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 />
44700 Suspension of bowel with prosthesis All<br />
44701 Intraop colon lavage add-on All<br />
44715 Prepare donor intestine All<br />
44720 Prep donor intestine/venous All<br />
44721 Prep donor intestine/artery All<br />
44799 Intestine surgery procedure All<br />
44800 Excision of bowel pouch All<br />
44820 Excision of mesentery lesion All<br />
44850 Repair of mesentery All<br />
44899 Bowel surgery procedure All<br />
44979 Unlisted laparoscopy, procedure, appendix All<br />
45108 Removal of anorectal lesion All<br />
45110 Removal of rectum All<br />
45111 Partial removal of rectum All<br />
45112 Removal of rectum All<br />
45113 Partial proctectomy All<br />
45114 Partial removal of rectum All<br />
45116 Partial removal of rectum All<br />
45119 Proctectomy with colonic reservoir All<br />
45120 Removal of rectum All<br />
45121 Removal of rectum and colon All<br />
45123 Partial proctectomy All<br />
45126 Pelvic exenteration All<br />
45130 Excision of rectal prolapse All<br />
45135 Excision of rectal prolapse All<br />
45136 Excison of ileoanal reservoir All<br />
45150 Excision of rectal stricture All<br />
45160 Excision of rectal lesion All<br />
45171 Exc rect tum transanal part All<br />
45172 Exc rect tum transanal full All<br />
45190 Destruction rectal tumor All<br />
45395 Lap, removal of rectum All<br />
45397 Lap, remove rectum w/pouch All<br />
45400 Laparoscopic proctopexy All<br />
45402 Lap proctopexy w/sig resect All<br />
26994OH0812
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