21146 prior authorization | Blue Cross and Blue Shield of Montana

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 Blue Cross and Blue Shield of Montana commercial 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: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 10 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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