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
Autologous blood or component, collection processing and storage; intra- or postoperative salvage
Service Code
86891 (CPT) Autologous blood or component, collection processing and storage; intra- or postoperative salvage
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Blood typing, serologic; ABO
Service Code
86900 (CPT) Blood typing, serologic; ABO
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Blood typing, serologic; Rh (D)
Service Code
86901 (CPT) Blood typing, serologic; Rh (D)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Blood typing, serologic; antigen testing of donor blood using reagent serum, each antigen test
Service Code
86902 (CPT) Blood typing, serologic; antigen testing of donor blood using reagent serum, each antigen test
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
Authorization Guidelines
See the Carolina Complete Health site for specific requirements
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
How to Submit
Please submit your request to Carolina Complete Health through Availity
Blood typing, serologic; antigen screening for compatible unit using patient serum, per unit screened
Service Code
86904 (CPT) Blood typing, serologic; antigen screening for compatible unit using patient serum, per unit screened
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Blood typing, serologic; RBC antigens, other than ABO or Rh (D), each
Service Code
86905 (CPT) Blood typing, serologic; RBC antigens, other than ABO or Rh (D), each
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Blood typing, serologic; Rh phenotyping, complete
Service Code
86906 (CPT) Blood typing, serologic; Rh phenotyping, complete
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Blood typing, for paternity testing, per individual; ABO, Rh and MN
Service Code
86910 (CPT) Blood typing, for paternity testing, per individual; ABO, Rh and MN
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Blood typing, for paternity testing, per individual; each additional antigen system
Service Code
86911 (CPT) Blood typing, for paternity testing, per individual; each additional antigen system
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Compatibility test each unit; immediate spin technique
Service Code
86920 (CPT) Compatibility test each unit; immediate spin technique
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Compatibility test each unit; incubation technique
Service Code
86921 (CPT) Compatibility test each unit; incubation technique
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Compatibility test each unit; antiglobulin technique
Service Code
86922 (CPT) Compatibility test each unit; antiglobulin technique
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Compatibility test each unit; electronic
Service Code
86923 (CPT) Compatibility test each unit; electronic
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Fresh frozen plasma, thawing, each unit
Service Code
86927 (CPT) Fresh frozen plasma, thawing, each unit
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Frozen blood, each unit; freezing (includes preparation)
Service Code
86930 (CPT) Frozen blood, each unit; freezing (includes preparation)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Frozen blood, each unit; thawing
Service Code
86931 (CPT) Frozen blood, each unit; thawing
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Frozen blood, each unit; freezing (includes preparation) and thawing
Service Code
86932 (CPT) Frozen blood, each unit; freezing (includes preparation) and thawing
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Hemolysins and agglutinins; auto, screen, each
Service Code
86940 (CPT) Hemolysins and agglutinins; auto, screen, each
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Hemolysins and agglutinins; incubated
Service Code
86941 (CPT) Hemolysins and agglutinins; incubated
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Irradiation of blood product, each unit
Service Code
86945 (CPT) Irradiation of blood product, each unit
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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