Passport Health Plan by Molina Healthcare policy
Pluvicto KY Effective Date December 4, 2025
Pluvicto KY Effective Date December 4, 2025 is a public Passport Health Plan by Molina Healthcare policy (effective Dec 4, 2025). It lists 3 CPT or HCPCS codes. Not a coverage decision; the payer's own document governs.
View the original policy (PDF) ↗
- Effective
- Dec 4, 2025
- Line of business
- Medicaid
- States
- KY
- Source
- www.molinahealthcare.com
Codes in this policy
The CPT and HCPCS codes the policy names. A policy can name a code it excludes.
| Code | Other Passport Health Plan by Molina Healthcare policies |
|---|---|
| 79101 | Policies naming 79101 |
| A9607 | Policies naming A9607 |
| A9699 | Policies naming A9699 |