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 />
40844 Reconstruction of mouth All<br />
40845 Reconstruction of mouth All<br />
40899 Mouth surgery procedure All<br />
41010 Incision of tongue fold All<br />
41115 Excision of tongue fold All<br />
41120 Partial removal of tongue All<br />
41130 Partial removal of tongue All<br />
41135 Tongue and neck surgery All<br />
41140 Removal of tongue All<br />
41145 Tongue removal; neck surgery All<br />
41150 Tongue, mouth, jaw surgery All<br />
41153 Tongue, mouth, neck surgery All<br />
41155 Tongue, jaw, & neck surgery All<br />
41512 Tongue suspension All<br />
41530 Tongue base vol reduction All<br />
41599 Tongue and mouth surgery All<br />
41800 Drainage of gum lesion All<br />
41805 Removal foreign body, gum All<br />
41806 Removal foreign body,jawbone All<br />
41821 Excision of gum flap All<br />
41822 Excision of gum lesion All<br />
41823 Excision of gum lesion All<br />
41825 Excision of gum lesion All<br />
41826 Excision of gum lesion All<br />
41827 Excision of gum lesion All<br />
41850 Treatment of gum lesion All<br />
41899 Dental surgery procedure All<br />
42104 Excision lesion, mouth roof All<br />
42106 Excision lesion, mouth roof All<br />
42107 Excision lesion, mouth roof All<br />
42120 Remove palate/lesion All<br />
42140 Excision of uvula All<br />
42145 Repair,palate,pharynx/uvula All<br />
42160 Treatment mouth roof lesion All<br />
42180 Repair palate All<br />
42182 Repair palate All<br />
26994OH0812
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