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
12465 Results
Open treatment of nasoethmoid fracture; with external fixation
Service Code
21339 (CPT) Open treatment of nasoethmoid fracture; with external fixation
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Percutaneous treatment of nasoethmoid complex fracture, with splint, wire or headcap fixation, including repair of canthal ligaments and/or the nasolacrimal apparatus
Service Code
21340 (CPT) Percutaneous treatment of nasoethmoid complex fracture, with splint, wire or headcap fixation, including repair of canthal ligaments and/or the nasolacrimal apparatus
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Open treatment of depressed frontal sinus fracture
Service Code
21343 (CPT) Open treatment of depressed frontal sinus fracture
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Open treatment of complicated (eg, comminuted or involving posterior wall) frontal sinus fracture, via coronal or multiple approaches
Service Code
21344 (CPT) Open treatment of complicated (eg, comminuted or involving posterior wall) frontal sinus fracture, via coronal or multiple approaches
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Closed treatment of nasomaxillary complex fracture (LeFort II type), with interdental wire fixation or fixation of denture or splint
Service Code
21345 (CPT) Closed treatment of nasomaxillary complex fracture (LeFort II type), with interdental wire fixation or fixation of denture or splint
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Open treatment of nasomaxillary complex fracture (LeFort II type); with wiring and/or local fixation
Service Code
21346 (CPT) Open treatment of nasomaxillary complex fracture (LeFort II type); with wiring and/or local fixation
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Open treatment of nasomaxillary complex fracture (LeFort II type); requiring multiple open approaches
Service Code
21347 (CPT) Open treatment of nasomaxillary complex fracture (LeFort II type); requiring multiple open approaches
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Open treatment of nasomaxillary complex fracture (LeFort II type); with bone grafting (includes obtaining graft)
Service Code
21348 (CPT) Open treatment of nasomaxillary complex fracture (LeFort II type); with bone grafting (includes obtaining graft)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Percutaneous treatment of fracture of malar area, including zygomatic arch and malar tripod, with manipulation
Service Code
21355 (CPT) Percutaneous treatment of fracture of malar area, including zygomatic arch and malar tripod, with manipulation
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Open treatment of depressed zygomatic arch fracture (eg, Gillies approach)
Service Code
21356 (CPT) Open treatment of depressed zygomatic arch fracture (eg, Gillies approach)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Open treatment of depressed malar fracture, including zygomatic arch and malar tripod
Service Code
21360 (CPT) Open treatment of depressed malar fracture, including zygomatic arch and malar tripod
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Open treatment of complicated (eg, comminuted or involving cranial nerve foramina) fracture(s) of malar area, including zygomatic arch and malar tripod; with internal fixation and multiple surgical approaches
Service Code
21365 (CPT) Open treatment of complicated (eg, comminuted or involving cranial nerve foramina) fracture(s) of malar area, including zygomatic arch and malar tripod; with internal fixation and multiple surgical approaches
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Open treatment of complicated (eg, comminuted or involving cranial nerve foramina) fracture(s) of malar area, including zygomatic arch and malar tripod; with bone grafting (includes obtaining graft)
Service Code
21366 (CPT) Open treatment of complicated (eg, comminuted or involving cranial nerve foramina) fracture(s) of malar area, including zygomatic arch and malar tripod; with bone grafting (includes obtaining graft)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Open treatment of orbital floor blowout fracture; transantral approach (Caldwell-Luc type operation)
Service Code
21385 (CPT) Open treatment of orbital floor blowout fracture; transantral approach (Caldwell-Luc type operation)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Open treatment of orbital floor blowout fracture; periorbital approach
Service Code
21386 (CPT) Open treatment of orbital floor blowout fracture; periorbital approach
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Open treatment of orbital floor blowout fracture; combined approach
Service Code
21387 (CPT) Open treatment of orbital floor blowout fracture; combined approach
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Open treatment of orbital floor blowout fracture; periorbital approach, with alloplastic or other implant
Service Code
21390 (CPT) Open treatment of orbital floor blowout fracture; periorbital approach, with alloplastic or other implant
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Open treatment of orbital floor blowout fracture; periorbital approach with bone graft (includes obtaining graft)
Service Code
21395 (CPT) Open treatment of orbital floor blowout fracture; periorbital approach with bone graft (includes obtaining graft)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Closed treatment of fracture of orbit, except blowout; without manipulation
Service Code
21400 (CPT) Closed treatment of fracture of orbit, except blowout; without manipulation
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
Closed treatment of fracture of orbit, except blowout; with manipulation
Service Code
21401 (CPT) Closed treatment of fracture of orbit, except blowout; with manipulation
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health
How to Submit
N/A - No authorization is required
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