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 />
63020 Neck spine disk surgery All<br />
63030 Low back disk surgery All<br />
63035 Added spinal disk surgery All<br />
63040 Neck spine disk surgery All<br />
63042 Low back disk surgery All<br />
63043 Laminotomy, addl cervical All<br />
63044 Laminotomy, addl lumbar All<br />
63045 Removal of spinal lamina All<br />
63046 Removal of spinal lamina All<br />
63047 Removal of spinal lamina All<br />
63048 Removal of spinal lamina All<br />
63050 Cervical laminoplasty All<br />
63051 C-laminoplasty w/graft/plate All<br />
63055 Decompress spinal cord All<br />
63056 Decompress spinal cord All<br />
63057 Decompress spinal cord All<br />
63064 Decompress spinal cord All<br />
63066 Decompress spinal cord All<br />
63075 Neck spine disk surgery All<br />
63076 Neck spine disk surgery All<br />
63077 Spine disk surgery, thorax All<br />
63078 Spine disk surgery, thorax All<br />
63081 Removal of vertebral body All<br />
63082 Removal of vertebral body All<br />
63085 Removal of vertebral body All<br />
63086 Removal of vertebral body All<br />
63087 Removal of vertebral body All<br />
63088 Removal of vertebral body All<br />
63090 Removal of vertebral body All<br />
63091 Removal of vertebral body All<br />
63101 Removal Of Vertebral Body All<br />
63102 Removal Of Vertebral Body All<br />
63103 Remove Vertebral Body Add-On All<br />
63170 Incise spinal cord tract(s) All<br />
63172 Drainage of spinal cyst All<br />
26994OH0812
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