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 />
67221 Destruction of lesion of choriod All<br />
67225 Ocular photodynamic therapy All<br />
67227 Treatment of retinal lesion All<br />
67228 Treatment of retinal lesion All<br />
67229 Tr retinal les preterm inf All<br />
67250 Reinforce eye wall All<br />
67255 Reinforce/graft eye wall All<br />
67299 Eye surgery procedure All<br />
67311 Revise eye muscle All<br />
67312 Revise two eye muscles All<br />
67314 Revise eye muscle All<br />
67316 Revise two eye muscles All<br />
67318 Revise eye muscle(s) All<br />
67320 Revise eye muscle(s) All<br />
67331 Eye surgery follow-up All<br />
67332 Rerevise eye muscles All<br />
67334 Revise eye muscle w/suture All<br />
67335 Eye suture during surgery All<br />
67340 Revise eye muscle All<br />
67343 Release eye tissue All<br />
67345 Destroy nerve of eye muscle All<br />
67346 Biopsy, eye muscle All<br />
67399 Eye muscle surgery procedure All<br />
67400 Explore/biopsy eye socket All<br />
67405 Explore/drain eye socket All<br />
67412 Explore/treat eye socket All<br />
67413 Explore/treat eye socket All<br />
67414 Explore/decompress eye socke All<br />
67420 Explore/treat eye socket All<br />
67430 Explore/treat eye socket All<br />
67440 Explore/drain eye socket All<br />
67445 Explore/decompress eye socke All<br />
67450 Explore/biopsy eye socket All<br />
67550 Insert eye socket implant All<br />
67560 Revise eye socket implant All<br />
67570 Decompress optic nerve All<br />
26994OH0812
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