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 />
67599 Orbit surgery procedure All<br />
67800 Remove eyelid lesion All<br />
67801 Remove eyelid lesions All<br />
67805 Remove eyelid lesions All<br />
67808 Remove eyelid lesion(s) All<br />
67900 Repair brow defect All<br />
67901 Repair eyelid defect All<br />
67902 Repair eyelid defect All<br />
67903 Repair eyelid defect All<br />
67904 Repair eyelid defect All<br />
67906 Repair eyelid defect All<br />
67908 Repair eyelid defect All<br />
67909 Revise eyelid defect All<br />
67911 Revise eyelid defect All<br />
67912 Correction Eyelid W/ Implant All<br />
67914 Repair eyelid defect All<br />
67915 Repair eyelid defect All<br />
67916 Repair eyelid defect All<br />
67917 Repair eyelid defect All<br />
67921 Repair eyelid defect All<br />
67922 Repair eyelid defect All<br />
67923 Repair eyelid defect All<br />
67924 Repair eyelid defect All<br />
67950 Revision of eyelid All<br />
67961 Revision of eyelid All<br />
67966 Revision of eyelid All<br />
67971 Reconstruction of eyelid All<br />
67973 Reconstruction of eyelid All<br />
67974 Reconstruction of eyelid All<br />
67975 Reconstruction of eyelid All<br />
67999 Eyelid surgery procedure All<br />
68320 Revise/graft eyelid lining All<br />
68325 Revise/graft eyelid lining All<br />
68326 Revise/graft eyelid lining All<br />
68328 Revise/graft eyelid lining All<br />
26994OH0812
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