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 />
55801 Removal of prostate All<br />
55810 Extensive prostate surgery All<br />
55812 Extensive prostate surgery All<br />
55815 Extensive prostate surgery All<br />
55821 Removal of prostate All<br />
55831 Removal of prostate All<br />
55840 Extensive prostate surgery All<br />
55842 Extensive prostate surgery All<br />
55845 Extensive prostate surgery All<br />
55860 Surgical exposure, prostate All<br />
55862 Extensive prostate surgery All<br />
55865 Extensive prostate surgery All<br />
55866 Laparo radical prostatectomy All<br />
55873 Cyrosurgical ablation of prostrate All<br />
55875 Transperi needle place, pros All<br />
55876 Place rt device/marker, pros All<br />
55899 Genital surgery procedure All<br />
56620 Partial removal of vulva All<br />
56625 Complete removal of vulva All<br />
56630 Extensive vulva surgery All<br />
56631 Extensive vulva surgery All<br />
56632 Extensive vulva surgery All<br />
56633 Extensive vulva surgery All<br />
56634 Extensive vulva surgery All<br />
56637 Extensive vulva surgery All<br />
56640 Extensive vulva surgery All<br />
56800 Repair of vagina All<br />
56805 Repair clitoris All<br />
56810 Repair of perineum All<br />
57106 Remove vagina wall, partial All<br />
57107 Remove vagina tissue/partial All<br />
57109 Vaginectomy partial w/nodes All<br />
57110 Removal of vagina All<br />
57111 Remove vagina tissue complete All<br />
57112 Vaginectomy complete w/nodes All<br />
26994OH0812
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