21159 prior authorization | Anthem Blue Cross Blue Shield of California

21159, Reconstruction midface, LeFort III (extra and intracranial) with forehead advancement (e.g., mono bloc), requiring bone grafts (includes obtaining autografts), is on the Anthem Blue Cross Blue Shield of California PPO prior authorization list. Not a coverage or referral decision.

Code: 21159
Description: Reconstruction midface, LeFort III (extra and intracranial) with forehead advancement (e.g., mono bloc), requiring bone grafts (includes obtaining autografts)
Source: California PPO Prior Authorization List, Pg 3 Original policy

Anthem Blue Cross Blue Shield of California prior authorization

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