CPT Codes Requiring Prior Authorization - Molina Healthcare
CPT Codes Requiring Prior Authorization - Molina Healthcare
CPT Codes Requiring Prior Authorization - Molina Healthcare
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
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 />
42972 Control nose/throat bleeding All<br />
42999 Throat surgery procedure All<br />
43100 Excision of esophagus lesion All<br />
43101 Excision of esophagus lesion All<br />
43107 Removal of esophagus All<br />
43108 Removal of esophagus All<br />
43112 Removal of esophagus All<br />
43113 Removal of esophagus All<br />
43116 Partial removal of esophagus All<br />
43117 Partial removal of esophagus All<br />
43118 Partial removal of esophagus All<br />
43121 Partial removal of esophagus All<br />
43122 Partial removal of esophagus All<br />
43123 Partial removal of esophagus All<br />
43124 Removal of esophagus All<br />
43130 Removal of esophagus pouch All<br />
43135 Removal of esophagus pouch All<br />
43279 Lap myotomy, heller All<br />
43280 Laparoscopy, esophagogastric fundoplasty All<br />
43281 Lap paraesophag hern repair All<br />
43282 Lap paraesoph her rpr w/mesh All<br />
43283 Laps esophageal lengthening addl All<br />
43289 Unlisted laparoscopy, procedure, esophagus<br />
All<br />
43300 Repair of esophagus All<br />
43305 Repair esophagus and fistula All<br />
43310 Repair of esophagus All<br />
43312 Repair esophagus and fistula All<br />
43313 Esophagoplasty defect,w/o repair fist All<br />
43314 Esophagoplasty c defect,w repair fist All<br />
43320 Fuse esophagus & stomach All<br />
43325 Revise esophagus & stomach All<br />
43327 Esopg/gstr fundoplasty w/lapt All<br />
43328 Esopg/gstr fundoplasty w/thorcom All<br />
43330 Repair of esophagus All<br />
43331 Repair of esophagus All<br />
26994OH0812
Change language