Prior Auth Required

21146 - bone grafts (includes obtaining autografts) (eg, ungrafted unilateral alveolar cleft)

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Procedure / Servicebone grafts (includes obtaining autografts) (eg, ungrafted unilateral alveolar cleft)
Procedure / Service Description

Ablation therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis) - 21145 Reconstruction Midface, Lefort I; 1 Piece, W/Bone Grafts Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, requiring 21146 bone grafts (includes obtaining autografts) (eg, ungrafted unilateral alveolar cleft) 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

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
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