MedicaidCoverageMedium impact
Orthognathic Surgery - MEDICAID - OKLAHOMA (New)
Humana·OK · Oral & Maxillofacial Surgery, Dentistry, Plastic Surgery·Medicaid
Effective date
May 15, 2026
We identified it
Jun 24, 2026
Summary
Humana Oklahoma Medicaid has established a new coverage policy for orthognathic surgery (corrective jaw surgery), defining specific medical criteria and documentation requirements that must be met for coverage approval. The policy covers CPT codes 21141-21143, 21145-21147, and 21196 when strict functional impairment criteria are documented.
Action Required
Before May 15, 2026: Billing team must update prior authorization protocols for orthognathic surgery CPT codes 21141-21147 and 21196 for Oklahoma Medicaid patients. Create documentation checklists requiring clinical photographs/dental models, functional impairment descriptions, detailed history/physical exam results, imaging documentation, and specific measurement criteria for anteroposterior, vertical, transverse discrepancies or asymmetries. Train providers on the strict eligibility requirements as claims will be denied without proper documentation.