Prior Auth Required

21086 - Impression and custom preparation; Prior Authorization Required Medical Necessity Submit history and physical

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceImpression and custom preparation; Prior Authorization Required Medical Necessity Submit history and physical
Procedure / Service Description

Code Description Plan Review Requirement Reviewed For Records Request - medical service or supply. Code Description Plan Review Requirement Reviewed For Records Request 21086 Impression and custom preparation; Prior Authorization Required Medical Necessity Submit history and physical, auricular prosthesis documentation of medical necessity. 21087 Impression and custom preparation; nasal Prior Authorization Required Medical Necessity Beginning 1/1/22 will only require review

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.