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
Antistreptolysin 0; screen
Service Code
86063 (CPT) Antistreptolysin 0; screen
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Blood bank physician services; difficult cross match and/or evaluation of irregular antibody(s), interpretation and written report
Service Code
86077 (CPT) Blood bank physician services; difficult cross match and/or evaluation of irregular antibody(s), interpretation and written report
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Blood bank physician services; investigation of transfusion reaction including suspicion of transmissible disease, interpretation and written report
Service Code
86078 (CPT) Blood bank physician services; investigation of transfusion reaction including suspicion of transmissible disease, interpretation and written report
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Blood bank physician services; authorization for deviation from standard blood banking procedures (eg, use of outdated blood, transfusion of Rh incompatible units), with written report
Service Code
86079 (CPT) Blood bank physician services; authorization for deviation from standard blood banking procedures (eg, use of outdated blood, transfusion of Rh incompatible units), with written report
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
C-reactive protein;
Service Code
86140 (CPT) C-reactive protein;
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
C-reactive protein; high sensitivity (hsCRP)
Service Code
86141 (CPT) C-reactive protein; high sensitivity (hsCRP)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Beta 2 Glycoprotein I antibody, each
Service Code
86146 (CPT) Beta 2 Glycoprotein I antibody, each
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cardiolipin (phospholipid) antibody, each Ig class
Service Code
86147 (CPT) Cardiolipin (phospholipid) antibody, each Ig class
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Anti-phosphatidylserine (phospholipid) antibody
Service Code
86148 (CPT) Anti-phosphatidylserine (phospholipid) antibody
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood);
Service Code
86152 (CPT) Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood);
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood); physician interpretation and report, when required
Service Code
86153 (CPT) Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood); physician interpretation and report, when required
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Chemotaxis assay, specify method
Service Code
86155 (CPT) Chemotaxis assay, specify method
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cold agglutinin; screen
Service Code
86156 (CPT) Cold agglutinin; screen
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cold agglutinin; titer
Service Code
86157 (CPT) Cold agglutinin; titer
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Complement; antigen, each component
Service Code
86160 (CPT) Complement; antigen, each component
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Complement; functional activity, each component
Service Code
86161 (CPT) Complement; functional activity, each component
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Complement; total hemolytic (CH50)
Service Code
86162 (CPT) Complement; total hemolytic (CH50)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Complement fixation tests, each antigen
Service Code
86171 (CPT) Complement fixation tests, each antigen
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cyclic citrullinated peptide (CCP), antibody
Service Code
86200 (CPT) Cyclic citrullinated peptide (CCP), antibody
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Deoxyribonuclease, antibody
Service Code
86215 (CPT) Deoxyribonuclease, antibody
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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