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

Filter By:
Clear Filters
12437 Results

Culture, bacterial; any source, except blood, anaerobic with isolation and presumptive identification of isolates

Service Code
87075 (CPT) Culture, bacterial; any source, except blood, anaerobic with isolation and presumptive identification of isolates
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Culture, bacterial; anaerobic isolate, additional methods required for definitive identification, each isolate

Service Code
87076 (CPT) Culture, bacterial; anaerobic isolate, additional methods required for definitive identification, each isolate
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate

Service Code
87077 (CPT) Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate
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
87081 (CPT) Culture, presumptive, pathogenic organisms, screening only;
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

STI screening may be performed only during an annual assessment, a comprehensive preventive medicine evaluation, or any of the six allowed inter-periodic visits under FP Medicaid.

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.

STI and other screening services under FP Medicaid are available only after an annual assessment or comprehensive preventive medicine evaluation has been performed. Telehealth is allowed only for select services in the policy; telehealth-eligible CPT visit codes are listed separately in Attachment A rather than as STI laboratory codes.

Exclusions

Family Planning Medicaid does not cover treatment for acute or chronic conditions discovered during screening when those conditions are unrelated to family planning or family planning-related services. Medical treatment for HIV, Hepatitis B, and Hepatitis C is not covered by Family Planning Medicaid. Hospital emergency room or emergency department services and inpatient hospital services are not covered for FP Medicaid beneficiaries. In addition, outpatient hospital services for FP Medicaid are generally not covered except for sterilization, medically necessary removal of contraceptive devices, or ultrasound for IUD-related complications.

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

Culture, presumptive, pathogenic organisms, screening only; with colony estimation from density chart

Service Code
87084 (CPT) Culture, presumptive, pathogenic organisms, screening only; with colony estimation from density chart
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Culture, bacterial; quantitative colony count, urine

Service Code
87086 (CPT) Culture, bacterial; quantitative colony count, urine
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Culture, bacterial; with isolation and presumptive identification of each isolate, urine

Service Code
87088 (CPT) Culture, bacterial; with isolation and presumptive identification of each isolate, urine
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; skin, hair, or nail

Service Code
87101 (CPT) Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; skin, hair, or nail
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; other source (except blood)

Service Code
87102 (CPT) Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; other source (except blood)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; blood

Service Code
87103 (CPT) Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; blood
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Culture, fungi, definitive identification, each organism; yeast

Service Code
87106 (CPT) Culture, fungi, definitive identification, each organism; yeast
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Culture, fungi, definitive identification, each organism; mold

Service Code
87107 (CPT) Culture, fungi, definitive identification, each organism; mold
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Culture, mycoplasma, any source

Service Code
87109 (CPT) Culture, mycoplasma, any source
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
87110 (CPT) Culture, chlamydia, any source
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.

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

Culture, tubercle or other acid-fast bacilli (eg, TB, AFB, mycobacteria) any source, with isolation and presumptive identification of isolates

Service Code
87116 (CPT) Culture, tubercle or other acid-fast bacilli (eg, TB, AFB, mycobacteria) any source, with isolation and presumptive identification of isolates
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Culture, mycobacterial, definitive identification, each isolate

Service Code
87118 (CPT) Culture, mycobacterial, definitive identification, each isolate
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Culture, typing; immunofluorescent method, each antiserum

Service Code
87140 (CPT) Culture, typing; immunofluorescent method, each antiserum
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Culture, typing; gas liquid chromatography (GLC) or high pressure liquid chromatography (HPLC) method

Service Code
87143 (CPT) Culture, typing; gas liquid chromatography (GLC) or high pressure liquid chromatography (HPLC) method
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Culture, typing; immunologic method, other than immunofluorescence (eg, agglutination grouping), per antiserum

Service Code
87147 (CPT) Culture, typing; immunologic method, other than immunofluorescence (eg, agglutination grouping), per antiserum
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Culture, typing; identification by nucleic acid (DNA or RNA) probe, direct probe technique, per culture or isolate, each organism probed

Service Code
87149 (CPT) Culture, typing; identification by nucleic acid (DNA or RNA) probe, direct probe technique, per culture or isolate, each organism probed
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required