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Passport Health Plan by Molina Healthcare policy

Radiation Therapy Services KY Effective Date December 4, 2025

Radiation Therapy Services KY Effective Date December 4, 2025 is a public Passport Health Plan by Molina Healthcare policy (effective Dec 4, 2025). It lists 144 CPT or HCPCS codes. Not a coverage decision; the payer's own document governs.

View the original policy (PDF) ↗

Payer
Passport Health Plan by Molina Healthcare
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.

CodeOther Passport Health Plan by Molina Healthcare policies
00006Policies naming 00006
00284Policies naming 00284
00639Policies naming 00639
00642Policies naming 00642
00663Policies naming 00663
00818Policies naming 00818
01567Policies naming 01567
02000Policies naming 02000
02118Policies naming 02118
02750Policies naming 02750
02873Policies naming 02873
03282Policies naming 03282
0394TPolicies naming 0394T
0395TPolicies naming 0395T
03965Policies naming 03965
12611Policies naming 12611
19294Policies naming 19294
19296Policies naming 19296
19297Policies naming 19297
19298Policies naming 19298
20555Policies naming 20555
21465Policies naming 21465
28923Policies naming 28923
30270Policies naming 30270
30607Policies naming 30607
31145Policies naming 31145
31643Policies naming 31643
32486Policies naming 32486
32514Policies naming 32514
32515Policies naming 32515
32701Policies naming 32701
41019Policies naming 41019
43499Policies naming 43499
47999Policies naming 47999
52514Policies naming 52514
55860Policies naming 55860
55862Policies naming 55862
55865Policies naming 55865
55875Policies naming 55875
55899Policies naming 55899
55920Policies naming 55920
57155Policies naming 57155
57156Policies naming 57156
58346Policies naming 58346
61085Policies naming 61085
61796Policies naming 61796
61797Policies naming 61797
61798Policies naming 61798
61799Policies naming 61799
61800Policies naming 61800
63620Policies naming 63620
63621Policies naming 63621
67218Policies naming 67218
76145Policies naming 76145
76873Policies naming 76873
76965Policies naming 76965
77011Policies naming 77011
77014Policies naming 77014
77261Policies naming 77261
77262Policies naming 77262
77263Policies naming 77263
77280Policies naming 77280
77285Policies naming 77285
77290Policies naming 77290
77293Policies naming 77293
77295Policies naming 77295
77299Policies naming 77299
77300Policies naming 77300
77301Policies naming 77301
77306Policies naming 77306
77307Policies naming 77307
77316Policies naming 77316
77317Policies naming 77317
77318Policies naming 77318
77321Policies naming 77321
77331Policies naming 77331
77332Policies naming 77332
77333Policies naming 77333
77334Policies naming 77334
77336Policies naming 77336
77338Policies naming 77338
77370Policies naming 77370
77371Policies naming 77371
77372Policies naming 77372
77373Policies naming 77373
77385Policies naming 77385
77386Policies naming 77386
77387Policies naming 77387
77399Policies naming 77399
77401Policies naming 77401
77402Policies naming 77402
77407Policies naming 77407
77412Policies naming 77412
77417Policies naming 77417
77424Policies naming 77424
77425Policies naming 77425
77427Policies naming 77427
77431Policies naming 77431
77432Policies naming 77432
77435Policies naming 77435
77469Policies naming 77469
77470Policies naming 77470
77499Policies naming 77499
77600Policies naming 77600
77605Policies naming 77605
77610Policies naming 77610
77615Policies naming 77615
77620Policies naming 77620
77750Policies naming 77750
77761Policies naming 77761
77762Policies naming 77762
77763Policies naming 77763
77767Policies naming 77767
77768Policies naming 77768
77770Policies naming 77770
77771Policies naming 77771
77772Policies naming 77772
77778Policies naming 77778
77789Policies naming 77789
77790Policies naming 77790
77799Policies naming 77799
C2616Policies naming C2616
G0339Policies naming G0339
G0340Policies naming G0340
G0458Policies naming G0458
G6001Policies naming G6001
G6002Policies naming G6002
G6003Policies naming G6003
G6004Policies naming G6004
G6005Policies naming G6005
G6006Policies naming G6006
G6007Policies naming G6007
G6008Policies naming G6008
G6009Policies naming G6009
G6010Policies naming G6010
G6011Policies naming G6011
G6012Policies naming G6012
G6013Policies naming G6013
G6014Policies naming G6014
G6015Policies naming G6015
G6016Policies naming G6016
G6017Policies naming G6017
S0360Policies naming S0360
S1470Policies naming S1470

All Passport Health Plan by Molina Healthcare policies

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.

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