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 />
33692 Repair of heart defects All<br />
33694 Repair of heart defects All<br />
33697 Repair of heart defects All<br />
33702 Repair of heart defects All<br />
33710 Repair of heart defects All<br />
33720 Repair of heart defect All<br />
33722 Repair of heart defect All<br />
33724 Repair venous anomaly All<br />
33726 Repair pul venous stenosis All<br />
33730 Repair heart-vein defect(s) All<br />
33732 Repair heart-vein defect All<br />
33735 Revision of heart chamber All<br />
33736 Revision of heart chamber All<br />
33737 Revision of heart chamber All<br />
33750 Major vessel shunt All<br />
33755 Major vessel shunt All<br />
33762 Major vessel shunt All<br />
33764 Major vessel shunt & graft All<br />
33766 Major vessel shunt All<br />
33767 Atrial septectomy/septostomy All<br />
33768 Cavopulmonary shunting All<br />
33770 Repair great vessels defect All<br />
33771 Repair great vessels defect All<br />
33774 Repair great vessels defect All<br />
33775 Repair great vessels defect All<br />
33776 Repair great vessels defect All<br />
33777 Repair great vessels defect All<br />
33778 Repair great vessels defect All<br />
33779 Repair great vessels defect All<br />
33780 Repair great vessels defect All<br />
33781 Repair great vessels defect All<br />
33782 Nikaidoh proc All<br />
33783 Nikaidoh proc w/ostia implt All<br />
33786 Repair arterial trunk All<br />
33788 Revision of pulmonary artery All<br />
33800 Aortic suspension All<br />
26994OH0812
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