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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12465 Results

0207 Burn care

Service Code
0207 (Revenue) 0207 Burn care
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health, Mental Health

Authorization Guidelines

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100

Conditional Requirements

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100, with the exception of 0160: Servicses Rendered in an IMD. For Behavioral Health, prior authorization is not required for the first 72 hours of service. For Physical Health, no prior authorization is required.

How to Submit

N/A - No authorization is required

0208 Trauma

Service Code
0208 (Revenue) 0208 Trauma
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health, Mental Health

Authorization Guidelines

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100

Conditional Requirements

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100, with the exception of 0160: Servicses Rendered in an IMD. For Behavioral Health, prior authorization is not required for the first 72 hours of service. For Physical Health, no prior authorization is required.

How to Submit

N/A - No authorization is required

0209 Other intensive care

Service Code
0209 (Revenue) 0209 Other intensive care
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health, Mental Health

Authorization Guidelines

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100

Conditional Requirements

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100, with the exception of 0160: Servicses Rendered in an IMD. For Behavioral Health, prior authorization is not required for the first 72 hours of service. For Physical Health, no prior authorization is required.

How to Submit

N/A - No authorization is required

Anesthesia for intracranial procedures; not otherwise specified

Service Code
00210 (CPT) Anesthesia for intracranial procedures; not otherwise specified
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Anesthesia for intracranial procedures; craniotomy or craniectomy for evacuation of hematoma

Service Code
00211 (CPT) Anesthesia for intracranial procedures; craniotomy or craniectomy for evacuation of hematoma
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Anesthesia for intracranial procedures; subdural taps

Service Code
00212 (CPT) Anesthesia for intracranial procedures; subdural taps
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0212 Pulmonary care

Service Code
0212 (Revenue) 0212 Pulmonary care
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health, Mental Health

Authorization Guidelines

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100

Conditional Requirements

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100, with the exception of 0160: Servicses Rendered in an IMD. For Behavioral Health, prior authorization is not required for the first 72 hours of service. For Physical Health, no prior authorization is required.

How to Submit

N/A - No authorization is required

0213 Heart transplant

Service Code
0213 (Revenue) 0213 Heart transplant
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health, Mental Health

Authorization Guidelines

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100

Conditional Requirements

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100, with the exception of 0160: Servicses Rendered in an IMD. For Behavioral Health, prior authorization is not required for the first 72 hours of service. For Physical Health, no prior authorization is required.

How to Submit

N/A - No authorization is required

Anesthesia for intracranial procedures; burr holes, including ventriculography

Service Code
00214 (CPT) Anesthesia for intracranial procedures; burr holes, including ventriculography
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0214 Intermediate coronary care unit (CCU)

Service Code
0214 (Revenue) 0214 Intermediate coronary care unit (CCU)
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health, Mental Health

Authorization Guidelines

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100

Conditional Requirements

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100, with the exception of 0160: Servicses Rendered in an IMD. For Behavioral Health, prior authorization is not required for the first 72 hours of service. For Physical Health, no prior authorization is required.

How to Submit

N/A - No authorization is required

Anesthesia for intracranial procedures; cranioplasty or elevation of depressed skull fracture, extradural (simple or compound)

Service Code
00215 (CPT) Anesthesia for intracranial procedures; cranioplasty or elevation of depressed skull fracture, extradural (simple or compound)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Anesthesia for intracranial procedures; vascular procedures

Service Code
00216 (CPT) Anesthesia for intracranial procedures; vascular procedures
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Anesthesia for intracranial procedures; procedures in sitting position

Service Code
00218 (CPT) Anesthesia for intracranial procedures; procedures in sitting position
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0219 Other coronary care

Service Code
0219 (Revenue) 0219 Other coronary care
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health, Mental Health

Authorization Guidelines

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100

Conditional Requirements

Inpatient Service Codes 0100 - 0219 should be requested under service code 0100, with the exception of 0160: Servicses Rendered in an IMD. For Behavioral Health, prior authorization is not required for the first 72 hours of service. For Physical Health, no prior authorization is required.

How to Submit

N/A - No authorization is required

Anesthesia for intracranial procedures; cerebrospinal fluid shunting procedures

Service Code
00220 (CPT) Anesthesia for intracranial procedures; cerebrospinal fluid shunting procedures
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0221 Admission charge

Service Code
0221 (Revenue) 0221 Admission charge
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Anesthesia for intracranial procedures; electrocoagulation of intracranial nerve

Service Code
00222 (CPT) Anesthesia for intracranial procedures; electrocoagulation of intracranial nerve
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0223 UR service charge

Service Code
0223 (Revenue) 0223 UR service charge
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0224 Late discharge, medically necessary

Service Code
0224 (Revenue) 0224 Late discharge, medically necessary
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0229 Other special charges

Service Code
0229 (Revenue) 0229 Other special charges
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required