Blue Cross and Blue Shield of Montana prior authorization 21147

Blue Cross and Blue Shield of Montana 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: 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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