Anthem Blue Cross and Blue Shield New Hampshire prior authorization 21155

Anthem Blue Cross and Blue Shield New Hampshire prior authorization for 21155: Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining autografts); with LeFort I

Code: 21155
Description: Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining autografts); with LeFort I
Source: New Hampshire Precertification List, Pg 86 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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