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 />
46740 Construction of absent anus All<br />
46742 Repair, imperforated anus All<br />
46744 Repair, cloacal anomaly All<br />
46746 Repair, cloacal anomaly All<br />
46748 Repair, cloacal anomaly All<br />
46750 Repair of anal sphincter All<br />
46751 Repair of anal sphincter All<br />
46753 Reconstruction of anus All<br />
46760 Repair of anal sphincter All<br />
46761 Repair of anal sphincter All<br />
46762 Implant artificial sphincter All<br />
46999 Anus surgery procedure All<br />
47001 Needle biopsy, liver All<br />
47015 Inject/aspirate liver cyst All<br />
47100 Wedge biopsy of liver All<br />
47120 Partial removal of liver All<br />
47122 Extensive removal of liver All<br />
47125 Partial removal of liver All<br />
47130 Partial removal of liver All<br />
47135 Transplantation of liver All<br />
47136 Transplantation of liver All<br />
47140 Partial Removal, Donor Liver All<br />
47141 Partial Removal, Donor Liver All<br />
47142 Partial Removal, Donor Liver All<br />
47143 Prep donor liver, whole All<br />
47144 Prep donor liver, 3-segment All<br />
47145 Prep donor liver, lobe split All<br />
47146 Prep donor liver/venous All<br />
47147 Prep donor liver/arterial All<br />
47300 Surgery for liver lesion All<br />
47370 Laparosc radiofreq ablat l tumor, radio All<br />
47371 Laparosc radiofreq ablat l tumor, cyro All<br />
47379 Laparoscope procedure, liver All<br />
47380 Ablation of liver tumor, 1 or more All<br />
47381 Open cryosurgical ablation liver tumor All<br />
47382 Perc radiofreq ablation liver tumor All<br />
26994OH0812
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