CPT Codes Requiring Prior Authorization - Molina Healthcare
CPT Codes Requiring Prior Authorization - Molina Healthcare
CPT Codes Requiring Prior Authorization - Molina Healthcare
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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 />
66710 Destruction, ciliary body All<br />
66711 Ciliary endoscopic ablation All<br />
66720 Destruction, ciliary body All<br />
66740 Destruction, ciliary body All<br />
66761 Revision of iris All<br />
66762 Revision of iris All<br />
66770 Removal of inner eye lesion All<br />
66825 Reposition intraocular lens All<br />
66840 Removal of lens material All<br />
66850 Removal of lens material All<br />
66852 Removal of lens material All<br />
66920 Extraction of lens All<br />
66930 Extraction of lens All<br />
66940 Extraction of lens All<br />
66985 Insert lens prosthesis All<br />
66986 Exchange lens prosthesis All<br />
66999 Eye surgery procedure All<br />
67027 Implantation of intravitreal drug delivery<br />
system<br />
All<br />
67040 Laser treatment of retina All<br />
67101 Repair, detached retina All<br />
67105 Repair, detached retina All<br />
67107 Repair detached retina All<br />
67108 Repair detached retina All<br />
67110 Repair detached retina All<br />
67112 Re-repair detached retina All<br />
67113 Repair retinal detach, cplx All<br />
67115 Release, encircling material All<br />
67120 Remove eye implant material All<br />
67121 Remove eye implant material All<br />
67141 Treatment of retina All<br />
67145 Treatment of retina All<br />
67208 Treatment of retinal lesion All<br />
67210 Treatment of retinal lesion All<br />
67218 Treatment of retinal lesion All<br />
67220 Treatment of choroid lesion All<br />
26994OH0812
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