Transcription of 2018 BCBSTX Newly Effective Preauthorization …
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2018 BCBSTX Newly Effective Preauthorization …
February 2018 Procedure CodeDescriptionNotes15824 RHYTIDECTOMY; FOREHEAD 15826 RHYTIDECTOMY; GLABELLAR FROWN LINES 19316 MASTOPEXY 19318 reduction mammaplasty 20930 ALLOGRAFT FOR SPINE SURGERY ONLY; MORSELIZED 20931 ALLOGRAFT FOR SPINE SURGERY ONLY; STRUCTURAL 20936 AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); LOCAL (EG, RIBS, SPINOUS PROCESS, OR LAMINAR FRAGMENTS) OBTAINED FROM SAME INCISION 20937 AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); MORSELIZED (THROUGH SEPARATE SKIN OR FASCIAL INCISION) 20938 AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); STRUCTURAL, BICORTICAL OR TRICORTICAL (THROUGH SEPARATE SKIN OR FASCIAL INCISION) 21085 IMPRESSION AND CUSTOM PREPARATION; ORAL SURGICAL SPLINT 21110 APPLICATION OF INTERDENTAL FIXATION DEVICE FOR CONDITIONS OTHER THAN FRACTURE OR DISLOCATION, INCLUDES REMOVAL 21125 AUGMENTATION, MANDIBULAR BODY OR ANGLE; PROSTHETIC MATERIAL 21127 AUGMENTATION, MANDIBULAR BODY OR ANGLE; WITH BONE GRAFT, ONLAY OR INTERPOSITIONAL (INCLUDES OBTAINING AUTOGRAFT) 21141 RECONSTRUCTION MIDFACE, LEFORT I; SINGLE PIECE, SEGMENT MOVEMENT IN ANY DIRECTION (EG, FOR LONG FACE SYNDROME), WITHOUT BONE GRAFT 21142 RECONSTRUCTION MIDFACE, LEFORT I; TWO PIECES, SEGMENT MOVEMENT IN ANY DIRECTION, WITHOUT BONE GRAFT 21143 RE
February 2018 Procedure Code Description Notes 15824 RHYTIDECTOMY; FOREHEAD 15826 RHYTIDECTOMY; GLABELLAR FROWN LINES 19316 MASTOPEXY 19318 REDUCTION MAMMAPLASTY
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