Anthem Blue Cross and Blue Shield New Hampshire prior authorization 21184

Anthem Blue Cross and Blue Shield New Hampshire prior authorization for 21184: Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra- and extracranial excision of benign tumor of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes obtaining grafts); total area of bone grafting greater than 80 sq cm

Code: 21184
Description: Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra- and extracranial excision of benign tumor of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes obtaining grafts); total area of bone grafting greater than 80 sq cm
Source: New Hampshire Precertification List, Pg 87 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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