CPT Codes Requiring Prior Authorization - Molina Healthcare

More documents

Recommendations

Info

Procedure Code CPT Codes Requiring Prior Authorization Service Description PA Required by POS 21029 Contour of face bone lesion All 21030 Removal of face bone lesion All 21031 Remove exostosis, mandible All 21032 Remove exostosis, maxilla All 21034 Removal of face bone lesion All 21040 Removal of jaw bone lesion All 21044 Removal of jaw bone lesion All 21045 Extensive jaw surgery All 21046 Remove mandible cyst complex All 21047 Excise lwr jaw cyst w/repair All 21048 Remove maxilla cyst complex All 21049 Excis uppr jaw cyst w/repair All 21050 Removal of jaw joint All 21060 Remove jaw joint cartilage All 21070 Remove coronoid process All 21076 Surgical obturator prosthesis All 21077 Orbital prosthesis All 21079 Interim obturator prosthesis All 21080 Definitive obturator prosthesis All 21081 Mandibular resection prosthesis All 21082 Palatal augmentation prosthesis All 21083 Palatal left prosthesis All 21084 Speech aid prosthesis All 21085 Oral surgical splint All 21086 Auricular prosthesis All 21087 Nasal prosthesis All 21088 Facial prosthesis All 21089 Unlisted maxillofacial prosthesis All 21100 Maxillofacial fixation All 21116 Injection, jaw joint x-ray All 21120 Reconstruction of chin All 21121 Reconstruction of chin All 21122 Reconstruction of chin All 21123 Reconstruction of chin All 21125 Augmentation lower jaw bone All 21127 Augmentation lower jaw bone All 26994OH0812
Procedure Code CPT Codes Requiring Prior Authorization Service Description PA Required by POS 21137 Reduction of forehead All 21138 Reduction of forehead All 21139 Reduction of forehead All 21141 Reconstruct midface, LeFort All 21142 Reconstruct midface, LeFort All 21143 Reconstruct midface, LeFort All 21145 Reconstruct midface, lefort All 21146 Reconstruct midface, lefort All 21147 Reconstruct midface, lefort All 21150 Reconstruct midface, lefort All 21151 Reconstruct midface, lefort All 21154 Reconstruct midface, lefort All 21155 Reconstruct midface, lefort All 21159 Reconstruct midface, lefort All 21160 Reconstruct midface, lefort All 21172 Reconstruct orbit/forehead All 21175 Reconstruct orbit/forehead All 21179 Reconstruct entire forehead All 21180 Reconstruct entire forehead All 21181 Contour cranial bone lesion All 21182 Reconstruct cranial bone All 21183 Reconstruct cranial bone All 21184 Reconstruct cranial bone All 21188 Reconstruction of midface All 21193 Reconstruct lower jaw bone All 21194 Reconstruct lower jaw bone All 21195 Reconstruct lower jaw bone All 21196 Reconstruct lower jaw bone All 21198 Reconstruct lower jaw bone All 21199 Reconstr lwr jaw w/advance All 21206 Reconstruct upper jaw bone All 21208 Augmentation of facial bones All 21209 Reduction of facial bones All 21210 Face bone graft All 21215 Lower jaw bone graft All 21230 Rib cartilage graft All 26994OH0812
Page 1 and 2: Procedure Code CPT Codes Requiring
Page 7: Procedure Code CPT Codes Requiring
Page 59 and 60:
Procedure Code CPT Codes Requiring
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
show all

CPT Codes Requiring Prior Authorization - Molina Healthcare

Create successful ePaper yourself

Delete template?

Save as template?