Prior Auth Required

21120 - Genioplasty; augmentation (autograft, Possible Denial; Medical Records Cosmetic Submit cephalometric, panoramic films

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Procedure / ServiceGenioplasty; augmentation (autograft, Possible Denial; Medical Records Cosmetic Submit cephalometric, panoramic films
Procedure / Service Description

joint arthrography medical necessity. - 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 allograft, prosthetic material) Optional and photos, age and history of orthodontic treatment. Fax to Dental

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.