MedicaidCoverageMedium impact
Orthognathic Surgery - MEDICAID - OKLAHOMA (Revised)
Humana·OK · Oral & Maxillofacial Surgery, Plastic Surgery·Medicaid
Effective date
Jun 24, 2026
We identified it
Jun 24, 2026
Summary
New Medicaid coverage policy for orthognathic (jaw) surgery in Oklahoma, establishing detailed criteria for coverage including specific measurements for jaw discrepancies, required documentation, and functional impairments that must be met for approval.
Action Required
Before June 24, 2026: Billing team must update prior authorization workflows for orthognathic surgery codes (21141-21143, 21145-21147, 21196, 21210) for Oklahoma Medicaid members. Ensure clinical staff document required measurements (4mm+ molar discrepancies, 5mm+ overjet, etc.), functional impairments, clinical photographs, and imaging studies. Claims without meeting specific criteria will be denied.