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 />
21630 Extensive sternum surgery All<br />
21632 Extensive sternum surgery All<br />
21685 Hyoid Myotomy & Suspension All<br />
21700 Revision of neck muscle All<br />
21705 Revision of neck muscle/rib All<br />
21720 Revision of neck muscle All<br />
21725 Revision of neck muscle All<br />
21740 Reconstruction of sternum All<br />
21742 Repair stern/nuss w/o scope All<br />
21743 Repair sternum/nuss w/scope All<br />
21899 Neck/chest surgery procedure All<br />
21931 Exc back les sc = 3 cm All<br />
21932 Exc back tum deep < 5 cm All<br />
21933 Exc back tum deep = 5 cm All<br />
21935 Resect back tum
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