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 />
44020 Exploration of small bowel All<br />
44021 Decompress small bowel All<br />
44025 Incision of large bowel All<br />
44050 Reduce bowel obstruction All<br />
44055 Correct malrotation of bowel All<br />
44110 Excision of bowel lesion(s) All<br />
44111 Excision of bowel lesion(s) All<br />
44120 Removal of small intestine All<br />
44121 Removal of small intestine All<br />
44125 Removal of small intestine All<br />
44126 Enterectomy sm intestine, w/o taper All<br />
44127 Enterectomy sm intestine, cong,w taper All<br />
44128 Enterectomy sm intest,,ea added resec All<br />
44130 Bowel to bowel fusion All<br />
44135 Intestine transplnt, cadaver All<br />
44137 Remove intestinal allograft All<br />
44139 Mobilization of colon All<br />
44140 Partial removal of colon All<br />
44141 Partial removal of colon All<br />
44143 Partial removal of colon All<br />
44144 Partial removal of colon All<br />
44145 Partial removal of colon All<br />
44146 Partial removal of colon All<br />
44147 Partial removal of colon All<br />
44150 Removal of colon All<br />
44151 Removal of colon/ileostomy All<br />
44155 Removal of colon All<br />
44156 Removal of colon/ileostomy All<br />
44157 Colectomy w/ileoanal anast All<br />
44158 Colectomy w/neo-rectum pouch All<br />
44160 Removal of colon All<br />
44180 Lap, enterolysis All<br />
44186 Lap, jejunostomy All<br />
44187 Lap, ileo/jejuno-stomy All<br />
44188 Lap, colostomy All<br />
26994OH0812
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