CPT Codes Requiring Prior Authorization - Molina Healthcare

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Procedure Code CPT Codes Requiring Prior Authorization Service Description PA Required by POS 35305 Rechanneling of artery All 35306 Rechanneling of artery All 35311 Rechanneling of artery All 35321 Rechanneling of artery All 35331 Rechanneling of artery All 35341 Rechanneling of artery All 35351 Rechanneling of artery All 35355 Rechanneling of artery All 35361 Rechanneling of artery All 35363 Rechanneling of artery All 35371 Rechanneling of artery All 35372 Rechanneling of artery All 35390 Reoperation, carotid All 35400 Angioscopy All 35450 Repair arterial blockage All 35452 Repair arterial blockage All 35458 Repair arterial blockage All 35460 Repair venous blockage All 35471 Repair arterial blockage All 35472 Repair arterial blockage All 35475 Repair arterial blockage All 35476 Repair venous blockage All 35495 Atherectomy, percutaneous All 35500 Vein harvest All 35501 Artery bypass graft All 35506 Artery bypass graft All 35508 Artery bypass graft All 35509 Artery bypass graft All 35510 Artery Bypass Graft All 35511 Artery bypass graft All 35512 Artery Bypass Graft All 35515 Artery bypass graft All 35516 Artery bypass graft All 35518 Artery bypass graft All 35521 Artery bypass graft All 26994OH0812
Procedure Code CPT Codes Requiring Prior Authorization Service Description PA Required by POS 35522 Artery Bypass Graft All 35523 Artery bypass graft All 35525 Artery Bypass Graft All 35526 Artery bypass graft All 35531 Artery bypass graft All 35533 Artery bypass graft All 35535 Artery bypass graft All 35536 Artery bypass graft All 35537 Artery bypass graft All 35538 Artery bypass graft All 35539 Artery bypass graft All 35540 Artery bypass graft All 35556 Artery bypass graft All 35558 Artery bypass graft All 35560 Artery bypass graft All 35563 Artery bypass graft All 35565 Artery bypass graft All 35566 Artery bypass graft All 35570 Artery bypass graft All 35571 Artery bypass graft All 35572 Harvest femoropopliteal vein All 35583 Vein bypass graft All 35585 Vein bypass graft All 35587 Vein bypass graft All 35600 Harvest artery for cabg All 35601 Artery bypass graft All 35606 Artery bypass graft All 35612 Artery bypass graft All 35616 Artery bypass graft All 35621 Artery bypass graft All 35623 Bypass graft, not vein All 35626 Artery bypass graft All 35631 Artery bypass graft All 35632 Artery bypass graft All 35633 Artery bypass graft All 35634 Artery bypass graft All 26994OH0812
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CPT Codes Requiring Prior Authorization - Molina Healthcare

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