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 />
32670 Thoracoscopy, surgical; with removal of<br />
two lobes (bilobectomy)<br />
All<br />
32671 Thoracoscopy, surgical; with removal of<br />
lung (pneumonectomy)<br />
All<br />
32672 Thoracoscopy, surgical; with resection-plication<br />
for emphysematous lung (bullous<br />
or non-bullous) for lung volume reduction<br />
(LVRS), unilateral includes any pleural<br />
procedure, when performed<br />
All<br />
32673 Thoracoscopy, surgical; with resection of<br />
thymus, unilateral or bilateral<br />
All<br />
32674 Thoracoscopy, surgical; with mediastinal<br />
and regional lymphadenectomy (List<br />
separately in addition to code for primary<br />
procedure)<br />
All<br />
32800 Repair lung hernia All<br />
32810 Close chest after drainage All<br />
32815 Close bronchial fistula All<br />
32820 Reconstruct injured chest All<br />
32851 Lung transplant, single All<br />
32852 Lung transplant w/bypass All<br />
32853 Lung transplant, double All<br />
32854 Lung transplant w/bypass All<br />
32855 Prepare donor lung, single All<br />
32856 Prepare donor lung, double All<br />
32900 Removal of rib(s) All<br />
32905 Revise & repair chest wall All<br />
32906 Revise & repair chest wall All<br />
32940 Revision of lung All<br />
32960 Therapeutic pneumothorax All<br />
32997 Total lung lavage (unilateral) All<br />
32998 Perq rf ablate tx, pul tumor All<br />
32999 Chest surgery procedure All<br />
33010 Drainage of heart sac All<br />
33011 Repeat drainage of heart sac All<br />
33015 Incision of heart sac All<br />
33020 Incision of heart sac All<br />
26994OH0812
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