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 />
51845 Repair bladder neck All<br />
51860 Repair of bladder wound All<br />
51865 Repair of bladder wound All<br />
51880 Repair of bladder opening All<br />
51900 Repair bladder/vagina lesion All<br />
51920 Close bladder-uterus fistula All<br />
51925 Hysterectomy/bladder repair All<br />
51940 Correction of bladder defect All<br />
51960 Revision of bladder & bowel All<br />
51980 Construct bladder opening All<br />
51990 Laparoscopy, urethral suspension All<br />
51992 Laparoscopy, sling operation All<br />
51999 Laparoscope proc, bladder All<br />
52000 Cystoscopy All<br />
52001 Cystourethroscopy- remove clots All<br />
52005 Cystoscopy & ureter catheter All<br />
52649 Prostate laser enucleation All<br />
53000 Incision of urethra All<br />
53010 Incision of urethra All<br />
53020 Incision of urethra All<br />
53025 Incision of urethra All<br />
53210 Removal of urethra All<br />
53215 Removal of urethra All<br />
53220 Treatment of urethra lesion All<br />
53230 Removal of urethra lesion All<br />
53235 Removal of urethra lesion All<br />
53240 Surgery for urethra pouch All<br />
53250 Removal of urethra gland All<br />
53260 Treatment of urethra lesion All<br />
53265 Treatment of urethra lesion All<br />
53270 Removal of urethra gland All<br />
53275 Repair of urethra defect All<br />
53400 Revise urethra, 1st stage All<br />
53405 Revise urethra, 2nd stage All<br />
53410 Reconstruction of urethra All<br />
26994OH0812
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