Prior Auth Required

21145 - Reconstruction midface, LeFort I; single Pre-Service Review Required Medical Necessity MDs fax to IHM at 800-843-1114; DDS or

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceReconstruction midface, LeFort I; single Pre-Service Review Required Medical Necessity MDs fax to IHM at 800-843-1114; DDS or
Procedure / Service Description

Code Description Plan Review Requirement Reviewed For Records Request - medical service or supply. Code Description Plan Review Requirement Reviewed For Records Request 21145 Reconstruction midface, LeFort I; single Pre-Service Review Required Medical Necessity MDs fax to IHM at 800-843-1114; DDS or piece, segment movement in any direction, DMDs: Complete the Dental Prior requiring bone grafts (includes obtaining Authorization form found at:

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.