Prior Auth Required

21188 - Cosmetic Potential Reconstruction midface, osteotomies (other than LeFort type) and

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceCosmetic Potential Reconstruction midface, osteotomies (other than LeFort type) and
Procedure / Service Description

Mountain Health Co-Op, Services Requiring Prior Authorization 7 - (includes obtaining grafts) Cosmetic Potential 21188 Reconstruction midface, osteotomies (other than LeFort type) and bone grafts (includes obtaining autografts)

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.