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 />
37230 Revsc opn/prq tib/pero w/stnt/angiop sm<br />
vsl<br />
All<br />
37231 Revsc opn/prq tib/pero w/stnt/athr/angiop<br />
sm vsl<br />
All<br />
37232 Revsc opn/prq tib/pero w/angioplasty uni<br />
ea vsl<br />
All<br />
37233 Revsc opn/prq tib/pero w/athrc/angiop<br />
uni ea vsl<br />
All<br />
37234 Revsc opn/prq tib/pero w/stnt/angiop uni<br />
ea vsl<br />
All<br />
37235 Revsc opn/prq tib/pero w/stnt/athr/angiop<br />
ea vsl<br />
All<br />
37250 Intravascular ultrasound, initial vessel All<br />
37251 Intravascular ultrasound, each additional<br />
vessel<br />
All<br />
37500 Endoscopy ligate perf veins All<br />
37501 Vascular endoscopy procedure All<br />
37565 Ligation of neck vein All<br />
37600 Ligation of neck artery All<br />
37605 Ligation of neck artery All<br />
37606 Ligation of neck artery All<br />
37607 Ligation of fistula All<br />
37615 Ligation of neck artery All<br />
37616 Ligation of chest artery All<br />
37617 Ligation of abdomen artery All<br />
37618 Ligation of extremity artery All<br />
37619 Ligation of inferior vena cava All<br />
37650 Revision of major vein All<br />
37660 Revision of major vein All<br />
37700 Revise leg vein All<br />
37718 Ligate/strip short leg vein All<br />
37722 Ligate/strip long leg vein All<br />
37735 Removal of leg veins/lesion All<br />
37760 Ligate leg veins radical All<br />
37761 Ligate leg veins open All<br />
37780 Revision of leg vein All<br />
37785 Revise secondary varicosity All<br />
26994OH0812
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