Medicare AdvantageAdministrativeLow impact
MA11.083a, Orthognathic Surgery
Independence Blue Cross·NJ · Oral & Maxillofacial Surgery, Plastic Surgery·Medical Policy
We identified it
Sep 5, 2026
Summary
This is a reissue of MA11.083a with no substantive changes to orthognathic surgery coverage criteria. The policy continues to cover orthognathic surgery for Independence Blue Cross Medicare Advantage members when medically necessary (not cosmetic) and when facial skeletal discrepancy measurements AND functional impairments are documented. The most recent reissue was 09/02/2026 as part of the annual review process; no new coverage criteria, restrictions, or billing code changes were introduced.
Action Required
No immediate action required. This reissue confirms the Company's continuing position on orthognathic surgery coverage with no substantive changes to medical necessity criteria, covered services, or billing codes. Billing team should verify current system rules align with the existing criteria: (1) orthognathic surgery is NOT covered when performed for cosmetic purposes; (2) surgery IS covered when nonsurgical correction has failed AND the patient meets BOTH a facial skeletal discrepancy measurement AND a functional impairment criterion; (3) pre- and postsurgical orthodontics remain non-covered. If your practice bills any of the listed CPT/HCPCS codes for orthognathic procedures, confirm documentation in patient records demonstrates both skeletal measurements and functional impairment per policy requirements to prevent denials.