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
Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
Service Code
86328 (CPT) Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Immunodiffusion; not elsewhere specified
Service Code
86329 (CPT) Immunodiffusion; not elsewhere specified
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Immunodiffusion; gel diffusion, qualitative (Ouchterlony), each antigen or antibody
Service Code
86331 (CPT) Immunodiffusion; gel diffusion, qualitative (Ouchterlony), each antigen or antibody
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Immune complex assay
Service Code
86332 (CPT) Immune complex assay
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Immunofixation electrophoresis; serum
Service Code
86334 (CPT) Immunofixation electrophoresis; serum
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Immunofixation electrophoresis; other fluids with concentration (eg, urine, CSF)
Service Code
86335 (CPT) Immunofixation electrophoresis; other fluids with concentration (eg, urine, CSF)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Inhibin A
Service Code
86336 (CPT) Inhibin A
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Insulin antibodies
Service Code
86337 (CPT) Insulin antibodies
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Intrinsic factor antibodies
Service Code
86340 (CPT) Intrinsic factor antibodies
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Islet cell antibody
Service Code
86341 (CPT) Islet cell antibody
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Leukocyte histamine release test (LHR)
Service Code
86343 (CPT) Leukocyte histamine release test (LHR)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Leukocyte phagocytosis
Service Code
86344 (CPT) Leukocyte phagocytosis
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Cellular function assay involving stimulation (eg, mitogen or antigen) and detection of biomarker (eg, ATP)
Service Code
86352 (CPT) Cellular function assay involving stimulation (eg, mitogen or antigen) and detection of biomarker (eg, ATP)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Lymphocyte transformation, mitogen (phytomitogen) or antigen induced blastogenesis
Service Code
86353 (CPT) Lymphocyte transformation, mitogen (phytomitogen) or antigen induced blastogenesis
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
B cells, total count
Service Code
86355 (CPT) B cells, total count
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Mononuclear cell antigen, quantitative (eg, flow cytometry), not otherwise specified, each antigen
Service Code
86356 (CPT) Mononuclear cell antigen, quantitative (eg, flow cytometry), not otherwise specified, each antigen
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Natural killer (NK) cells, total count
Service Code
86357 (CPT) Natural killer (NK) cells, total count
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
T cells; total count
Service Code
86359 (CPT) T cells; total count
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
T cells; absolute CD4 and CD8 count, including ratio
Service Code
86360 (CPT) T cells; absolute CD4 and CD8 count, including ratio
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
T cells; absolute CD4 count
Service Code
86361 (CPT) T cells; absolute CD4 count
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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