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 />
43332 Rpr paraesoph hiatal hernia w/lapt w/o<br />
mesh<br />
All<br />
43333 Lapt rpr paraesoph hiatal hernia w/ mesh All<br />
43334 Rpr paraesoph hiatal hernia w/thorcom<br />
w/o mesh<br />
All<br />
43335 Rpr paraesoph hiatal hernia w/thorcom w/<br />
mesh<br />
All<br />
43336 Rpr paraesoph hiatal hernia thorcoabdom<br />
w/o mesh<br />
All<br />
43337 Rpr paraesoph hiatal hernia thorcoabdom<br />
w/mesh<br />
All<br />
43338 Esophagus lengthening All<br />
43340 Fuse esophagus & intestine All<br />
43341 Fuse esophagus & intestine All<br />
43350 Surgical opening, esophagus All<br />
43351 Surgical opening, esophagus All<br />
43352 Surgical opening, esophagus All<br />
43360 Gastrointestinal repair All<br />
43361 Gastrointestinal repair All<br />
43400 Ligate esophagus veins All<br />
43401 Esophagus surgery for veins All<br />
43405 Ligate/staple esophagus All<br />
43410 Repair esophagus wound All<br />
43415 Repair esophagus wound All<br />
43420 Repair esophagus opening All<br />
43425 Repair esophagus opening All<br />
43496 Microvascular jejunum transfer All<br />
43499 Esophagus surgery procedure All<br />
43500 Surgical opening of stomach All<br />
43501 Surgical repair of stomach All<br />
43502 Surgical repair of stomach All<br />
43510 Surgical opening of stomach All<br />
43520 Incision of pyloric muscle All<br />
43605 Biopsy of stomach All<br />
43610 Excision of stomach lesion All<br />
43611 Excision of stomach lesion All<br />
26994OH0812
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