CommercialAdministrativeLow impact
11.14.08d, Orthognathic Surgery
Independence Blue Cross·Oral & Maxillofacial Surgery, Plastic Surgery, General Surgery·Medical Policy
We identified it
Jun 19, 2026
Summary
Independence Blue Cross has reissued orthognathic surgery policy 11.14.08d to reaffirm its continuing position on coverage. The policy remains unchanged: orthognathic surgery is covered only when medically necessary (not cosmetic), nonsurgical correction has failed, AND the patient meets specific facial skeletal discrepancy measurements AND functional impairment criteria. Pre- and post-surgical orthodontics remain non-covered under medical benefits for commercial products.
Action Required
No immediate action required. This is a policy reissue confirming the Company's continuing position with no substantive changes to coverage criteria or billing requirements. Billing team should verify that current claim submission practices align with the documented medical necessity criteria (facial skeletal discrepancy measurements AND functional impairments) and that cosmetic procedures are being properly denied. Ensure pre- and post-surgical orthodontics (e.g., CPT codes related to braces/alignment) are not being billed under medical benefits for commercial plans.