21194 prior authorization | Anthem Blue Cross Blue Shield of Georgia
21194, Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; with bone graft (includes obtaining graft), is on the Anthem Blue Cross Blue Shield of Georgia prior authorization list. Not a coverage or referral decision.
- Code
- 21194
- Description
- Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; with bone graft (includes obtaining graft)
- Source
- Standard Local Prior Authorization Code List, Pg 128 Original policy
Anthem Blue Cross Blue Shield of Georgia prior authorization