Orthognathic surgery is corrective jaw surgery, which payers classify as either medically necessary or aesthetic (not medically necessary). With most payers, surgery performed to correct functional impairments, after conservative measures have failed, would be considered medically necessary.
Conditions considered medically necessary for this surgery may include:
Skeletal deformities of the maxilla or mandible causing significant dysfunction of the muscles that move the jaw and the temporomandibular joints, including: antero-posterior discrepancies, vertical discrepancies, transverse discrepancies, or asymmetries (Q67.0)
Irritation of buccal or lingual soft tissues from the opposing arch in a patient with a deep overbite
Skeletal discrepancies associated with sleep apnea, airway defects, and soft tissue discrepancies
Acute traumatic facial injuries and/or their post surgical sequela
Benign tumors, malignant tumors, cysts, or their post-surgical sequela
Congenital anomalies like midface hypoplasia (Q87.0), Pierre Robin Syndrome (Q87.0), Hemifacial microsomia (Q67.4), and Treacher Collins Syndrome (Q75.4)
Cleft palate (Q35.-), Cleft lip (Q36.-), or both cleft palate with cleft lip (Q37.-)
Supraeruption of a dento-alveolar segment due to lack of opposing occlusion creating dysfunction with failed trial of prosthetics
Note: Always check individual payer policies to identify the specific criteria that must be met for the diagnosis to qualify as medically necessary for orthognathic surgery, as each payer policy may slightly differ from the other.
TIP: Orthognathic surgery for temporomandibular joint pathology, pain, or dysfunction is generally considered experimental/investigational and therefore excluded from coverage. There may be exceptions to this so be sure to verify specific payer policies.
Article Tags (click on a tag to see related articles)
Publish this Article on your Website, Blog or Newsletter
This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. If you would like to publish this article, please contact us and let us know where you will be publishing it. The easiest way to get the text of the article is to highlight and copy. Or use your browser's "View Source" option to capture the HTML formatted code.
If you would like a specific article written on a medical coding and billing topic, please Contact Us.
Our contact information
Find A Code, LLC
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (9-5 Mountain)