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2018 BCBSTX Newly Effective Preauthorization Codes for ...

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 2

2018 Blue Cross and Blue Shield of Texas Newly Effective Preauthorization Codes for Health Advocacy Solutions Premier Package

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