21147 prior authorization | Anthem Blue Cross and Blue Shield Virginia

21147, Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, requiring bone grafts (includes o, is on the Anthem Blue Cross and Blue Shield Virginia HMO/EPO prior authorization list. Not a coverage or referral decision.

Code: 21147
Description: Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, requiring bone grafts (includes o
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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