High impact
Orthognathic Surgery (CPB 0095, reviewed 2026-03-18)
Aetna·Effective Mar 18, 2026
Aetna has issued a comprehensive clinical policy bulletin (CPB 0095) for orthognathic surgery that defines medical necessity criteria, documentation requirements, and coverage exclusions. The policy requires precertification before orthognathic surgery and clearly delineates covered skeletal deformities (masticatory dysfunction, airway defects, speech impairment with cleft) versus non-covered cosmetic procedures. Billing teams must implement precertification workflows and ensure orthognathic surgery is approved BEFORE any pre-surgical orthodontic treatment begins.