Prior Auth Required

21243 - Arthroplasty, temporomandibular joint, with 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 / ServiceArthroplasty, temporomandibular joint, with Pre-Service Review Required Medical Necessity MDs fax to IHM at 800-843-1114; DDS or
Procedure / Service Description

documentation of medical necessity and - Fax to Dental Review @ 425-918-5956 21243 Arthroplasty, temporomandibular joint, with Pre-Service Review Required Medical Necessity MDs fax to IHM at 800-843-1114; DDS or prosthetic joint replacement DMDs: Complete the Dental Prior 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.