CPT Codes Requiring Prior Authorization - Molina Healthcare
CPT Codes Requiring Prior Authorization - Molina Healthcare
CPT Codes Requiring Prior Authorization - Molina Healthcare
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
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 />
26478 Lengthening of hand tendon All<br />
26479 Shortening of hand tendon All<br />
26480 Transplant hand tendon All<br />
26483 Transplant/graft hand tendon All<br />
26485 Transplant palm tendon All<br />
26489 Transplant/graft palm tendon All<br />
26490 Revise thumb tendon All<br />
26492 Tendon transfer with graft All<br />
26494 Hand tendon/muscle transfer All<br />
26496 Revise thumb tendon All<br />
26497 Finger tendon transfer All<br />
26498 Finger tendon transfer All<br />
26499 Revision of finger All<br />
26500 Hand tendon reconstruction All<br />
26502 Hand tendon reconstruction All<br />
26508 Release thumb contracture All<br />
26510 Thumb tendon transfer All<br />
26516 Fusion of knuckle joint All<br />
26517 Fusion of knuckle joints All<br />
26518 Fusion of knuckle joints All<br />
26520 Release knuckle contracture All<br />
26525 Release finger contracture All<br />
26530 Revise knuckle joint All<br />
26531 Revise knuckle with implant All<br />
26535 Revise finger joint All<br />
26536 Revise/implant finger joint All<br />
26540 Repair hand joint All<br />
26541 Repair hand joint with graft All<br />
26542 Repair hand joint with graft All<br />
26545 Reconstruct finger joint All<br />
26546 Repair non-union metacarpal or phalanx All<br />
26548 Reconstruct finger joint All<br />
26550 Construct thumb replacement All<br />
26551 Microvascular toe-to-hand transfer All<br />
26553 Microvascular toe-to-hand transfer All<br />
26994OH0812
Change language