procedure code 71260 — prior authorization under Medicaid
Billing code 71260 · Category: imaging
In our reference, this procedure typically requires prior authorization.
Typical turnaround is 5 day(s); Medicaid's
standard turnaround is 14 calendar days (3 business days if urgent).
How to submit
State Medicaid portal, MCO portal if managed care
Documentation typically required
Chest X-ray results
Clinical indication
Pulmonology referral
Common reasons this gets denied
Chest X-ray not obtained first
Clinical indication unclear
Medicaid-specific notes
PA requirements vary by state and MCO
EPSDT may bypass PA for children
Retroactive PA possible within state-defined windows
Emergency services cannot require PA under federal law
Coverage limits: this page does not confirm authorization for any specific member's plan, and does not cover state-specific plan variants, out-of-network requests, or every payer x procedure pair in existence. For a definitive answer, contact Medicaid directly using the submission method above.
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