Prior Auth Required

21255 - Cosmetic Potential Reconstruction of zygomatic arch and glenoid fossa

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceCosmetic Potential Reconstruction of zygomatic arch and glenoid fossa
Procedure / Service Description

Mountain Health Co-Op, Services Requiring Prior Authorization 8 - Cosmetic Potential 21249 RECONSTR JAW,FULL,ENDO IMPLNT Cosmetic Potential 21255 Reconstruction of zygomatic arch and glenoid fossa with bone and cartilage (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.