Orthognathic Surgery (CPB 0095, reviewed 2026-03-18)
Effective date
Not stated in the notice
Identified
Aug 12, 2026
Summary
Aetna considers orthognathic surgery medically necessary for correction of maxillary or mandibular skeletal deformities that contribute to significant masticatory dysfunction, to airway dysfunction, or to obstructive sleep apnea, when dental therapeutics and orthodontics alone cannot adequately treat them, and for speech impairments accompanying severe cleft deformity. Orthognathic surgery performed primarily for cosmetic purposes is not covered, and no benefits are available for it. Orthognathic surgery for temporomandibular joint disease is considered experimental, investigational, or unproven, and so are several listed techniques such as Kinesio taping and three-dimensional virtual treatment planning.
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01Billing team: before pre-surgical orthodontic care begins, get orthognathic surgery precertified by Aetna's Oral and Maxillofacial Surgery Unit in plans that require precertification, because failure to obtain precertification prior to orthodontic care may result in the denial of benefits.
02Forward the following to that unit for review: a written explanation of the member's clinical course, including dates and nature of any previous treatment; physical evidence of the skeletal, facial or craniofacial deformity defined by study models and pre-orthodontic imaging; and a detailed description of the functional impairment considered to be the direct result of the skeletal abnormality.
03Orthodontic expenses for the pre- and post-surgical phases are dental in nature and are not covered under Aetna's medical plans.
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