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

Accessory for speech generating device, mounting system

Service Code
E2512 (HCPCS) Accessory for speech generating device, mounting system
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.

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health through Availity

Accessory for speech generating device, electromyographic sensor

Service Code
E2513 (HCPCS) Accessory for speech generating device, electromyographic sensor
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

Accessory for speech generating device, not otherwise classified

Service Code
E2599 (HCPCS) Accessory for speech generating device, not otherwise classified
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.

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health through Availity

General use wheelchair seat cushion, width less than 22 in, any depth

Service Code
E2601 (HCPCS) General use wheelchair seat cushion, width less than 22 in, any depth
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.

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health through Availity

General use wheelchair seat cushion, width 22 in or greater, any depth

Service Code
E2602 (HCPCS) General use wheelchair seat cushion, width 22 in or greater, any depth
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.

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health through Availity

Skin protection wheelchair seat cushion, width less than 22 in, any depth

Service Code
E2603 (HCPCS) Skin protection wheelchair seat cushion, width less than 22 in, any depth
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.

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health through Availity

Skin protection wheelchair seat cushion, width 22 in or greater, any depth

Service Code
E2604 (HCPCS) Skin protection wheelchair seat cushion, width 22 in or greater, any depth
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.

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health through Availity

Positioning wheelchair seat cushion, width less than 22 in, any depth

Service Code
E2605 (HCPCS) Positioning wheelchair seat cushion, width less than 22 in, any depth
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.

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health through Availity

Positioning wheelchair seat cushion, width 22 in or greater, any depth

Service Code
E2606 (HCPCS) Positioning wheelchair seat cushion, width 22 in or greater, any depth
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.

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health through Availity

Skin protection and positioning wheelchair seat cushion, width less than 22 in, any depth

Service Code
E2607 (HCPCS) Skin protection and positioning wheelchair seat cushion, width less than 22 in, any depth
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.

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health through Availity

Skin protection and positioning wheelchair seat cushion, width 22 in or greater, any depth

Service Code
E2608 (HCPCS) Skin protection and positioning wheelchair seat cushion, width 22 in or greater, any depth
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.

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health through Availity

Custom fabricated wheelchair seat cushion, any size

Service Code
E2609 (HCPCS) Custom fabricated wheelchair seat cushion, any size
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.

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health through Availity

General use wheelchair back cushion, width less than 22 in, any height, including any type mounting hardware

Service Code
E2611 (HCPCS) General use wheelchair back cushion, width less than 22 in, any height, including any type mounting hardware
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.

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health through Availity

General use wheelchair back cushion, width 22 in or greater, any height, including any type mounting hardware

Service Code
E2612 (HCPCS) General use wheelchair back cushion, width 22 in or greater, any height, including any type mounting hardware
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.

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health through Availity

Positioning wheelchair back cushion, posterior, width less than 22 in, any height, including any type mounting hardware

Service Code
E2613 (HCPCS) Positioning wheelchair back cushion, posterior, width less than 22 in, any height, including any type mounting hardware
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.

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health through Availity

Positioning wheelchair back cushion, posterior, width 22 in or greater, any height, including any type mounting hardware

Service Code
E2614 (HCPCS) Positioning wheelchair back cushion, posterior, width 22 in or greater, any height, including any type mounting hardware
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.

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health through Availity

Positioning wheelchair back cushion, posterior-lateral, width less than 22 in, any height, including any type mounting hardware

Service Code
E2615 (HCPCS) Positioning wheelchair back cushion, posterior-lateral, width less than 22 in, any height, including any type mounting hardware
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.

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health through Availity

Positioning wheelchair back cushion, posterior-lateral, width 22 in or greater, any height, including any type mounting hardware

Service Code
E2616 (HCPCS) Positioning wheelchair back cushion, posterior-lateral, width 22 in or greater, any height, including any type mounting hardware
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.

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health through Availity

Custom fabricated wheelchair back cushion, any size, including any type mounting hardware

Service Code
E2617 (HCPCS) Custom fabricated wheelchair back cushion, any size, including any type mounting hardware
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.

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health through Availity

Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 in, any height, including any type mounting hardware

Service Code
E2620 (HCPCS) Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 in, any height, including any type mounting hardware
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.

Reauthorization Guidelines

See the Carolina Complete Health site for specific requirements

How to Submit

Please submit your request to Carolina Complete Health through Availity