21172 prior authorization | Anthem Blue Cross Blue Shield of Georgia
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 Georgia 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
- Standard Local Prior Authorization Code List, Pg 96 Original policy
Anthem Blue Cross Blue Shield of Georgia prior authorization