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 />
28238 Revision of foot tendon All<br />
28240 Release of big toe All<br />
28250 Revision of foot fascia All<br />
28260 Release of midfoot joint All<br />
28261 Revision of foot tendon All<br />
28262 Revision of foot and ankle All<br />
28264 Release of midfoot joint All<br />
28270 Release of foot contracture All<br />
28272 Release of toe joint, each Hospital setting only or if performed by a podiatrist<br />
28280 Fusion of toes All<br />
28285 Repair of hammertoe All<br />
28286 Repair of hammertoe All<br />
28288 Partial removal of foot bone All<br />
28289 Hallux rigidus correction All<br />
28290 Correction of bunion All<br />
28292 Correction of bunion All<br />
28293 Correction of bunion All<br />
28294 Correction of bunion All<br />
28296 Correction of bunion All<br />
28297 Correction of bunion All<br />
28298 Correction of bunion All<br />
28299 Correction of bunion All<br />
28300 Incision of heel bone All<br />
28302 Incision of ankle bone All<br />
28304 Incision of midfoot bones All<br />
28305 Incise/graft midfoot bones All<br />
28306 Incision of metatarsal All<br />
28307 Incision of metatarsal All<br />
28308 Incision of metatarsal All<br />
28309 Incision of metatarsals All<br />
28310 Revision of big toe All<br />
28312 Revision of toe All<br />
28313 Repair deformity of toe All<br />
28315 Removal of sesamoid bone All<br />
28320 Repair of foot bones All<br />
26994OH0812