Orthognathic Surgery - (0209)

Orthognathic surgery is covered only when BOTH a specified, quantified facial skeletal deformity and a documented functional impairment are present; procedures done solely for cosmetic appearance (e.g., genioplasty, rhinoplasty, contouring and other listed CPT codes) are excluded, and adjuncts (oral splints, computer-assisted planning/3D printing, interdental wiring, distraction osteogenesis when part of the procedure) are integral to the primary procedure and not separately reimbursable. Key requirements are meeting the numeric/clinical thresholds (e.g., overjet ≥5 mm or ≤0 mm, molar discrepancy ≥4 mm, vertical/transverse/asymmetry criteria), demonstration of functional deficits (mastication/swallowing issues, malnutrition, speech impairment, chronic myofascial pain, or OSA with sleep study and failed conservative therapy), and comprehensive documentation (H&P, cephalometric radiographs/tracings, photos, dental models, prior conservative treatment records); benefits ultimately depend on the specific plan document.