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Member and Recipient Service Line: 1-877-685-2415

Provider Support Service Line: 1-855-250-1539

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12437 Results

Antibody; cytomegalovirus (CMV), IgM

Service Code
86645 (CPT) Antibody; cytomegalovirus (CMV), IgM
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Antibody; Diphtheria

Service Code
86648 (CPT) Antibody; Diphtheria
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Antibody; encephalitis, California (La Crosse)

Service Code
86651 (CPT) Antibody; encephalitis, California (La Crosse)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Antibody; encephalitis, Eastern equine

Service Code
86652 (CPT) Antibody; encephalitis, Eastern equine
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Antibody; encephalitis, St. Louis

Service Code
86653 (CPT) Antibody; encephalitis, St. Louis
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Antibody; encephalitis, Western equine

Service Code
86654 (CPT) Antibody; encephalitis, Western equine
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Antibody; enterovirus (eg, coxsackie, echo, polio)

Service Code
86658 (CPT) Antibody; enterovirus (eg, coxsackie, echo, polio)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Antibody; Epstein-Barr (EB) virus, early antigen (EA)

Service Code
86663 (CPT) Antibody; Epstein-Barr (EB) virus, early antigen (EA)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Antibody; Epstein-Barr (EB) virus, nuclear antigen (EBNA)

Service Code
86664 (CPT) Antibody; Epstein-Barr (EB) virus, nuclear antigen (EBNA)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Antibody; Epstein-Barr (EB) virus, viral capsid (VCA)

Service Code
86665 (CPT) Antibody; Epstein-Barr (EB) virus, viral capsid (VCA)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Antibody; Ehrlichia

Service Code
86666 (CPT) Antibody; Ehrlichia
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Antibody; Francisella tularensis

Service Code
86668 (CPT) Antibody; Francisella tularensis
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Antibody; fungus, not elsewhere specified

Service Code
86671 (CPT) Antibody; fungus, not elsewhere specified
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Antibody; Giardia lamblia

Service Code
86674 (CPT) Antibody; Giardia lamblia
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Antibody; Helicobacter pylori

Service Code
86677 (CPT) Antibody; Helicobacter pylori
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Antibody; helminth, not elsewhere specified

Service Code
86682 (CPT) Antibody; helminth, not elsewhere specified
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Antibody; Haemophilus influenza

Service Code
86684 (CPT) Antibody; Haemophilus influenza
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Antibody; HTLV-I

Service Code
86687 (CPT) Antibody; HTLV-I
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Antibody; HTLV-II

Service Code
86688 (CPT) Antibody; HTLV-II
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

1E-7 Family Planning Services

Service Code
86689 (CPT) Antibody; HTLV or HIV antibody, confirmatory test (eg, Western Blot)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Family Planning Medicaid services are provided to an eligible Medicaid beneficiary of childbearing age to temporarily or permanently prevent or delay pregnancy. Medicaid Family Planning is designed to reduce unintended pregnancies and improve the well-being of children and families in North Carolina.

Limits

HIV screening may be performed only during an annual assessment, a comprehensive preventive medicine evaluation, or one of the six allowed inter-periodic visits.

FP Medicaid beneficiaries are limited to six inter-periodic visits per 365 calendar days; each in-person or telehealth encounter counts toward this six-visit limit.

HIV and other STI screenings may be performed during those visit types after an annual assessment or comprehensive preventive medicine evaluation has been performed. For FP Medicaid claims, the Annual Assessment Date or Comprehensive Preventive Medicine Evaluation Date must be included on claims for laboratory procedures.

Exclusions

Medical treatment for HIV is not covered by Family Planning Medicaid. In addition, FP Medicaid does not cover treatment for acute or chronic conditions discovered during screening, and does not cover medical conditions unrelated to family planning or family planning-related services.

Place of Service

Non-Telehealth Claims: a. Inpatient hospitals (not applicable for a FP Medicaid beneficiary) b. Outpatient hospital: For a FP Medicaid beneficiary, the only surgical procedure or service allowed requiring outpatient beneficiary registration is sterilization, IUD removal or ultrasound for IUD related complications including missing strings. c. Office: utilizing offices within places of service 11 (Office), 19 (Off Campus Outpatient) or 22 (On Campus Outpatient) d. Ambulatory Surgical Centers (applicable for a FP Medicaid beneficiary for a sterilization. Numeric POS code(s): 02-Telehealth Provided Other than in Patient's Home.

Additional Service Specifics

FP. GT applies only when the service is telehealth billable and delivered by interactive audio-video.

How to Submit

N/A - No authorization is required

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