Orthognathic (Jaw) Surgery – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare considers orthognathic surgery medically necessary only for documented, measurable facial skeletal deformities associated with masticatory malocclusion (e.g., overjet ≥5 mm, molar discrepancy ≥4 mm, vertical/transverse abnormalities ≥2 SD from norms, open bite/impactions, asymmetry >3 mm) with accompanying functional impairment (masticatory/swallowing dysfunction or speech impairment); purely cosmetic procedures are excluded and OSA/TMJ surgery is covered under separate policies. Coverage requires objective documentation of the qualifying measurements, high-quality imaging/cephalometric analysis, a treating physician’s plan with surgical objectives, and is subject to member-specific benefit limits.

"Orthognathic (jaw) surgery may be considered Reconstructive and medically necessary when the following criteria are met:"

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