21193 prior authorization | Anthem Blue Cross and Blue Shield Virginia

21193, Reconstruction, Mandibular Rami, Horizontal, Vertical, "C"/"L" Osteotomy; W/O Bone Graft, is on the Anthem Blue Cross and Blue Shield Virginia HMO/EPO prior authorization list. Not a coverage or referral decision.

Code: 21193
Description: Reconstruction, Mandibular Rami, Horizontal, Vertical, "C"/"L" Osteotomy; W/O Bone Graft
Source: Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 13 Original policy

Anthem Blue Cross and Blue Shield Virginia prior authorization

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