21172 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

21172, Reconstruction superior-lateral orbital rim and lower forehead, advancement or alteration, with or without grafts (includes obtaining autografts), is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.

Code: 21172
Description: Reconstruction superior-lateral orbital rim and lower forehead, advancement or alteration, with or without grafts (includes obtaining autografts)
Source: New Hampshire Precertification List, Pg 87 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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