last updated 08/01/2012 garcarl
|27412||Autologous chondrocyte implantation, knee|
|27415||Osteochondral allograft, knee, open|
|27416||Osteochondral autograft(s), knee, open (eg, mosaicplasty) (includes harvesting of autograft[s])|
If you are already securely logged in and would like to submit your request online click on “Authorization Submission.”
To login/enroll in our online “Authorization Submission,” please click hyperlink.
If you would like a .pdf version of our prior authorization (hysterectomy) form, please click here.