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

Plasma, cryoprecipitate reduced, pathogen reduced, each unit

Service Code
P9025 (HCPCS) Plasma, cryoprecipitate reduced, pathogen reduced, each unit
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

Cryoprecipitated fibrinogen complex, pathogen reduced, each unit

Service Code
P9026 (HCPCS) Cryoprecipitated fibrinogen complex, pathogen reduced, each unit
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

Red blood cells, leukocytes reduced, oxygen/ carbon dioxide reduced, each unit

Service Code
P9027 (HCPCS) Red blood cells, leukocytes reduced, oxygen/ carbon dioxide reduced, each unit
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

Platelets, leukocytes reduced, each unit

Service Code
P9031 (HCPCS) Platelets, leukocytes reduced, each unit
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

Platelets, irradiated, each unit

Service Code
P9032 (HCPCS) Platelets, irradiated, each unit
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

Platelets, leukocytes reduced, irradiated, each unit

Service Code
P9033 (HCPCS) Platelets, leukocytes reduced, irradiated, each unit
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

Platelets, pheresis, each unit

Service Code
P9034 (HCPCS) Platelets, pheresis, each unit
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

Platelets, pheresis, leukocytes reduced, each unit

Service Code
P9035 (HCPCS) Platelets, pheresis, leukocytes reduced, each unit
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

Platelets, pheresis, irradiated, each unit

Service Code
P9036 (HCPCS) Platelets, pheresis, irradiated, each unit
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

Platelets, pheresis, leukocytes reduced, irradiated, each unit

Service Code
P9037 (HCPCS) Platelets, pheresis, leukocytes reduced, irradiated, each unit
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

Red blood cells, irradiated, each unit

Service Code
P9038 (HCPCS) Red blood cells, irradiated, each unit
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

Red blood cells, deglycerolized, each unit

Service Code
P9039 (HCPCS) Red blood cells, deglycerolized, each unit
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

Red blood cells, leukocytes reduced, irradiated, each unit

Service Code
P9040 (HCPCS) Red blood cells, leukocytes reduced, irradiated, each unit
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

Infusion, albumin (human), 5%, 50 ml

Service Code
P9041 (HCPCS) Infusion, albumin (human), 5%, 50 ml
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

Infusion, plasma protein fraction (human), 5%, 50 ml

Service Code
P9043 (HCPCS) Infusion, plasma protein fraction (human), 5%, 50 ml
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

Plasma, cryoprecipitate reduced, each unit

Service Code
P9044 (HCPCS) Plasma, cryoprecipitate reduced, each unit
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

Infusion, albumin (human), 5%, 250 ml

Service Code
P9045 (HCPCS) Infusion, albumin (human), 5%, 250 ml
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

Infusion, albumin (human), 25%, 20 ml

Service Code
P9046 (HCPCS) Infusion, albumin (human), 25%, 20 ml
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

Infusion, albumin (human), 25%, 50 ml

Service Code
P9047 (HCPCS) Infusion, albumin (human), 25%, 50 ml
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

Infusion, plasma protein fraction (human), 5%, 250 ml

Service Code
P9048 (HCPCS) Infusion, plasma protein fraction (human), 5%, 250 ml
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