21146 prior authorization | Blue Cross Blue Shield Oklahoma

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 Blue Shield Oklahoma 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 Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 205 Original policy

Blue Cross Blue Shield Oklahoma prior authorization

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