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Orthognathic Surgery - MEDICAID - VIRGINIA (New)

Humana·VA · Oral & Maxillofacial Surgery, Plastic Surgery, General Surgery·Medicaid
Effective date
May 27, 2026
We identified it
Jun 24, 2026
Days to comply

Summary

This is a new Humana Medicaid policy for Virginia that establishes coverage criteria for orthognathic surgery (corrective jaw surgery). The policy defines specific anatomical measurements, functional impairments, and documentation requirements that must be met for coverage approval.

Action Required

Action needed
Before May 27, 2026: Billing team must update prior authorization requirements for all orthognathic surgery CPT codes for Virginia Humana Medicaid patients. Providers must document specific anatomical measurements (overjet, overbite, discrepancies), functional impairments, clinical photographs, imaging studies, and meet detailed coverage criteria outlined in policy HUM-VA-2637-000. Update EMR templates to capture required documentation elements. Claims without proper documentation will be denied.

Affected Billing Codes

21100
21110
21125
21127
21141
21142
21143
21145
21146
21147
21150
21151
21154
21155
21159
21160
21188
21193
21194
21195
21196
21210
21215
21244
21247