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
Antibody; Listeria monocytogenes
Service Code
86723 (CPT) Antibody; Listeria monocytogenes
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Antibody; lymphocytic choriomeningitis
Service Code
86727 (CPT) Antibody; lymphocytic choriomeningitis
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Antibody; mucormycosis
Service Code
86732 (CPT) Antibody; mucormycosis
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Antibody; mumps
Service Code
86735 (CPT) Antibody; mumps
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Antibody; mycoplasma
Service Code
86738 (CPT) Antibody; mycoplasma
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Antibody; Neisseria meningitidis
Service Code
86741 (CPT) Antibody; Neisseria meningitidis
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Antibody; Nocardia
Service Code
86744 (CPT) Antibody; Nocardia
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Antibody; parvovirus
Service Code
86747 (CPT) Antibody; parvovirus
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Antibody; Plasmodium (malaria)
Service Code
86750 (CPT) Antibody; Plasmodium (malaria)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Antibody; protozoa, not elsewhere specified
Service Code
86753 (CPT) Antibody; protozoa, not elsewhere specified
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Antibody; respiratory syncytial virus
Service Code
86756 (CPT) Antibody; respiratory syncytial virus
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Antibody; Rickettsia
Service Code
86757 (CPT) Antibody; Rickettsia
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Antibody; rotavirus
Service Code
86759 (CPT) Antibody; rotavirus
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Antibody; rubella
Service Code
86762 (CPT) Antibody; rubella
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Antibody; rubeola
Service Code
86765 (CPT) Antibody; rubeola
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Antibody; Salmonella
Service Code
86768 (CPT) Antibody; Salmonella
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
Service Code
86769 (CPT) Antibody; 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
Antibody; Shigella
Service Code
86771 (CPT) Antibody; Shigella
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Antibody; tetanus
Service Code
86774 (CPT) Antibody; tetanus
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Antibody; Toxoplasma
Service Code
86777 (CPT) Antibody; Toxoplasma
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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