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

Filter By:
Clear Filters
12437 Results

Full sole and heel wedge, between sole

Service Code
L3420 (HCPCS) Full sole and heel wedge, between sole
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

Conditional Requirements

Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.

How to Submit

If applicable, please submit your request to Carolina Complete Health.

Heel, counter, plastic reinforced

Service Code
L3430 (HCPCS) Heel, counter, plastic reinforced
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

Conditional Requirements

Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.

How to Submit

If applicable, please submit your request to Carolina Complete Health.

Heel, counter, leather reinforced

Service Code
L3440 (HCPCS) Heel, counter, leather reinforced
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

Conditional Requirements

Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.

How to Submit

If applicable, please submit your request to Carolina Complete Health.

Heel, SACH cushion type

Service Code
L3450 (HCPCS) Heel, SACH cushion type
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

Conditional Requirements

Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.

How to Submit

If applicable, please submit your request to Carolina Complete Health.

Heel, new leather, standard

Service Code
L3455 (HCPCS) Heel, new leather, standard
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

Conditional Requirements

Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.

How to Submit

If applicable, please submit your request to Carolina Complete Health.

Heel, new rubber, standard

Service Code
L3460 (HCPCS) Heel, new rubber, standard
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

Conditional Requirements

Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.

How to Submit

If applicable, please submit your request to Carolina Complete Health.

Heel, Thomas with wedge

Service Code
L3465 (HCPCS) Heel, Thomas with wedge
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

Conditional Requirements

Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.

How to Submit

If applicable, please submit your request to Carolina Complete Health.

Heel, Thomas extended to ball

Service Code
L3470 (HCPCS) Heel, Thomas extended to ball
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

Conditional Requirements

Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.

How to Submit

If applicable, please submit your request to Carolina Complete Health.

Heel, pad and depression for spur

Service Code
L3480 (HCPCS) Heel, pad and depression for spur
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

Conditional Requirements

Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.

How to Submit

If applicable, please submit your request to Carolina Complete Health.

Heel, pad, removable for spur

Service Code
L3485 (HCPCS) Heel, pad, removable for spur
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

Conditional Requirements

Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.

How to Submit

If applicable, please submit your request to Carolina Complete Health.

Orthopedic shoe addition, insole, leather

Service Code
L3500 (HCPCS) Orthopedic shoe addition, insole, leather
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

Conditional Requirements

Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.

How to Submit

If applicable, please submit your request to Carolina Complete Health.

Orthopedic shoe addition, insole, rubber

Service Code
L3510 (HCPCS) Orthopedic shoe addition, insole, rubber
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

Conditional Requirements

Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.

How to Submit

If applicable, please submit your request to Carolina Complete Health.

Orthopedic shoe addition, insole, felt covered with leather

Service Code
L3520 (HCPCS) Orthopedic shoe addition, insole, felt covered with leather
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

Conditional Requirements

Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.

How to Submit

If applicable, please submit your request to Carolina Complete Health.

Orthopedic shoe addition, sole, half

Service Code
L3530 (HCPCS) Orthopedic shoe addition, sole, half
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

Conditional Requirements

Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.

How to Submit

If applicable, please submit your request to Carolina Complete Health.

Orthopedic shoe addition, sole, full

Service Code
L3540 (HCPCS) Orthopedic shoe addition, sole, full
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

Conditional Requirements

Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.

How to Submit

If applicable, please submit your request to Carolina Complete Health.

Orthopedic shoe addition, toe tap, standard

Service Code
L3550 (HCPCS) Orthopedic shoe addition, toe tap, standard
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

Conditional Requirements

Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.

How to Submit

If applicable, please submit your request to Carolina Complete Health.

Orthopedic shoe addition, toe tap, horseshoe

Service Code
L3560 (HCPCS) Orthopedic shoe addition, toe tap, horseshoe
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

Conditional Requirements

Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.

How to Submit

If applicable, please submit your request to Carolina Complete Health.

Orthopedic shoe addition, special extension to instep (leather with eyelets)

Service Code
L3570 (HCPCS) Orthopedic shoe addition, special extension to instep (leather with eyelets)
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

Conditional Requirements

Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.

How to Submit

If applicable, please submit your request to Carolina Complete Health.

Orthopedic shoe addition, convert instep to Velcro closure

Service Code
L3580 (HCPCS) Orthopedic shoe addition, convert instep to Velcro closure
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

Conditional Requirements

Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.

How to Submit

If applicable, please submit your request to Carolina Complete Health.

Orthopedic shoe addition, convert firm shoe counter to soft counter

Service Code
L3590 (HCPCS) Orthopedic shoe addition, convert firm shoe counter to soft counter
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

Conditional Requirements

Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.

How to Submit

If applicable, please submit your request to Carolina Complete Health.