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 />
31090 Exploration of sinuses All<br />
31200 Removal of ethmoid sinus All<br />
31201 Removal of ethmoid sinus All<br />
31205 Removal of ethmoid sinus All<br />
31225 Removal of upper jaw All<br />
31230 Removal of upper jaw All<br />
31295 Nsl/sinus ndsc surg w/dilat maxillary<br />
sinus<br />
All<br />
31296 Nsl/sinus ndsc surg w/dilat frontal sinus All<br />
31297 Nsl/sinus ndsc surg w/dilat sphenoid sinus All<br />
31299 Sinus surgery procedure All<br />
31300 Removal of larynx lesion All<br />
31320 Diagnostic incision larynx All<br />
31360 Removal of larynx All<br />
31365 Removal of larynx All<br />
31367 Partial removal of larynx All<br />
31368 Partial removal of larynx All<br />
31370 Partial removal of larynx All<br />
31375 Partial removal of larynx All<br />
31380 Partial removal of larynx All<br />
31382 Partial removal of larynx All<br />
31390 Removal of larynx & pharynx All<br />
31395 Reconstruct larynx & pharynx All<br />
31400 Revision of larynx All<br />
31420 Removal of epiglottis All<br />
31580 Revision of larynx All<br />
31582 Revision of larynx All<br />
31584 Repair of larynx fracture All<br />
31587 Revision of larynx All<br />
31588 Revision of larynx All<br />
31590 Reinnervate larynx All<br />
31595 Larynx nerve surgery All<br />
31599 Larynx surgery procedure All<br />
31600 Incision of windpipe All<br />
31601 Incision of windpipe All<br />
26994OH0812
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