CPT Codes Requiring Prior Authorization - Molina Healthcare
CPT Codes Requiring Prior Authorization - Molina Healthcare
CPT Codes Requiring Prior Authorization - Molina Healthcare
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
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 />
54430 Revision of penis All<br />
54435 Revision of penis All<br />
54440 Repair of penis All<br />
54512 Excise lesion testis All<br />
54520 Removal of testis All<br />
54522 Orchiectomy, partial All<br />
54530 Removal of testis All<br />
54535 Extensive testis surgery All<br />
54550 Exploration for testis All<br />
54560 Exploration for testis All<br />
54600 Reduce testis torsion All<br />
54620 Suspension of testis All<br />
54660 Revision of testis All<br />
54670 Repair testis injury All<br />
54680 Relocation of testis(es) All<br />
54690 Laparoscopy, orchiectomy All<br />
54699 Unlisted laparoscopy procedure, testis All<br />
54900 Fusion of spermatic ducts All<br />
54901 Fusion of spermatic ducts All<br />
55000 Drainage of hydrocele All<br />
55040 Removal of hydrocele All<br />
55041 Removal of hydroceles All<br />
55060 Repair of hydrocele All<br />
55250 Removal of sperm duct(s) All<br />
55500 Removal of hydrocele All<br />
55530 Revise spermatic cord veins All<br />
55535 Revise spermatic cord veins All<br />
55540 Revise hernia & sperm veins All<br />
55550 Laparoscopy, spermatic veins All<br />
55559 Unlisted laparoscopy procedure, spermatic<br />
cord<br />
All<br />
55600 Incise sperm duct pouch All<br />
55605 Incise sperm duct pouch All<br />
55650 Remove sperm duct pouch All<br />
55680 Remove sperm pouch lesion All<br />
26994OH0812
Change language