CPT Codes Requiring Prior Authorization - Molina Healthcare
CPT Codes Requiring Prior Authorization - Molina Healthcare
CPT Codes Requiring Prior Authorization - Molina Healthcare
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
Procedure<br />
Code<br />
<strong>CPT</strong> <strong>Codes</strong> <strong>Requiring</strong><br />
<strong>Prior</strong> <strong>Authorization</strong><br />
Service Description PA Required by POS<br />
64865 Repair of facial nerve All<br />
64866 Fusion of facial/other nerve All<br />
64868 Fusion of facial/other nerve All<br />
64870 Fusion of facial/other nerve All<br />
64872 Subsequent repair of nerve All<br />
64874 Repair & revise nerve All<br />
64876 Repair nerve; shorten bone All<br />
64885 Nerve graft, head or neck All<br />
64886 Nerve graft, head or neck All<br />
64890 Nerve graft, hand or foot All<br />
64891 Nerve graft, hand or foot All<br />
64892 Nerve graft, arm or leg All<br />
64893 Nerve graft, arm or leg All<br />
64895 Nerve graft, hand or foot All<br />
64896 Nerve graft, hand or foot All<br />
64897 Nerve graft, arm or leg All<br />
64898 Nerve graft, arm or leg All<br />
64901 Additional nerve graft All<br />
64902 Additional nerve graft All<br />
64905 Nerve pedicle transfer All<br />
64907 Nerve pedicle transfer All<br />
64910 Nerve repair w/allograft All<br />
64911 Neurorraphy w/vein autograft All<br />
64999 Nervous system surgery All<br />
65091 Revise eye All<br />
65093 Revise eye with implant All<br />
65101 Removal of eye All<br />
65103 Remove eye/insert implant All<br />
65105 Remove eye/attach implant All<br />
65110 Removal of eye All<br />
65112 Remove eye, revise socket All<br />
65114 Remove eye, revise socket All<br />
65125 Revise ocular implant All<br />
65130 Insert ocular implant All<br />
65135 Insert ocular implant All<br />
65140 Attach ocular implant All<br />
26994OH0812
Change language