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 />
33935 Transplantation, heart/lung All<br />
33944 Prepare donor heart All<br />
33945 Transplantation of heart All<br />
33960 External circulation assist All<br />
33961 External circulation assist All<br />
33967 Perc insertion intra-aortic balloon All<br />
33968 Removal of intra-aortic balloon assist<br />
device<br />
All<br />
33970 Aortic circulation assist All<br />
33971 Aortic circulation assist All<br />
33973 Insert balloon device All<br />
33974 Remove intra-aortic balloon All<br />
33975 Implant ventricular device All<br />
33976 Implant ventricular device All<br />
33977 Remove ventricular device All<br />
33978 Remove ventricular device All<br />
33979 Insert intracorp ventric assist device All<br />
33980 Remove intracorp ventr assist device All<br />
33981 Replace vad pump ext All<br />
33982 Replace vad intra w/o bp All<br />
33983 Replace vad intra w/bp All<br />
33999 Cardiac surgery procedure All<br />
34001 Removal of artery clot All<br />
34051 Removal of artery clot All<br />
34101 Removal of artery clot All<br />
34111 Removal of arm artery clot All<br />
34151 Removal of artery clot All<br />
34201 Removal of artery clot All<br />
34203 Removal of leg artery clot All<br />
34401 Removal of vein clot All<br />
34421 Removal of vein clot All<br />
34451 Removal of vein clot All<br />
34471 Removal of vein clot All<br />
34490 Removal of vein clot All<br />
34501 Repair valve, femoral vein All<br />
34502 Reconstruct, vena cava All<br />
26994OH0812
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