Prior Auth Required

21127 - 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 - orthodontic treatment. Fax to Dental Review @ 425-918-5956 21127 Augmentation, mandibular body or angle; Pre-Service Review Required Medical Necessity Submit cephalometric, panoramic films with bone graft, onlay or interpositional and photos, age and history of (includes obtaining autograft) 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.