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
Euglobulin lysis
Service Code
85360 (CPT) Euglobulin lysis
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Fibrin(ogen) degradation (split) products (FDP) (FSP); agglutination slide, semiquantitative
Service Code
85362 (CPT) Fibrin(ogen) degradation (split) products (FDP) (FSP); agglutination slide, semiquantitative
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Fibrin(ogen) degradation (split) products (FDP) (FSP); paracoagulation
Service Code
85366 (CPT) Fibrin(ogen) degradation (split) products (FDP) (FSP); paracoagulation
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Fibrin(ogen) degradation (split) products (FDP) (FSP); quantitative
Service Code
85370 (CPT) Fibrin(ogen) degradation (split) products (FDP) (FSP); quantitative
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Fibrin degradation products, D-dimer; qualitative or semiquantitative
Service Code
85378 (CPT) Fibrin degradation products, D-dimer; qualitative or semiquantitative
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Fibrin degradation products, D-dimer; quantitative
Service Code
85379 (CPT) Fibrin degradation products, D-dimer; quantitative
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Fibrin degradation products, D-dimer; ultrasensitive (eg, for evaluation for venous thromboembolism), qualitative or semiquantitative
Service Code
85380 (CPT) Fibrin degradation products, D-dimer; ultrasensitive (eg, for evaluation for venous thromboembolism), qualitative or semiquantitative
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Fibrinogen; activity
Service Code
85384 (CPT) Fibrinogen; activity
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Fibrinogen; antigen
Service Code
85385 (CPT) Fibrinogen; antigen
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Fibrinolysins or coagulopathy screen, interpretation and report
Service Code
85390 (CPT) Fibrinolysins or coagulopathy screen, interpretation and report
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Coagulation/fibrinolysis assay, whole blood (eg, viscoelastic clot assessment), including use of any pharmacologic additive(s), as indicated, including interpretation and written report, per day
Service Code
85396 (CPT) Coagulation/fibrinolysis assay, whole blood (eg, viscoelastic clot assessment), including use of any pharmacologic additive(s), as indicated, including interpretation and written report, per day
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Coagulation and fibrinolysis, functional activity, not otherwise specified (eg, ADAMTS-13), each analyte
Service Code
85397 (CPT) Coagulation and fibrinolysis, functional activity, not otherwise specified (eg, ADAMTS-13), each analyte
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Fibrinolytic factors and inhibitors; plasmin
Service Code
85400 (CPT) Fibrinolytic factors and inhibitors; plasmin
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Fibrinolytic factors and inhibitors; alpha-2 antiplasmin
Service Code
85410 (CPT) Fibrinolytic factors and inhibitors; alpha-2 antiplasmin
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Fibrinolytic factors and inhibitors; plasminogen activator
Service Code
85415 (CPT) Fibrinolytic factors and inhibitors; plasminogen activator
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Fibrinolytic factors and inhibitors; plasminogen, except antigenic assay
Service Code
85420 (CPT) Fibrinolytic factors and inhibitors; plasminogen, except antigenic assay
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Fibrinolytic factors and inhibitors; plasminogen, antigenic assay
Service Code
85421 (CPT) Fibrinolytic factors and inhibitors; plasminogen, antigenic assay
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Heinz bodies; direct
Service Code
85441 (CPT) Heinz bodies; direct
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Heinz bodies; induced, acetyl phenylhydrazine
Service Code
85445 (CPT) Heinz bodies; induced, acetyl phenylhydrazine
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Hemoglobin or RBCs, fetal, for fetomaternal hemorrhage; differential lysis (Kleihauer-Betke)
Service Code
85460 (CPT) Hemoglobin or RBCs, fetal, for fetomaternal hemorrhage; differential lysis (Kleihauer-Betke)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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