|
13.3.4.10 Oral and Maxillofacial Surgery
Prior authorization is required for most oral and maxillofacial surgery, including, but not limited to, invasive procedures for clients with cleft lip or cleft palate or craniofacial anomalies which must be performed by approved cleft-craniofacial teams.
All oral surgery procedures include local anesthesia and visits for routine postoperative care.
The following procedure codes do not require prior authorization:
Use the following procedure codes for oral and maxillofacial surgery:
|
Procedure Codes
|
Limitations
|
|
D7111
|
A = NA
|
|
D7140
|
A = NA
|
|
D7210
|
A = NA
|
|
D7220
|
A = NA
|
|
D7230
|
A = NA
|
|
D7240
|
A = NA
|
|
D7241
|
A = 1 year of age and older
|
|
D7250
|
A = 1 year of age and older
|
|
D7260
|
A = NA, prior authorization
|
|
D7261
|
A = NA
|
|
D7270
|
A = NA
|
|
D7272
|
A = 1 year of age and older, prior authorization
|
|
D7280
|
A = 1 year of age and older
|
|
D7282
|
A = 1 year of age and older
|
|
D7283
|
A = 1 year of age and older
|
|
D7285
|
A = NA, prior authorization
|
|
D7286
|
A = NA, prior authorization
|
|
D7290
|
A = NA, prior authorization
|
|
D7291
|
A = 1 year of age and older, prior authorization
|
|
D7310
|
A = 1 year of age and older, prior authorization
|
|
D7320
|
A = 1 year of age and older, prior authorization
|
|
D7340
|
A = 1 year of age and older, prior authorization
|
|
D7350
|
A = 1 year of age and older, prior authorization
|
|
D7410
|
A = NA, prior authorization
|
|
D7411
|
A = NA
|
|
D7413
|
A = NA
|
|
D7414
|
A = NA
|
|
D7440
|
A = NA, prior authorization
|
|
D7441
|
A = NA, prior authorization
|
|
D7450
|
A = NA, prior authorization
|
|
D7451
|
A = NA, prior authorization
|
|
D7460
|
A = NA, prior authorization
|
|
D7461
|
A = NA, prior authorization
|
|
D7465
|
A = NA, prior authorization
|
|
D7471
|
A = NA, prior authorization
|
|
D7472
|
A = NA
|
|
D7510
|
A = NA
|
|
D7520
|
A = NA
|
|
D7530
|
A = NA, prior authorization
|
|
D7540
|
A = NA, prior authorization
|
|
D7550
|
A = NA, prior authorization
|
|
D7560
|
A = NA, prior authorization
|
|
D7670
|
A = NA
|
|
D7820
|
A = NA, prior authorization
|
|
D7880
|
A = NA, prior authorization
|
|
D7899
|
A = 1 year of age and older, prior authorization
|
|
D7910
|
A = NA
|
|
D7911
|
A = NA
|
|
D7912
|
A = NA
|
|
D7955
|
A = NA, prior authorization
|
|
D7960
|
A = NA, prior authorization
|
|
D7970
|
A = NA, prior authorization
|
|
D7971
|
A = NA, prior authorization
|
|
D7972
|
A = 1 year of age and older, prior authorization
|
|
D7980
|
A = NA, prior authorization
|
|
D7983
|
A = NA, prior authorization
|
|
D7997
|
A = NA, prior authorization
|
|
D7999
|
A = NA, prior authorization
|
|
|
|
