Anthem Blue Cross Blue Shield of Georgia prior authorization 21147

Anthem Blue Cross Blue Shield of Georgia prior authorization for 21147: Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted bilateral alveolar cleft or multiple osteotomies)

Code: 21147
Description: Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted bilateral alveolar cleft or multiple osteotomies)
Source: Standard Local Prior Authorization Code List, Pg 96 Original policy

Anthem Blue Cross Blue Shield of Georgia prior authorization

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