Prior Auth Required

21480 - Closed treatment of temporomandibular Pre-Service Review Required Medical Necessity Submit diagnosis, prognosis and chart

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceClosed treatment of temporomandibular Pre-Service Review Required Medical Necessity Submit diagnosis, prognosis and chart
Procedure / Service Description

(eg, for treatment of benign masseteric medical necessity, procedure report. - dental fax to Dental Review @ 425-918- 5956 21480 Closed treatment of temporomandibular Pre-Service Review Required Medical Necessity Submit diagnosis, prognosis and chart dislocation; initial or subsequent notes including history of non-invasive or non-surgical attempts to treat the TMJ.

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.