Passport Health Plan by Molina Healthcare policies

Search Passport Health Plan by Molina Healthcare's public medical, payment and drug policies by CPT or HCPCS code, keyword or policy number, with links to the payer's own documents. Links open the payer's own document; check its current version before relying on it.

2 policies name J2916, those listing the fewest codes first. A policy that names a code may also list it as excluded.

Passport Health Plan by Molina Healthcare policies
Policy	Details	Codes	Source
End Stage Renal Disease (ESRD) Consolidated Billing Policy	Effective Aug 4, 2025 · Commercial, Medicaid	29	Original policy ↗
Hydrolyzed Enteral Formula Diagnosis	Commercial	30	Original policy ↗

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