21194 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

21194, Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; with bone graft (includes obtaining graft), is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.

Code: 21194
Description: Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; with bone graft (includes obtaining graft)
Source: New Hampshire Precertification List, Pg 88 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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