MedicaidPrior AuthHigh impact
Clarification of Orthognathic Surgery Medical Necessity Definitions - Surgery Codes
Connecticut Medicaid (HUSKY Health)·CT · Oral & Maxillofacial Surgery, Dentistry·Provider Bulletin
Effective date
Dec 1, 2016
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid has updated medical necessity criteria for orthognathic surgery, specifying when procedures are covered versus non-covered, and requiring prior authorization for all operating room or inpatient cases. The policy clarifies that orthognathic surgery is not covered when cosmetic, for simple malocclusion correction, or when conservative treatments haven't been tried for sleep apnea patients.
Action Required
Immediately: Oral and maxillofacial surgery billing teams must implement prior authorization requirements for all orthognathic surgeries performed in operating room or requiring overnight admission. Submit PA requests to Community Health Network of Connecticut via fax at 203-265-3994 with required documentation including diagnostic imaging, cephalometric tracings, functional impairment descriptions, diagnostic testing, and facial photographs. Update billing workflows to verify patients meet medical necessity criteria before scheduling procedures. Claims without proper prior authorization will be denied.