21172 prior authorization | Anthem Blue Cross Blue Shield of California

21172, Reconstruction superior-lateral orbital rim and lower forehead, advancement or alteration, with or without 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: 21172
Description: Reconstruction superior-lateral orbital rim and lower forehead, advancement or alteration, with or without 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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