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Clotting inhibitors or anticoagulants; antithrombin III, activity
Service Code
85300 (CPT) Clotting inhibitors or anticoagulants; antithrombin III, activity
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Clotting inhibitors or anticoagulants; antithrombin III, antigen assay
Service Code
85301 (CPT) Clotting inhibitors or anticoagulants; antithrombin III, antigen assay
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Clotting inhibitors or anticoagulants; protein C, antigen
Service Code
85302 (CPT) Clotting inhibitors or anticoagulants; protein C, antigen
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Clotting inhibitors or anticoagulants; protein C, activity
Service Code
85303 (CPT) Clotting inhibitors or anticoagulants; protein C, activity
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Clotting inhibitors or anticoagulants; protein S, total
Service Code
85305 (CPT) Clotting inhibitors or anticoagulants; protein S, total
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Clotting inhibitors or anticoagulants; protein S, free
Service Code
85306 (CPT) Clotting inhibitors or anticoagulants; protein S, free
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Activated Protein C (APC) resistance assay
Service Code
85307 (CPT) Activated Protein C (APC) resistance assay
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Factor inhibitor test
Service Code
85335 (CPT) Factor inhibitor test
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Thrombomodulin
Service Code
85337 (CPT) Thrombomodulin
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Coagulation time; Lee and White
Service Code
85345 (CPT) Coagulation time; Lee and White
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Coagulation time; activated
Service Code
85347 (CPT) Coagulation time; activated
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Coagulation time; other methods
Service Code
85348 (CPT) Coagulation time; other methods
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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