21194 prior authorization | Anthem Blue Cross Blue Shield of California
21194, Mandibular/Maxillary (Orthognathic) Surgery - Reconstruction of mandibular rami, horizontal, vertical, C or L osteotomy; with bone graft, is on the Anthem Blue Cross Blue Shield of California PPO prior authorization list. Not a coverage or referral decision.
- Code
- 21194
- Description
- Mandibular/Maxillary (Orthognathic) Surgery - Reconstruction of mandibular rami, horizontal, vertical, C or L osteotomy; with bone graft
- Source
- California PPO Prior Authorization List, Pg 36 Original policy
Anthem Blue Cross Blue Shield of California prior authorization