21143 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

21143, Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, without bone graft, is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.

Code: 21143
Description: Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, without bone graft
Source: New Hampshire Precertification List, Pg 86 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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