These surgeries may be recognized for payment as long as one of the following criteria is met:
1. That there is enough functional inability resulting from illness, trauma, congenital or development
anomalies. This functional inability must be directly related to facial skeletal deformities of the maxilla or mandible (that is, other causes have been ruled out) and must include one or more of the following:
a. Intraoral trauma directly related to malocclusion.
b. Difficulty in swallowing.
c. Speech difficulty resulting in unintelligible language, which has not responded to speech therapy.
d. Documented loss of biting or chewing functions.
e. Documented constriction of the person’s airway.
2. Significant Over or Under jet documented by any of the following:
a. Reverse over jet of 3mm or more, in cases of maxillary deficiency or protruded jaw.
b. An over jet of 4mm or more in cases of mandible deficiencies.
c. Open bite of 4mm or more .
d. Impinging deep bite of 7mm or more.
e. Less than 8 mm, posterior teeth in functional intercuspation as a result of abnormal growth or development. (As opposed to the loss of teeth in the arch).
3. Malocclusions not amenable to conventional orthodontic correction.
