21146 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

21146, Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted unilateral alveolar cleft), is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.

Code: 21146
Description: Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted unilateral alveolar cleft)
Source: New Hampshire Precertification List, Pg 86 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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