Prior Auth Required

14021 - Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq cm to 30.0 sq cm

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Procedure / ServiceAdjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq cm to 30.0 sq cm
Procedure / Service Description

Code NAME/DESCRIPTION COMMENTS - 11047 each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) 14000 Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less 14021 Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq cm to 30.0 sq cm Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands 14040 and/or feet; defect 10 sq cm or less

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
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  • Use the insurer authorization workflow for this listed code.