Prior Auth Required

21147 - Reconstruction midface, LeFort I; 3 or 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.

Check another codeExplore policy data
Prior authorizationPrior Auth Required
Procedure / ServiceReconstruction midface, LeFort I; 3 or Pre-Service Review Required Medical Necessity MDs fax to IHM at 800-843-1114; DDS or
Procedure / Service Description

requiring bone grafts (includes obtaining Authorization form found at - films and photos, age and history of orthodontic treatment 21147 Reconstruction midface, LeFort I; 3 or Pre-Service Review Required Medical Necessity MDs fax to IHM at 800-843-1114; DDS or more pieces, segment movement in any DMDs: Complete the Dental Prior direction, requiring bone grafts (includes 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.