Prior Auth Required

21125 - Augmentation, mandibular body or angle; Pre-Service Review Required Medical Necessity Submit cephalometric, panoramic films

This procedure appears on the selected insurer prior authorization source.

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Procedure / ServiceAugmentation, mandibular body or angle; Pre-Service Review Required Medical Necessity Submit cephalometric, panoramic films
Procedure / Service Description

Code Description Plan Review Requirement Reviewed For Records Request - obtaining autografts) orthodontic treatment. Fax to Dental Review @ 425-918-5956 21125 Augmentation, mandibular body or angle; Pre-Service Review Required Medical Necessity Submit cephalometric, panoramic films prosthetic material 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.