Hospital OP Procedures PA Requirement Changes, effective 1/15/2025
Date: 12/10/24
Medicaid & Marketplace Outpatient Hospital
Prior Authorization Requirement Changes Effective 1/15/2025
Effective 01/15/2025, Arizona Complete Health will require prior authorization (PA) for certain procedures when performed in an outpatient hospital setting for Medicaid and Ambetter lines of business. The list of these procedures is in the table below. No PA will be required for these procedures if performed by an in-network provider at an in-network ambulatory surgical center (ASC) or office setting, when clinically appropriate.
Our clinical policy, Surgical Site of Care Optimization AZ.CP.MP.158, which will be utilized for PA review and determination, can be found on our website at www.arizonacompletehealth.com > For Providers > Provider Resources > Clinical & Payment Policies.
NON-PARTICIPATING PROVIDERS & FACILITIES REQUIRE PA FOR ALL SERVICES EXCEPT WHERE OTHWERISE SPECIFICALLY INDICATED.
Benefits are separate from PA requirements. If the service is a covered benefit, we then follow the PA requirements. In addition, payment, regardless of PA requirements, is contingent on the member’s eligibility at the time service is rendered. As a result, please verify eligibility and benefits prior to rendering services to members.
The table below outlines the procedures that will require PA for Medicaid and Ambetter members when performed in an Outpatient Hospital setting effective 1/15/2025:
| Procedure Type | CPT Code | Description |
| Auditory System | 69205 | RMVL FB XTRNL AUDITORY CANAL ANES |
Adenoidectomy | 42831 | ADENOIDECTOMY PRIM; AGE 12/OVER |
Adenoidectomy | 42835 | ADENOIDECTOMY SECNDRY; UNDER AGE 12 |
Adenoidectomy | 42836 | ADENOIDECTOMY SECNDRY; AGE 12/OVER |
Cardiovascular System | 36590 | RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ |
| Cardiovascular System | 36832 | REVJ OPN ARVEN FSTL W/O THRMBC DIAL GRF |
| Carpal Tunnel Surgery | 64721 | NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE |
| Cataract Surgery | 66821 | POST-CATARACT LASER SURGERY |
| Cataract Surgery | 66982 | XCAPSL CTRC RMVL INSJ IO LENS PROSTH CPLX WO ECP |
| Cataract Surgery | 66984 | XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP |
Colonoscopy | 45378 | COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD |
Colonoscopy | 45380 | COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE |
Colonoscopy | 45384 | COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS |
Colonoscopy | 45385 | COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ |
Cosmetic and Reconstructive | 13101 | REPAIR COMPLEX TRUNK 2.6-7.5 CM |
Cosmetic and Reconstructive | 13132 | REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM |
Cosmetic and Reconstructive | 14040 | ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/< |
Cosmetic and Reconstructive | 14060 | ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/< |
Cosmetic and Reconstructive | 14301 | ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM |
Cosmetic and Reconstructive | 21552 | EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/> |
Cosmetic and Reconstructive | 21931 | EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/> |
| Procedure Type | CPT Code | Description |
| Digestive System | 42415 | EXC PRTD TUM/PRTD GLND LAT DSJ&PRSRV FACIAL NR |
| Digestive System | 42440 | EXCISION SUBMANDIBULAR SUBMAXILLARY GLAND |
| Digestive System | 43200 | ESOPHAGOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC |
| Digestive System | 43236 | ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION |
| Digestive System | 43237 | ESOPHAGOGASTRODUODENOSCOPY US SCOPE W/ADJ STRXRS |
| Digestive System | 43238 | EGD INTRMURAL US NEEDLE ASPIRATE/BIOPSY ESOPHAGS |
| Digestive System | 43242 | EGD INTRMURAL NEEDLE ASPIR/BIOP ALTERED ANATOMY |
| Digestive System | 43245 | EGD DILATION GASTRIC/DUODENAL STRICTURE |
| Digestive System | 43246 | EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE |
| Digestive System | 43247 | EGD FLEXIBLE FOREIGN BODY REMOVAL |
| Digestive System | 43248 | EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS |
| Digestive System | 43251 | EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH |
Digestive System | 43254 | EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION |
Digestive System | 43255 | EGD TRANSORAL CONTROL BLEEDING ANY METHOD |
Digestive System | 43259 | EDG US EXAM SURGICAL ALTER STOM DUODENUM/JEJUNUM |
Digestive System | 44360 | ENDOSCOPY UPPER SMALL INTESTINE |
Digestive System | 44361 | ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY |
Digestive System | 45171 | EXC RCT TUM NOT INCL MUSCULARIS PROPRIA |
Digestive System | 45334 | SIGMOIDOSCOPY FLX CONTROL BLEEDING |
Digestive System | 45335 | SGMDSC FLX DIRED SBMCSL NJX ANY SBST |
Digestive System | 45381 | COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST |
Digestive System | 45390 | COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION |
Digestive System | 45990 | ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX |
Digestive System | 46020 | PLACEMENT SETON |
Digestive System | 46040 | I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX |
Digestive System | 46050 | I&D PERIANAL ABSCESS SUPERFICIAL |
Digestive System | 46200 | FISSURECTOMY INCL SPHINCTEROTOMY WHEN PERFORMED |
Digestive System | 46220 | EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS |
Digestive System | 46221 | HEMORRHOIDECTOMY, INTERNAL, BY RUBBER BAND LIGATION (S) |
Digestive System | 46250 | HEMORRHOIDECTOMY XTRNL 2/> COLUMN/GROUP |
Digestive System | 46255 | HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP |
Digestive System | 46261 | HRHC NTRNL & XTRNL 2/> COLUMN/GROUP W/FISSU |
Digestive System | 46270 | SURG TX ANAL FISTULA SUBQ |
Digestive System | 46275 | SURG TX ANAL FISTULA INTERSPHINCTERIC |
Digestive System | 46288 | CLSR ANAL FSTL W/RCT ADVMNT FLAP |
Digestive System | 46505 | CHEMODENERVATION INTERNAL ANAL SPHINCTER |
Digestive System | 46750 | SPHNCTROP ANAL INCONTINENCE/PROLAPSE ADULT |
Digestive System | 46910 | DSTRJ LESION ANUS SMPL ELTRDSICCATION |
Digestive System | 46946 | INT HRHC BY LIGATION 2+ HROID W/O IMG GDN |
| ENT Procedures | 21320 | CLOSED TX NASAL BONE FX W/MNPJ W/STABILIZATION |
| ENT Procedures | 30140 | SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL |
| ENT Procedures | 69436 | TYMPANOSTOMY GENERAL ANESTHESIA |
| ENT Procedures | 69631 | TYMPANOPLASTY W/O MASTOIDECT W/O OSSICLE RECNSTJ |
| Procedure Type | CPT Code | Description |
Eye and ocular adnexa | 65710 | KERATOPLASTY ANTERIOR LAMELLAR |
Eye and ocular adnexa | 65820 | GONIOTOMY |
Eye and ocular adnexa | 66250 | REVJ/RPR OPRATIVE WOUND ANTERIOR SEGMENT |
Eye and ocular adnexa | 66710 | CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL |
Eye and ocular adnexa | 66711 | ECP CILIARY BODY DSTRJ W/O RMVL CRYSTALLINE LENS |
Eye and ocular adnexa | 66825 | REPOSITIONING IO LENS PROSTHESIS REQ INC SPX |
Eye and ocular adnexa | 66986 | EXCHANGE INTRAOCULAR LENS |
Eye and ocular adnexa | 66987 | XCAPSL CTRC RMVL INSJ IO LENS PROSTH CPLX W/ECP |
Eye and ocular adnexa | 66988 | XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/ECP |
Eye and ocular adnexa | 67010 | RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT |
Eye and ocular adnexa | 67041 | VITRECTOMY PARS PLANA REMOVE PRERETINAL MEMBRANE |
Eye and ocular adnexa | 67042 | VITRECTOMY PARS PLANA REMOVE INT MEMB RETINA |
Eye and ocular adnexa | 67105 | RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID PC |
Eye and ocular adnexa | 67108 | RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH |
Eye and ocular adnexa | 67113 | RPR COMPLEX RETINA DETACH VITRECT &MEMBRANE PEEL |
Eye and ocular adnexa | 67840 | EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE |
Eye and ocular adnexa | 68110 | EXCISION OF LESION, CONJUNCTIVA; UP TO 1 CM |
Eye and ocular adnexa | 68115 | EXCISION LESION CONJUNCTIVA > 1 CM |
Eye and ocular adnexa | 68320 | CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT |
Eye and ocular adnexa | 68720 | DACRYOCSTORHINOSTOMY |
Eye and ocular adnexa | 68815 | PROBE NASOLACRIMAL DUCT W/WO IRRG INSJ TUBE/STNT |
Female genital system | 57240 | ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYSTO |
Female genital system | 57250 | POSTERIOR COLPORRHAPHY FOR REPAIR OF RECTOCELE INCLUDING PERINEORRHAPHY IF PERFORMED |
Female genital system | 57461 | COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX |
Female genital system | 57520 | CONIZATION CERVIX W/WO D&C RPR KNIFE/LASER |
Female genital system | 58561 | HYSTEROSCOPY REMOVAL LEIOMYOMATA |
Female genital system | 58562 | HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY |
Gynecologic Procedures | 57522 | CONIZATION CERVIX W/WO D&C RPR ELTRD EXC |
Gynecologic Procedures | 58353 | ENDOMETRIAL ABLTJ THERMAL W/O HYSTEROSCOPIC GUID |
Gynecologic Procedures | 58558 | HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C |
Gynecologic Procedures | 58563 | HYSTEROSCOPY ENDOMETRIAL ABLATION |
Gynecologic Procedures | 58565 | HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS |
Hemic and Lymphatic systems | 38500 | BX/EXC LYMPH NODE OPEN SUPERFICIAL |
Hemic and Lymphatic systems | 38510 | BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE |
Hemic and Lymphatic systems | 38525 | BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE |
| Hernia Repair | 49505 | RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE |
| Hernia Repair | 49591 | RPR AA Hernia 1st <3CM, REDUCIBLE |
| Hernia Repair | 49593 | RPR AA Hernia 1st 3-10 CM, REDUCIBLE |
| Hernia Repair | 49613 | RPR AA Hernia RECUR <3CM, REDUCIBLE |
| Hernia Repair | 49615 | RPR AA HERNIA RECUR 3-10CM, REDUCIBLE |
| Hernia Repair | 49650 | LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA |
| Hernia Repair | 49651 | LAPS SURG RPR RECURRENT INGUINAL HERNIA |
Integumentary System | 10121 | INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMP |
Integumentary System | 11440 | EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/< |
Integumentary System | 11450 | EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR |
Integumentary System | 11624 | EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM |
Integumentary System | 11770 | EXCISION PILONIDAL CYST/SINUS SIMPLE |
Integumentary System | 13121 | REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM |
Procedure Type | CPT Code | Description |
Integumentary System | 15100 | SPLIT AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD |
Integumentary System | 15120 | SPLIT AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/</1 % |
Integumentary System | 15240 | FTH/GF FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/< |
Integumentary System | 19020 | MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP |
Integumentary System | 19120 | EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION |
Integumentary System | 19125 | EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES |
Liver Biopsy | 47000 | BIOPSY LIVER NEEDLE PERCUTANEOUS |
Male Genital System | 54840 | EXCISION SPERMATOCELE W/WO EPIDIDYMECTOMY |
Musculoskeletal System | 21012 | EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/> |
Musculoskeletal System | 21013 | EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM |
Musculoskeletal System | 21336 | OPEN TX NASAL SEPTAL FRACTURE W/WO STABILIZATION |
Musculoskeletal System | 21554 | EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/> |
| Musculoskeletal System | 21555 | EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM |
| Musculoskeletal System | 21556 | EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM |
| Musculoskeletal System | 21930 | EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM |
| Musculoskeletal System | 22902 | EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM |
| Musculoskeletal System | 22903 | EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/> |
| Musculoskeletal System | 23071 | EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/> |
| Musculoskeletal System | 23075 | EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM |
| Musculoskeletal System | 24071 | EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/> |
| Musculoskeletal System | 27327 | EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM |
| Musculoskeletal System | 27337 | EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/> |
Musculoskeletal System | 27632 | EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3 CM/> |
Musculoskeletal System | 28035 | RELEASE TARSAL TUNNEL |
Musculoskeletal System | 28039 | EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/> |
Musculoskeletal System | 28041 | EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5 CM/> |
Musculoskeletal System | 28060 | FASCIECTOMY PLANTAR FASCIA PARTIAL SPX |
Musculoskeletal System | 28080 | EXCISION INTERDIGITAL MORTON NEUROMA SINGLE EACH |
Musculoskeletal System | 28090 | EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT |
Musculoskeletal System | 28104 | EXC/CURTG BONE CYST/B9 TUMORTARSAL/METATARSAL |
Musculoskeletal System | 28110 | OSTECTOMY PRTL 5TH METAR HEAD SPX |
Musculoskeletal System | 28118 | OSTECTOMY CALCANEUS |
Musculoskeletal System | 28119 | OSTECTOMY CALCANEUS SPUR W/WO PLNTAR FASCIAL RLS |
Musculoskeletal System | 28124 | PARTICAL EXCISION BONE PHALANX TOE |
Musculoskeletal System | 28285 | CORRECTION HAMMERTOE |
Musculoskeletal System | 28289 | HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/O IMPLT |
Musculoskeletal System | 28292 | CORRJ HLX VLGS BNCTY SESMDC RESCJ PROX PHLX BASE |
Musculoskeletal System | 28296 | CORRJ HLX VLGS BNCTY SESMDC DSTL METAR OSTEOT |
Musculoskeletal System | 28297 | CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS |
Musculoskeletal System | 28298 | CORRJ HLX VLGS BNCTY SESMDC PROX PHLX OSTEOT |
Musculoskeletal System | 28299 | CORRJ HLX VLGS BNCTY SESMDC W/DOUBLE OSTEOTOMY |
Musculoskeletal System | 29835 | ARTHROSCOPY ELBOW SURGICAL SYNOVECTOMY PARTIAL |
| Musculoskeletal System | 29840 | ARTHROSCOPY WRIST DIAG W/WO SYNOVIAL BIOPSY SPX |
| Musculoskeletal System | 29845 | ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY COMPLETE |
| Musculoskeletal System | 29846 | ARTHRS WRST EXC&/RPR TRIANG FIBROCART&/JOINT |
| Procedure Type | CPT Code | Description |
Musculoskeletal System | 29848 | NDSC WRST SURG W/RLS TRANSVRS CARPL LIGM |
Musculoskeletal System | 29893 | ENDOSCOPIC PLANTAR FASCIOTOMY |
| Ophthalmologic | 65426 | EXCISION/TRANSPOSITION PTERYGIUM W/GRAFG |
| Ophthalmologic | 65730 | KERATOPLASTY PENTRG EXCEPT APHAKIA/PSEUDOPHAKIA |
| Ophthalmologic | 65855 | TRABECULOPLASTY BY LASER SURGERY |
| Ophthalmologic | 66170 | FSTLJ SCLERA GLAUCOMA TRABECULECT AB EXTERNO |
| Ophthalmologic | 66761 | IRIDOTOMY/IRRIDECTOMY LASER SURG PER SESSION |
| Ophthalmologic | 67028 | INTRAVITREAL NJX PHARMACOLOGIC AGT SPX |
| Ophthalmologic | 67036 | VITRECTOMY MECHANICAL PARS PLANA |
| Ophthalmologic | 67040 | VTRECTOMY MCHNL PARS PLNA ENDOLASER PANRTA PC |
| Ophthalmologic | 67228 | TREATMENT EXTENSIVE RETINOPATHY PHOTOCOAGULATION |
| Ophthalmologic | 67311 | STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC |
| Ophthalmologic | 67312 | STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC |
Respiratory System | 30802 | ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL |
Respiratory System | 30930 | FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC |
Respiratory System | 31525 | LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN |
Respiratory System | 31535 | LARYNGOSCOPY DIRECT OPERATIVE W/BIOPSY |
Respiratory System | 31536 | LARYNGOSCOPY W/BIOPSY MICROSCOPE/TELESCOPE |
Respiratory System | 31541 | LARGSC EXC TUM&/STRPG CORDS/EPIGL MCRSCP/TLSCP |
Respiratory System | 31624 | BRNCHSC W/BRNCL ALVEOLAR LAVAGE |
| Tonsillectomy and Adenoidectomy | 42820 | TONSILLECTOMY & ADENOIDECTOMY <AGE 12 |
| Tonsillectomy and Adenoidectomy | 42821 | TONSILLECTOMY & ADENOIDECTOMY AGE 12/> |
| Tonsillectomy and Adenoidectomy | 42825 | TONSILLECTOMY PRIMARY/SECONDARY <AGE 12 |
| Tonsillectomy and Adenoidectomy | 42826 | TONSILLECTOMY PRIMARY/SECONDARY AGE 12/> |
| Tonsillectomy and Adenoidectomy | 42830 | ADENOIDECTOMY PRIMARY <AGE 12 |
Upper Gastrointestinal Endoscopy | 43235 | ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC |
Upper Gastrointestinal Endoscopy | 43239 | EGD TRANSORAL BIOPSY SINGLE/MULTIPLE |
Upper Gastrointestinal Endoscopy | 43249 | EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM |
Urinary System | 52276 | CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY |
Urinary System | 52287 | CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER |
Urinary System | 52320 | CYSTOURETHROSCOPY W/RMVL URETERAL CALCULUS |
Urinary System | 52344 | CYSTO W/URTROSCOPY W/TX URETERAL STRICTURE |
Urologic Procedures | 50590 | LITHOTRIPSY XTRCORP SHOCK WAVE |
Urologic Procedures | 52000 | CYSTOURETHROSCOPY |
Urologic Procedures | 52005 | CYSTO BLADDER W/URETERAL CATHETERIZATION |
Urologic Procedures | 52204 | CYSTOURETHROSCOPY WITH BIOPSY |
Urologic Procedures | 52224 | CYSTO W/REMOVAL OF LESIONS SMALL |
Urologic Procedures | 52234 | CYSTO W/REMOVAL OF TUMORS SMALL |
Urologic Procedures | 52235 | CYSTOURETHROSCOPY W/DEST &/RMVL MED BLADDER TUM |
| Procedure Type | CPT Code | Description |
Urologic Procedures | 52260 | CYSTOURETHROSCOPY W/DIL BLADDER GENERAL ANESTH |
Urologic Procedures | 52281 | CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS |
Urologic Procedures | 52310 | CYSTO W/SIMPLE REMOVAL STONE & STENT |
Urologic Procedures | 52332 | CYSTO W/INSERT URETERAL STENT |
Urologic Procedures | 52351 | CYSTO W/URTROSCOPY&/PYELOSCOPY DX |
Urologic Procedures | 52352 | CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES |
Urologic Procedures | 52353 | CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH LITHOTRIPSY |
Urologic Procedures | 52356 | CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT |
Urologic Procedures | 55040 | EXCISION HYDROCELE UNILATERAL |
Urologic Procedures | 55700 | PROSTATE NEEDLE BIOPSY ANY APPROACH |
Urologic Procedures | 57288 | SLING OPERATION STRESS INCONTINENCE |
To confirm if a CPT/HCPCS code requires PA, please use the applicable Pre-Auth Check Tool on our website www.arizonacompletehealth.com > For Providers > Pre-Auth Check. Please Note: This tool displays the PA requirements at the time of the look-up. It does not display future changes to PA requirements.
If you have questions, please contact your Provider Engagement Specialist. If you need your assigned Provider Engagement Specialist’s contact information, please email us: AzCHProviderEngagement@azcompletehealth.com.