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
Antibody; hepatitis, delta agent
How to Submit
N/A - No authorization is required
1E-7 Family Planning Services
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.
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
Resources
1E-7 Family Planning Services
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.
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
Resources
1E-7 Family Planning Services
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.
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
Resources
Antibody; histoplasma
How to Submit
N/A - No authorization is required
1E-7 Family Planning Services
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
Resources
1E-7 Family Planning Services
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
Resources
1E-7 Family Planning Services
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
Resources
1E-7 Family Planning Services
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
Family Planning Medicaid allows STI screenings during the annual assessment, comprehensive preventive medicine evaluation, or the six inter-periodic visits.
Pregnancy tests, sexually transmitted infection screening, and HIV screening can be performed during an annual assessment, comprehensive preventive medicine evaluation, or any of the six inter-periodic visits allowed under the program.
For FP Medicaid beneficiaries, the annual assessment or comprehensive preventive medicine evaluation is generally required before other family planning or family planning-related services are rendered; if one has been completed within the previous 365 days, another is not required before receiving services.
Exclusions
For FP Medicaid beneficiaries, medical conditions unrelated to family planning or family planning-related services are not covered, and treatment for acute or chronic conditions discovered during screening is not covered. Medical treatment for HIV, Hepatitis B, and Hepatitis C is also not covered by Family Planning Medicaid.
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, QW. GT applies only when the service is telehealth billable and delivered by interactive audio-video.
How to Submit
N/A - No authorization is required
Resources
1E-7 Family Planning Services
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
FP Medicaid allows Hepatitis B screening only during an annual assessment, a comprehensive preventive medicine evaluation, or one of the six inter-periodic visits allowed under the FP Medicaid program.
HIV, Hepatitis B, Hepatitis C, and other STI screenings can be performed during those visit types only after an annual assessment or comprehensive preventive medicine evaluation has been performed.
FP Medicaid beneficiaries are limited to one comprehensive preventive medicine evaluation or one annual assessment per 365 calendar days.
FP Medicaid beneficiaries are limited to six inter-periodic visits per 365 calendar days in addition to the annual assessment or comprehensive preventive medicine evaluation.
Exclusions
Family Planning Medicaid does not cover medical treatment for Hepatitis B discovered through screening. FP Medicaid also 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; beneficiaries must be referred to primary care or a safety net provider for non-covered care.
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
Resources
Hepatitis B core antibody (HBcAb); IgM antibody
How to Submit
N/A - No authorization is required
1E-7 Family Planning Services
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
FP Medicaid allows Hepatitis B screening only during an annual assessment, a comprehensive preventive medicine evaluation, or one of the six inter-periodic visits allowed under the FP Medicaid program.
HIV, Hepatitis B, Hepatitis C, and other STI screenings can be performed during those visit types only after an annual assessment or comprehensive preventive medicine evaluation has been performed.
FP Medicaid beneficiaries are limited to one comprehensive preventive medicine evaluation or one annual assessment per 365 calendar days.
FP Medicaid beneficiaries are limited to six inter-periodic visits per 365 calendar days in addition to the annual assessment or comprehensive preventive medicine evaluation.
Exclusions
Family Planning Medicaid does not cover medical treatment for Hepatitis B discovered through screening. FP Medicaid also 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; beneficiaries must be referred to primary care or a safety net provider for non-covered care.
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
Resources
Hepatitis Be antibody (HBeAb)
How to Submit
N/A - No authorization is required
Hepatitis A antibody (HAAb)
How to Submit
N/A - No authorization is required
Hepatitis A antibody (HAAb), IgM antibody
How to Submit
N/A - No authorization is required
Antibody; influenza virus
How to Submit
N/A - No authorization is required
Antibody; JC (John Cunningham) virus
How to Submit
N/A - No authorization is required
Antibody; Legionella
How to Submit
N/A - No authorization is required
Antibody; Leishmania
How to Submit
N/A - No authorization is required
Antibody; Leptospira
How to Submit
N/A - No authorization is required
If you find any wrong or out of date information on our pages, we want to know. Please email info@TrilliumNC.org with any corrections.