Prior Auth Required

21155 - Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining

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Procedure / ServiceReconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining
Procedure / Service Description

Code NAME/DESCRIPTION COMMENTS - 21154 Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining autografts); without LeFort I 21155 Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining autografts); with LeFort I 21159 Reconstruction midface, LeFort III (extra and intracranial) with forehead advancement (eg, mono bloc),

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.