Prior Auth Required

21194 - Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; with bone graft (includes obtaining

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Prior authorizationPrior Auth Required
Procedure / ServiceReconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; with bone graft (includes obtaining
Procedure / Service Description

Code NAME/DESCRIPTION COMMENTS - 21193 Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; without bone graft Code NAME/DESCRIPTION COMMENTS 21194 Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; with bone graft (includes obtaining graft) 21195 Reconstruction of mandibular rami and/or body, sagittal split; without internal rigid fixation

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  • Submit clinical notes if requested by the plan
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