21127 prior authorization | Anthem Blue Cross and Blue Shield Virginia

21127, Augmentation, Mandibular Body/Angle; W/Bone Graft/Onlay/Interpositional W/Obtaining Autograft, is on the Anthem Blue Cross and Blue Shield Virginia HMO/EPO prior authorization list. Not a coverage or referral decision.

Code: 21127
Description: Augmentation, Mandibular Body/Angle; W/Bone Graft/Onlay/Interpositional W/Obtaining Autograft
Source: Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 12 Original policy

Anthem Blue Cross and Blue Shield Virginia prior authorization

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