Anthem Blue Cross and Blue Shield New Hampshire prior authorization 21146

Anthem Blue Cross and Blue Shield New Hampshire prior authorization for 21146: Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted unilateral alveolar cleft)

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: New Hampshire Precertification List, Pg 86 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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