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

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12437 Results

99235 25 Observation or inpatient hospital care, for the evaluation and management of a patient. Medical decision making that is of moderate complexity;SEPARATELY IDENTIFIABLE E/M SERVICE BY THE SAME PROVIDER SAME DAY OF PROCEDURE

Service Code
99235 (CPT) 99235 25 Observation or inpatient hospital care, for the evaluation and management of a patient. Medical decision making that is of moderate complexity;SEPARATELY IDENTIFIABLE E/M SERVICE BY THE SAME PROVIDER SAME DAY OF PROCEDURE
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

99236 25 Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date.SEPARATELY IDENTIFIABLE E/M SERVICE BY THE SAME PROVIDER SAME DAY OF PROCEDURE

Service Code
99236 (CPT) 99236 25 Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date.SEPARATELY IDENTIFIABLE E/M SERVICE BY THE SAME PROVIDER SAME DAY OF PROCEDURE
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

99238 Q6 Hospital discharge day management; 30 minutes or less ;LOCUM TENENS

Service Code
99238 (CPT) 99238 Q6 Hospital discharge day management; 30 minutes or less ;LOCUM TENENS
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

99239 25 Significant separate identifiable evaluation of management of service by the same physician on the same day of the procedure or other service

Service Code
99239 (CPT) 99239 25 Significant separate identifiable evaluation of management of service by the same physician on the same day of the procedure or other service
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

Office consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physician

Service Code
99241 (CPT) Office consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physician
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

99242 TN Office consultation for a new or established patient.Physician time approximately 30 minutes;Rural Provider

Service Code
99242 (CPT) 99242 TN Office consultation for a new or established patient.Physician time approximately 30 minutes;Rural Provider
Prior Authorization Required
No
Benefit Plan
Medicaid
Age Group
ALL
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

99243 25 Office consultation for a new or established patient.Physician time approx 40 min SEPARATELY IDENTIFIABLE E/M SERVICE BY THE SAME PROVIDER SAME DAY OF PROCEDURE

Service Code
99243 (CPT) 99243 25 Office consultation for a new or established patient.Physician time approx 40 min SEPARATELY IDENTIFIABLE E/M SERVICE BY THE SAME PROVIDER SAME DAY OF PROCEDURE
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

99244 24 Office consultation for a new or established patient. Physician time approximate 60 minutes ; UNRELATED E/M SERVICE BY THE SAME PHYSICIAN DURING A POSTOPERATIVE PERIOD

Service Code
99244 (CPT) 99244 24 Office consultation for a new or established patient. Physician time approximate 60 minutes ; UNRELATED E/M SERVICE BY THE SAME PHYSICIAN DURING A POSTOPERATIVE PERIOD
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

99245 24 Office consultation for a new or established patient. Physiciam time approximate 80 minutes;UNRELATED E/M SERVICE BY THE SAME PHYSICIAN DURING A POSTOPERATIVE PERIOD

Service Code
99245 (CPT) 99245 24 Office consultation for a new or established patient. Physiciam time approximate 80 minutes;UNRELATED E/M SERVICE BY THE SAME PHYSICIAN DURING A POSTOPERATIVE PERIOD
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

99252 25 Inpatient consultation for a new or established patient. Physician time approximate 40 minutes.SEPARATELY IDENTIFIABLE E/M SERVICE BY THE SAME PROVIDER SAME DAY OF PROCEDURE

Service Code
99252 (CPT) 99252 25 Inpatient consultation for a new or established patient. Physician time approximate 40 minutes.SEPARATELY IDENTIFIABLE E/M SERVICE BY THE SAME PROVIDER SAME DAY OF PROCEDURE
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

99253 25 Inpatient consultation for a new or established patient. Physician time approximate 55 min.SEPARATELY IDENTIFIABLE E/M SERVICE BY THE SAME PROVIDER SAME DAY OF PROCEDURE

Service Code
99253 (CPT) 99253 25 Inpatient consultation for a new or established patient. Physician time approximate 55 min.SEPARATELY IDENTIFIABLE E/M SERVICE BY THE SAME PROVIDER SAME DAY OF PROCEDURE
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

99254 25 Inpatient consultation for a new or established patient. Physician time approximate 80 min.

Service Code
99254 (CPT) 99254 25 Inpatient consultation for a new or established patient. Physician time approximate 80 min.
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

99255 25 Inpatient consultation for a new or established patient. Physician time approximate 110 min.SEPARATELY IDENTIFIABLE E/M SERVICE BY THE SAME PROVIDER SAME DAY OF PROCEDURE

Service Code
99255 (CPT) 99255 25 Inpatient consultation for a new or established patient. Physician time approximate 110 min.SEPARATELY IDENTIFIABLE E/M SERVICE BY THE SAME PROVIDER SAME DAY OF PROCEDURE
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

99281 25 Emergency department visit for the evaluation and management of a patient. Self limited or minor SEPARATELY IDENTIFIABLE E/M SERVICE BY THE SAME PROVIDER SAME DAY OF PROCEDURE

Service Code
99281 (CPT) 99281 25 Emergency department visit for the evaluation and management of a patient. Self limited or minor SEPARATELY IDENTIFIABLE E/M SERVICE BY THE SAME PROVIDER SAME DAY OF PROCEDURE
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

99282:25 Emergency department visit for the evaluation and management of a patient. Low to moderate severity; Significant, Separately Identifiable Evaluation and Managment Service by Same Physician on Same Day of theProcedure or Other Service

Service Code
99282 (CPT) 99282:25 Emergency department visit for the evaluation and management of a patient. Low to moderate severity; Significant, Separately Identifiable Evaluation and Managment Service by Same Physician on Same Day of theProcedure or Other Service
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

99283 CS -Emergency department visit for the evaluation and management of a patient. Moderate severity; Cost Sharing Covid 19

Service Code
99283 (CPT) 99283 CS -Emergency department visit for the evaluation and management of a patient. Moderate severity; Cost Sharing Covid 19
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

99284 CS-Emergency department visit for the evaluation and management of a patient. Medical decision making of moderate severity. Cost Sharing

Service Code
99284 (CPT) 99284 CS-Emergency department visit for the evaluation and management of a patient. Medical decision making of moderate severity. Cost Sharing
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

99285 CS Emergency department visit for the evaluation and management of a patient. Medical decision making of high complexity.; Cost sharing for COVID related testing services

Service Code
99285 (CPT) 99285 CS Emergency department visit for the evaluation and management of a patient. Medical decision making of high complexity.; Cost sharing for COVID related testing services
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

Physician or other qualified health care professional direction of emergency medical systems (EMS) emergency care, advanced life support

Service Code
99288 (CPT) Physician or other qualified health care professional direction of emergency medical systems (EMS) emergency care, advanced life support
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

99291 25 CS -CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE UNSTABLE CRITICALLY ILL;SEPARATELY IDENTIFIABLE E/M SERVICE BY THE SAME PROVIDER SAME DAY OF PROCEDURE; Cost Sharing

Service Code
99291 (CPT) 99291 25 CS -CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE UNSTABLE CRITICALLY ILL;SEPARATELY IDENTIFIABLE E/M SERVICE BY THE SAME PROVIDER SAME DAY OF PROCEDURE; Cost Sharing
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required