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 />
68330 Revise eyelid lining All<br />
68335 Revise/graft eyelid lining All<br />
68340 Separate eyelid adhesions All<br />
68360 Revise eyelid lining All<br />
68362 Revise eyelid lining All<br />
68371 Harvest Eye Tissue, Alograft All<br />
68399 Eyelid lining surgery All<br />
68700 Repair tear ducts All<br />
68899 Tear duct system surgery All<br />
69110 Partial removal external ear All<br />
69120 Removal of external ear All<br />
69140 Remove ear canal lesion(s) All<br />
69145 Remove ear canal lesion(s) All<br />
69150 Extensive ear canal surgery All<br />
69155 Extensive ear/neck surgery All<br />
69300 Revise external ear All<br />
69310 Rebuild outer ear canal All<br />
69320 Rebuild outer ear canal All<br />
69399 Outer ear surgery procedure All<br />
69501 Mastoidectomy All<br />
69502 Mastoidectomy All<br />
69505 Remove mastoid structures All<br />
69511 Extensive mastoid surgery All<br />
69530 Extensive mastoid surgery All<br />
69535 Remove part of temporal bone All<br />
69550 Remove ear lesion All<br />
69552 Remove ear lesion All<br />
69554 Remove ear lesion All<br />
69601 Mastoid surgery revision All<br />
69602 Mastoid surgery revision All<br />
69603 Mastoid surgery revision All<br />
69604 Mastoid surgery revision All<br />
69605 Mastoid surgery revision All<br />
69650 Release middle ear bone All<br />
69660 Revise middle ear bone All<br />
26994OH0812
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