MedicaidCoverageMedium impact
Orthognathic Surgery - MEDICAID - FLORIDA (New)
Humana·FL · Oral & Maxillofacial Surgery, Plastic Surgery·Medicaid
Effective date
Jun 22, 2026
We identified it
Jun 24, 2026
Summary
New Florida Medicaid policy establishes coverage criteria for orthognathic surgery procedures. The policy defines specific documentation requirements and clinical criteria including anteroposterior discrepancies of 4+ mm, vertical deformities 2+ standard deviations from norms, and functional impairments like speech/swallowing issues.
Action Required
Before June 22, 2026: Billing team must update prior authorization requirements for orthognathic surgery CPT codes for Florida Medicaid members. Ensure documentation includes clinical photographs, functional impairment descriptions, detailed history/physical, imaging, and specific measurement criteria (4+ mm discrepancies, 2+ standard deviation deformities). Update encounter forms to prompt providers for required documentation elements. Claims without proper documentation will be denied.