Prior Auth Required

21088 - Impression and custom preparation; facial Pre-Service Review Required Cosmetic - Reconstructive Submit chart notes including type of

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceImpression and custom preparation; facial Pre-Service Review Required Cosmetic - Reconstructive Submit chart notes including type of
Procedure / Service Description

documentation of medical necessity and - procedure report. 21088 Impression and custom preparation; facial Pre-Service Review Required Cosmetic - Reconstructive Submit chart notes including type of prosthesis appliance, history of re-occurring TMJ and copy of diagnostic sleep studies. Fax

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.