Prior Auth Required

21150 - Reconstruction midface, LeFort II; anterior 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 / ServiceReconstruction midface, LeFort II; anterior Pre-Service Review Required Medical Necessity Submit cephalometric, panoramic films
Procedure / Service Description

direction, requiring bone grafts (includes Authorization form found at - films and photos, age and history of orthodontic treatment 21150 Reconstruction midface, LeFort II; anterior Pre-Service Review Required Medical Necessity Submit cephalometric, panoramic films intrusion (eg, Treacher-Collins Syndrome) 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.