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
Deoxyribonucleic acid (DNA) antibody; native or double stranded
Service Code
86225 (CPT) Deoxyribonucleic acid (DNA) antibody; native or double stranded
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Deoxyribonucleic acid (DNA) antibody; single stranded
Service Code
86226 (CPT) Deoxyribonucleic acid (DNA) antibody; single stranded
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Extractable nuclear antigen, antibody to, any method (eg, nRNP, SS-A, SS-B, Sm, RNP, Sc170, J01), each antibody
Service Code
86235 (CPT) Extractable nuclear antigen, antibody to, any method (eg, nRNP, SS-A, SS-B, Sm, RNP, Sc170, J01), each antibody
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Fluorescent noninfectious agent antibody; screen, each antibody
Service Code
86255 (CPT) Fluorescent noninfectious agent antibody; screen, each antibody
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Fluorescent noninfectious agent antibody; titer, each antibody
Service Code
86256 (CPT) Fluorescent noninfectious agent antibody; titer, each antibody
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Growth hormone, human (HGH), antibody
Service Code
86277 (CPT) Growth hormone, human (HGH), antibody
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Hemagglutination inhibition test (HAI)
Service Code
86280 (CPT) Hemagglutination inhibition test (HAI)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Immunoassay for tumor antigen, qualitative or semiquantitative (eg, bladder tumor antigen)
Service Code
86294 (CPT) Immunoassay for tumor antigen, qualitative or semiquantitative (eg, bladder tumor antigen)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Immunoassay for tumor antigen, quantitative; CA 15-3 (27.29)
Service Code
86300 (CPT) Immunoassay for tumor antigen, quantitative; CA 15-3 (27.29)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Immunoassay for tumor antigen, quantitative; CA 19-9
Service Code
86301 (CPT) Immunoassay for tumor antigen, quantitative; CA 19-9
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Immunoassay for tumor antigen, quantitative; CA 125
Service Code
86304 (CPT) Immunoassay for tumor antigen, quantitative; CA 125
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Human epididymis protein 4 (HE4)
Service Code
86305 (CPT) Human epididymis protein 4 (HE4)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Heterophile antibodies; screening
Service Code
86308 (CPT) Heterophile antibodies; screening
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Heterophile antibodies; titer
Service Code
86309 (CPT) Heterophile antibodies; titer
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Heterophile antibodies; titers after absorption with beef cells and guinea pig kidney
Service Code
86310 (CPT) Heterophile antibodies; titers after absorption with beef cells and guinea pig kidney
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Immunoassay for tumor antigen, other antigen, quantitative (eg, CA 50, 72-4, 549), each
Service Code
86316 (CPT) Immunoassay for tumor antigen, other antigen, quantitative (eg, CA 50, 72-4, 549), each
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Immunoassay for infectious agent antibody, quantitative, not otherwise specified
Service Code
86317 (CPT) Immunoassay for infectious agent antibody, quantitative, not otherwise specified
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip);
Service Code
86318 (CPT) Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip);
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Immunoelectrophoresis; serum
Service Code
86320 (CPT) Immunoelectrophoresis; serum
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Immunoelectrophoresis; other fluids (eg, urine, cerebrospinal fluid) with concentration
Service Code
86325 (CPT) Immunoelectrophoresis; other fluids (eg, urine, cerebrospinal fluid) with concentration
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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