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 />
35636 Artery bypass graft All<br />
35637 Artery bypass graft All<br />
35638 Artery bypass graft All<br />
35642 Artery bypass graft All<br />
35645 Artery bypass graft All<br />
35646 Artery bypass graft All<br />
35647 Aorotofemoral bypass graft All<br />
35650 Artery bypass graft All<br />
35654 Artery bypass graft All<br />
35656 Artery bypass graft All<br />
35661 Artery bypass graft All<br />
35663 Artery bypass graft All<br />
35665 Artery bypass graft All<br />
35666 Artery bypass graft All<br />
35671 Artery bypass graft All<br />
35681 Artery bypass graft All<br />
35682 Composite bypass graft All<br />
35683 Composite bypass graft All<br />
35685 Bypass graft patency/ vein patch All<br />
35686 Bypass graft patency/AV fistula patch All<br />
35691 Arterial transposition All<br />
35693 Arterial transposition All<br />
35694 Arterial transposition All<br />
35695 Arterial transposition All<br />
35697 Reimplant Artery Each All<br />
35700 Reoperation, bypass graft All<br />
35701 Exploration, carotid artery All<br />
35721 Exploration, femoral artery All<br />
35741 Exploration popliteal artery All<br />
35761 Exploration of artery/vein All<br />
35800 Explore neck vessels All<br />
35820 Explore chest vessels All<br />
35840 Explore abdominal vessels All<br />
35860 Explore limb vessels All<br />
35870 Repair vessel graft defect All<br />
26994OH0812