MedicaidCoverageHigh impact
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
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
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.