Prior Auth Required

21147 - Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, requiring bone grafts

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Procedure / ServiceReconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, requiring bone grafts
Procedure / Service Description

Code NAME/DESCRIPTION COMMENTS - 21146 Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted unilateral alveolar cleft) 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) 21150 Reconstruction midface, LeFort II; anterior intrusion (eg, Treacher-Collins Syndrome)

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