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

Removal of sutures under anesthesia (other than local), other surgeon

Service Code
15851 (CPT) Removal of sutures under anesthesia (other than local), other surgeon
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Dressing change (for other than burns) under anesthesia (other than local)

Service Code
15852 (CPT) Dressing change (for other than burns) under anesthesia (other than local)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Removal of sutures or staples not requiring anesthesia (List separately in addition to E/M code)

Service Code
15853 (CPT) Removal of sutures or staples not requiring anesthesia (List separately in addition to E/M code)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Removal of sutures and staples not requiring anesthesia (List separately in addition to E/M code)

Service Code
15854 (CPT) Removal of sutures and staples not requiring anesthesia (List separately in addition to E/M code)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Intravenous injection of agent (eg, fluorescein) to test vascular flow in flap or graft

Service Code
15860 (CPT) Intravenous injection of agent (eg, fluorescein) to test vascular flow in flap or graft
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Suction assisted lipectomy; head and neck

Service Code
15876 (CPT) Suction assisted lipectomy; head and neck
Prior Authorization Required
Yes
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

Please submit your request to Trillium Health Resources

Suction assisted lipectomy; trunk

Service Code
15877 (CPT) Suction assisted lipectomy; trunk
Prior Authorization Required
Yes
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

Please submit your request to Trillium Health Resources

Suction assisted lipectomy; upper extremity

Service Code
15878 (CPT) Suction assisted lipectomy; upper extremity
Prior Authorization Required
Yes
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

Please submit your request to Trillium Health Resources

Suction assisted lipectomy; lower extremity

Service Code
15879 (CPT) Suction assisted lipectomy; lower extremity
Prior Authorization Required
Yes
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

Please submit your request to Trillium Health Resources

Excision, coccygeal pressure ulcer, with coccygectomy; with primary suture

Service Code
15920 (CPT) Excision, coccygeal pressure ulcer, with coccygectomy; with primary suture
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Excision, coccygeal pressure ulcer, with coccygectomy; with flap closure

Service Code
15922 (CPT) Excision, coccygeal pressure ulcer, with coccygectomy; with flap closure
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Excision, sacral pressure ulcer, with primary suture;

Service Code
15931 (CPT) Excision, sacral pressure ulcer, with primary suture;
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Excision, sacral pressure ulcer, with primary suture; with ostectomy

Service Code
15933 (CPT) Excision, sacral pressure ulcer, with primary suture; with ostectomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Excision, sacral pressure ulcer, with skin flap closure;

Service Code
15934 (CPT) Excision, sacral pressure ulcer, with skin flap closure;
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Excision, sacral pressure ulcer, with skin flap closure; with ostectomy

Service Code
15935 (CPT) Excision, sacral pressure ulcer, with skin flap closure; with ostectomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Excision, sacral pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure;

Service Code
15936 (CPT) Excision, sacral pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure;
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Excision, sacral pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure; with ostectomy

Service Code
15937 (CPT) Excision, sacral pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure; with ostectomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Excision, ischial pressure ulcer, with primary suture;

Service Code
15940 (CPT) Excision, ischial pressure ulcer, with primary suture;
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Excision, ischial pressure ulcer, with primary suture; with ostectomy (ischiectomy)

Service Code
15941 (CPT) Excision, ischial pressure ulcer, with primary suture; with ostectomy (ischiectomy)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Excision, ischial pressure ulcer, with skin flap closure;

Service Code
15944 (CPT) Excision, ischial pressure ulcer, with skin flap closure;
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required