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 />
27446 Revision of knee joint All<br />
27447 Total knee replacement All<br />
27448 Incision of thigh All<br />
27450 Incision of thigh All<br />
27454 Realignment of thigh bone All<br />
27455 Realignment of knee All<br />
27457 Realignment of knee All<br />
27465 Shortening of thigh bone All<br />
27466 Lengthening of thigh bone All<br />
27468 Shorten/lengthen thighs All<br />
27470 Repair of thigh All<br />
27472 Repair/graft of thigh All<br />
27475 Surgery to stop leg growth All<br />
27477 Surgery to stop leg growth All<br />
27479 Surgery to stop leg growth All<br />
27485 Surgery to stop leg growth All<br />
27486 Revise knee joint replace All<br />
27487 Revise knee joint replace All<br />
27488 Removal of knee prosthesis All<br />
27495 Reinforce thigh All<br />
27496 Decompression of thigh/knee All<br />
27497 Decompression of thigh/knee All<br />
27498 Decompression of thigh/knee All<br />
27499 Decompression of thigh/knee All<br />
27580 Fusion of knee All<br />
27590 Amputate leg at thigh All<br />
27591 Amputate leg at thigh All<br />
27592 Amputate leg at thigh All<br />
27594 Amputation follow-up surgery All<br />
27596 Amputation follow-up surgery All<br />
27598 Amputate lower leg at knee All<br />
27599 Leg surgery procedure All<br />
27600 Decompression of lower leg All<br />
27601 Decompression of lower leg All<br />
27602 Decompression of lower leg All<br />
26994OH0812
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