MedicaidCoverageMedium impact
Orthognathic Surgery - MEDICAID - MICHIGAN (New)
Humana·MI · Oral & Maxillofacial Surgery, Dentistry·Medicaid
Effective date
May 22, 2026
We identified it
Jun 24, 2026
Summary
Humana has established a new comprehensive coverage policy for orthognathic (corrective jaw) surgery under Michigan Medicaid, effective May 22, 2026. The policy defines detailed eligibility criteria including specific measurements for jaw discrepancies, required documentation of functional impairments, and covers 24 specific CPT codes for various jaw reconstruction procedures.
Action Required
Before May 22, 2026: Oral and maxillofacial surgery practices in Michigan must update prior authorization processes for orthognathic surgery CPT codes to include detailed documentation requirements: clinical photographs/dental models, specific functional impairment descriptions, imaging documentation, and precise jaw discrepancy measurements (4mm+ anteroposterior discrepancies, 2+ standard deviations for skeletal deformities, 3mm+ asymmetries). Update intake forms and EMR templates to capture required measurements and functional assessments. Train staff on new measurement criteria to avoid claim denials.