21146 prior authorization | Anthem Blue Cross Blue Shield of Georgia

21146, Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted unilateral alveolar cleft), is on the Anthem Blue Cross Blue Shield of Georgia prior authorization list. Not a coverage or referral decision.

Code: 21146
Description: Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted unilateral alveolar cleft)
Source: Standard Local Prior Authorization Code List, Pg 96 Original policy

Anthem Blue Cross Blue Shield of Georgia prior authorization

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