MedicaidCoverageMedium impact
Orthognathic Surgery - MEDICAID - SOUTH CAROLINA (New)
Humana·SC · Oral & Maxillofacial Surgery, Dentistry·Medicaid
Effective date
May 25, 2026
We identified it
Jun 24, 2026
Summary
New Medicaid policy establishes comprehensive coverage criteria for orthognathic (corrective jaw) surgery in South Carolina, requiring specific documentation of functional impairments and measurable skeletal deformities. This affects billing for oral and maxillofacial surgical procedures with detailed prior authorization requirements.
Action Required
Before May 25, 2026: Billing team and oral surgeons must update prior authorization processes for orthognathic surgery codes to require clinical photographs/dental models, detailed functional impairment documentation, imaging studies, and specific measurements of skeletal deformities (anteroposterior discrepancies of 4mm+, vertical deformities 2+ standard deviations from norms, etc.). Update encounter forms and EMR templates to capture required documentation elements. Claims will be denied without meeting all specified criteria.