Anthem Blue Cross and Blue Shield New Hampshire prior authorization 21154
Anthem Blue Cross and Blue Shield New Hampshire prior authorization for 21154: Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining autografts); without LeFort I
- Code
- 21154
- Description
- Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining autografts); without LeFort I
- Source
- New Hampshire Precertification List, Pg 86 Original policy
Anthem Blue Cross and Blue Shield New Hampshire prior authorization