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 />
34510 Transposition of vein valve All<br />
34520 Cross-over vein graft All<br />
34530 Leg vein fusion All<br />
34800 Endovasc abdo repair w/tube All<br />
34802 Endovasc abdo repr w/device All<br />
34803 Endovas aaa repr w/3-p part All<br />
34804 Endovasc abdo repr w/device All<br />
34805 Endovasc Abdo Repair W/Pros All<br />
34806 Aneurysm press sensor add-on All<br />
34808 Endovasc abdo occlud device All<br />
34812 Xpose for endoprosth, aortic All<br />
34813 Xpose for endoprosth, femorl All<br />
34820 Xpose for endoprosth, iliac All<br />
34825 Endovasc extend prosth, init All<br />
34826 Endovasc exten prosth, addl All<br />
34830 Open aortic tube prosth repr All<br />
34831 Open aortoiliac prosth repr All<br />
34832 Open aortofemor prosth repr All<br />
34833 Xpose for endoprosth, iliac All<br />
34834 Xpose, endoprosth, brachial All<br />
34900 Endovasc iliac repr w/graft All<br />
35001 Repair defect of artery All<br />
35002 Repair artery rupture, neck All<br />
35005 Repair defect of artery All<br />
35011 Repair defect of artery All<br />
35013 Repair artery rupture, arm All<br />
35021 Repair defect of artery All<br />
35022 Repair artery rupture, chest All<br />
35045 Repair defect of arm artery All<br />
35081 Repair defect of artery All<br />
35082 Repair artery rupture, aorta All<br />
35091 Repair defect of artery All<br />
35092 Repair artery rupture, aorta All<br />
35102 Repair defect of artery All<br />
35103 Repair artery rupture, groin All<br />
26994OH0812