Medicare AdvantageAdministrativeLow impact
MA11.083a, Orthognathic Surgery
Independence Blue Cross·NJ · Oral & Maxillofacial Surgery, Plastic Surgery·Medical Policy
Effective date
Sep 2, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross has reissued MA11.083a with no substantive changes to orthognathic surgery coverage criteria for Medicare Advantage plans. The policy maintains existing medical necessity requirements based on facial skeletal discrepancy measurements AND functional impairments, continues to exclude cosmetic procedures, and denies coverage for pre- and post-surgical orthodontics. This is a routine annual review reissuance effective 09/02/2026.
Action Required
No immediate action required. This is a reissuance with no changes to coverage criteria, billing codes, or medical necessity requirements. Billing team should file this updated policy version in the compliance documentation system and note the 09/02/2026 effective date for reference, but existing billing workflows, prior authorization processes, and coding practices for orthognathic surgery under Independence Blue Cross Medicare Advantage plans remain unchanged. Continue applying the same facial skeletal discrepancy measurements and functional impairment criteria documented in this policy.