21138 prior authorization | Premera Blue Cross of Washington

21138, Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) These criteria do not imply or guarantee approval., is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 21138
Description: Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) These criteria do not imply or guarantee approval.
Source: Clinical Review by Code List PBCWA, Pg 246 Original policy

Premera Blue Cross of Washington prior authorization

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