Blue Cross and Blue Shield of Montana prior authorization 21146

Blue Cross and Blue Shield of Montana 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: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 10 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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