Prior Auth Required

21175 - Reconstruction, bifrontal, superior-lateral orbital rims and lower forehead, advancement or alteration (eg

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Prior authorizationPrior Auth Required
Procedure / ServiceReconstruction, bifrontal, superior-lateral orbital rims and lower forehead, advancement or alteration (eg
Procedure / Service Description

Code NAME/DESCRIPTION COMMENTS - 21172 Reconstruction superior-lateral orbital rim and lower forehead, advancement or alteration, with or without grafts (includes obtaining autografts) 21175 Reconstruction, bifrontal, superior-lateral orbital rims and lower forehead, advancement or alteration (eg, plagiocephaly, trigonocephaly, brachycephaly), with or without grafts (includes obtaining autografts) 21179 Reconstruction, entire or majority of forehead and/or supraorbital rims; with grafts (allograft or prosthetic

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  • Submit clinical notes if requested by the plan
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