Medicare AdvantageCoverageMedium impact
Orthognathic Surgery - Medicare Advantage (Revised)
Humana·Oral & Maxillofacial Surgery, Dentistry, Plastic Surgery·Medicare Advantage
Effective date
Feb 2, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated their orthognathic surgery coverage policy with revised criteria for medical necessity determination. The policy establishes specific documentation requirements and measurement thresholds for jaw surgery coverage, including anteroposterior discrepancies of 4mm or more, vertical discrepancies 2+ standard deviations from norms, and transverse discrepancies of 3-4mm or greater.
Action Required
Before February 2, 2026: Billing team must update pre-authorization documentation requirements for orthognathic surgery cases to include clinical photographs/dental models, detailed functional impairment descriptions, imaging documentation, and specific measurement criteria (4mm+ anteroposterior discrepancies, 2+ standard deviation vertical discrepancies, 3-4mm+ transverse discrepancies). Providers must document skeletal deformity source and permanency. Note that CT scans (76376, 76377) are now considered integral and not separately billable.