Prior Auth Required
11921 - Updated: September 1, 2025 Page 22 of 61
This procedure appears on the selected insurer prior authorization source.
Prior authorizationPrior Auth Required
Procedure / ServiceUpdated: September 1, 2025 Page 22 of 61
Procedure / Service Description
Procedures - 58553, 58554, 58570, 58571, 58572, 58573, 58661, 58720 11920, 11921, 11922, 11950, Updated: September 1, 2025 Page 22 of 61 © 2025 Medica
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.