Distraction Osteogenesis for Craniofacial Defects

Aetna covers distraction osteogenesis only for correction of functional impairments from specified congenital craniofacial deformities—cleft lip/palate; hemifacial microsomia in children with sufficient bone for corticotomy/osteotomy and pin placement (Pruzansky I/IIa); severe congenital mandibular deficiency requiring >10 mm lengthening; and severe micrognathia with airway obstruction—and considers it experimental/investigational for acquired craniofacial defects, obstructive sleep apnea, other craniofacial indications, use of BMPs/platelet/bone marrow adjuncts, cosmetic-only cases, and for dental/orthodontic preparation when those benefits are excluded. Key requirements: documentation of functional impairment and the specific anatomic criteria (sufficient bone for distraction or >10 mm required for mandibular lengthening; airway obstruction for micrognathia), check benefit plan for dental/orthodontic coverage, and CPT codes 0232T and 0481T are not covered for these indications.