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 />
50580 Kidney endoscopy & treatment All<br />
50590 Fragmenting of kidney stone All<br />
50592 Perc rf ablate renal tumor All<br />
50593 Perc cryo ablate renal tum All<br />
50600 Exploration of ureter All<br />
50605 Insert ureteral support All<br />
50610 Removal of ureter stone All<br />
50620 Removal of ureter stone All<br />
50630 Removal of ureter stone All<br />
50650 Removal of ureter All<br />
50660 Removal of ureter All<br />
50700 Revision of ureter All<br />
50715 Release of ureter All<br />
50722 Release of ureter All<br />
50725 Release/revise ureter All<br />
50727 Revise ureter All<br />
50728 Revise ureter All<br />
50740 Fusion of ureter & kidney All<br />
50750 Fusion of ureter & kidney All<br />
50760 Fusion of ureters All<br />
50770 Splicing of ureters All<br />
50780 Reimplant ureter in bladder All<br />
50782 Reimplant ureter in bladder All<br />
50783 Reimplant ureter in bladder All<br />
50785 Reimplant ureter in bladder All<br />
50800 Implant ureter in bowel All<br />
50810 Fusion of ureter & bowel All<br />
50815 Urine shunt to bowel All<br />
50820 Construct bowel bladder All<br />
50825 Construct bowel bladder All<br />
50830 Revise urine flow All<br />
50840 Replace ureter by bowel All<br />
50845 Appendico-vesicostomy All<br />
50860 Transplant ureter to skin All<br />
50900 Repair of ureter All<br />
26994OH0812
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