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
Culture, typing; identification by nucleic acid (DNA or RNA) probe, amplified probe technique, per culture or isolate, each organism probed
Service Code
87150 (CPT) Culture, typing; identification by nucleic acid (DNA or RNA) probe, amplified 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
Culture, typing; identification by pulse field gel typing
Service Code
87152 (CPT) Culture, typing; identification by pulse field gel typing
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 sequencing method, each isolate (eg, sequencing of the 16S rRNA gene)
Service Code
87153 (CPT) Culture, typing; identification by nucleic acid sequencing method, each isolate (eg, sequencing of the 16S rRNA gene)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Culture, typing; other methods
Service Code
87158 (CPT) Culture, typing; other methods
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Dark field examination, any source (eg, penile, vaginal, oral, skin); includes specimen collection
Service Code
87164 (CPT) Dark field examination, any source (eg, penile, vaginal, oral, skin); includes specimen collection
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Dark field examination, any source (eg, penile, vaginal, oral, skin); without collection
Service Code
87166 (CPT) Dark field examination, any source (eg, penile, vaginal, oral, skin); without collection
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Macroscopic examination; arthropod
Service Code
87168 (CPT) Macroscopic examination; arthropod
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Macroscopic examination; parasite
Service Code
87169 (CPT) Macroscopic examination; parasite
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Pinworm exam (eg, cellophane tape prep)
Service Code
87172 (CPT) Pinworm exam (eg, cellophane tape prep)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Homogenization, tissue, for culture
Service Code
87176 (CPT) Homogenization, tissue, for culture
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Ova and parasites, direct smears, concentration and identification
Service Code
87177 (CPT) Ova and parasites, direct smears, concentration and identification
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Susceptibility studies, antimicrobial agent; agar dilution method, per agent (eg, antibiotic gradient strip)
Service Code
87181 (CPT) Susceptibility studies, antimicrobial agent; agar dilution method, per agent (eg, antibiotic gradient strip)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Susceptibility studies, antimicrobial agent; carbapenemase enzyme detection (eg, Klebsiella pneumoniae carbapenemase [KPC], New Delhi metallo-beta-lactamase [NDM], Verona integron-encoded metallo-beta-lactamase [VIM]), multiplex immunoassay, qualitative,
Service Code
87182 (CPT) Susceptibility studies, antimicrobial agent; carbapenemase enzyme detection (eg, Klebsiella pneumoniae carbapenemase [KPC], New Delhi metallo-beta-lactamase [NDM], Verona integron-encoded metallo-beta-lactamase [VIM]), multiplex immunoassay, qualitative,
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
Authorization Guidelines
Authorization is required for non-participating independent labs. For all other providers, no auth is required.
Conditional Requirements
Authorization is required for non-participating independent labs. For all other providers, no auth is required.
How to Submit
If applicable, please submit your request to Trillium.
Susceptibility studies, antimicrobial agent; carbapenem resistance genes (eg, blaKPC, blaNDM, blaVIM, blaOXA-48, blaIMP), amplified probe technique, per isolate
Service Code
87183 (CPT) Susceptibility studies, antimicrobial agent; carbapenem resistance genes (eg, blaKPC, blaNDM, blaVIM, blaOXA-48, blaIMP), amplified probe technique, per isolate
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
Authorization Guidelines
Authorization is required for non-participating independent labs. For all other providers, no auth is required.
Conditional Requirements
Authorization is required for non-participating independent labs. For all other providers, no auth is required.
How to Submit
If applicable, please submit your request to Trillium.
Susceptibility studies, antimicrobial agent; disk method, per plate (12 or fewer agents)
Service Code
87184 (CPT) Susceptibility studies, antimicrobial agent; disk method, per plate (12 or fewer agents)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Susceptibility studies, antimicrobial agent; enzyme detection (eg, beta lactamase), per enzyme
Service Code
87185 (CPT) Susceptibility studies, antimicrobial agent; enzyme detection (eg, beta lactamase), per enzyme
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Susceptibility studies, antimicrobial agent; microdilution or agar dilution (minimum inhibitory concentration [MIC] or breakpoint), each multi-antimicrobial, per plate
Service Code
87186 (CPT) Susceptibility studies, antimicrobial agent; microdilution or agar dilution (minimum inhibitory concentration [MIC] or breakpoint), each multi-antimicrobial, per plate
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Susceptibility studies, antimicrobial agent; microdilution or agar dilution, minimum lethal concentration (MLC), each plate (List separately in addition to code for primary procedure)
Service Code
87187 (CPT) Susceptibility studies, antimicrobial agent; microdilution or agar dilution, minimum lethal concentration (MLC), each plate (List separately in addition to code for primary procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Susceptibility studies, antimicrobial agent; macrobroth dilution method, each agent
Service Code
87188 (CPT) Susceptibility studies, antimicrobial agent; macrobroth dilution method, each agent
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Susceptibility studies, antimicrobial agent; mycobacteria, proportion method, each agent
Service Code
87190 (CPT) Susceptibility studies, antimicrobial agent; mycobacteria, proportion method, each agent
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
See something that needs to be updated?
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.