Prior Auth Required

21116 - Injection procedure for temporomandibular Pre-Service Review Required Medical Necessity History and Physical, documentation of

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Procedure / ServiceInjection procedure for temporomandibular Pre-Service Review Required Medical Necessity History and Physical, documentation of
Procedure / Service Description

documentation of medical necessity and - and copy of diagnostic sleep studies. Fax to Dental Review @ 425-918-5956. 21116 Injection procedure for temporomandibular Pre-Service Review Required Medical Necessity History and Physical, documentation of joint arthrography medical necessity. 21120 Genioplasty; augmentation (autograft, Possible Denial; Medical Records Cosmetic Submit cephalometric, panoramic films

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.