CommercialCoverageMedium impact
Orthognathic Surgery (Overbite/Underbite)
Blue Cross & Blue Shield of Mississippi·MS · Oral & Maxillofacial Surgery, Plastic Surgery, ENT (Ear, Nose & Throat) +1 more·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBS Mississippi updated their orthognathic surgery policy with specific clinical criteria for medical necessity determinations. The policy defines precise measurements and conditions required for coverage of jaw surgery procedures, including treatment for overbite/underbite and sleep apnea cases.
Action Required
Immediately: Billing team must update prior authorization processes for orthognathic surgery cases to ensure compliance with specific clinical criteria including skeletal measurements, cephalometric angles, and documentation requirements. Providers must document precise measurements (overjet >5mm, ANB angles, facial height ratios) and failed conservative treatments before submitting claims. Update encounter forms to include required clinical measurements checklist.