Anthem Blue Cross and Blue Shield New Hampshire prior authorization 21145

Anthem Blue Cross and Blue Shield New Hampshire prior authorization for 21145: Reconstruction midface, LeFort I; single piece, segment movement in any direction, requiring bone grafts (includes obtaining autografts)

Code: 21145
Description: Reconstruction midface, LeFort I; single piece, segment movement in any direction, requiring bone grafts (includes obtaining autografts)
Source: New Hampshire Precertification List, Pg 86 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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