CommercialAdministrativeLow impact
11.14.08d, Orthognathic Surgery
Independence Blue Cross·Oral & Maxillofacial Surgery, Plastic Surgery·Medical Policy
We identified it
Sep 3, 2026
Summary
Independence Blue Cross reissued Policy 11.14.08d on orthognathic surgery, confirming continued coverage for medically necessary procedures when non-surgical correction has failed and patients meet specific facial skeletal discrepancy measurements AND functional impairment criteria. This is a reissue with no substantive coverage changes; the policy maintains its existing position that cosmetic orthognathic surgery remains excluded and that pre-/post-operative orthodontics are not covered under medical benefits.
Action Required
No immediate action required. This is a reissue confirming the Company's continuing position on orthognathic surgery with no substantive changes to coverage criteria or billing rules. Billing team should verify that current internal procedures align with the documented medical necessity requirements (facial skeletal discrepancy measurements AND functional impairments) for prior authorization and claim processing. No workflow changes are needed unless internal policies have deviated from these requirements.