Prior Auth Required

21193 - Reconstruction of mandibular rami, Pre-Service Review Required Medical Necessity Submit cephalometric, panoramic films

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceReconstruction of mandibular rami, Pre-Service Review Required Medical Necessity Submit cephalometric, panoramic films
Procedure / Service Description

Code Description Plan Review Requirement Reviewed For Records Request - (other than LeFort type) and bone grafts Physical including functional impairment, (includes obtaining autografts) and Operative report 21193 Reconstruction of mandibular rami, Pre-Service Review Required Medical Necessity Submit cephalometric, panoramic films horizontal, vertical, C, or L osteotomy; and photos, age and history of without bone graft 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.