Cosmetic and Reconstructive Surgery
JJ · Effective Oct 1, 2015
3 active Medicare policies list 21195, and 21 commercial payer policies list it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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JJ · Effective Oct 1, 2015
JM · Effective Oct 1, 2015
National · Effective Jan 1, 2026
21 policies from 10 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 21195 |
|---|---|---|
| Orthognathic Surgery | Jan 1, 2026 | Covered |
| Sleep Related Breathing Disorders: Surgical Management | Jan 1, 2026 | Covered |
| Temporomandibular Joint Disorders | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 21195 |
|---|---|---|
| Orthognathic Surgery | Jan 1, 2026 | Covered |
| Sleep Related Breathing Disorders: Surgical Management |
| Jan 1, 2026 |
| Covered |
| Temporomandibular Joint Disorders | Jan 1, 2026 | Covered |
|---|
| Policy | Effective | Status of 21195 |
|---|---|---|
| Orthognathic Surgery | Jan 1, 2026 | Covered |
| Sleep Related Breathing Disorders: Surgical Management | Jan 1, 2026 | Covered |
| Temporomandibular Joint Disorders | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 21195 |
|---|---|---|
| Orthognathic Surgery | Jan 1, 2026 | Covered |
| Sleep Related Breathing Disorders: Surgical Management | Jan 1, 2026 | Covered |
| Temporomandibular Joint Disorders | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 21195 |
|---|---|---|
| Mandibular/Maxillary (Orthognathic) Surgery | Jul 1, 2026 | Covered |
| Oral, Pharyngeal and Maxillofacial Surgical Treatment for Obstructive Sleep Apnea or Snoring | Oct 1, 2026 | Covered |
| Policy | Effective | Status of 21195 |
|---|---|---|
| Cigna Commercial Other Services Code List | Mar 7, 2026 | Prior auth required |
| Cigna Comprehensive Code List | Mar 7, 2026 | Prior auth required |
| Policy | Effective | Status of 21195 |
|---|---|---|
| Gender Affirming Interventions for Gender Dysphoria | Apr 1, 2026 | Covered |
| Orthognathic Surgery | Apr 1, 2026 | Covered |
| Policy | Effective | Status of 21195 |
|---|---|---|
| Orthognathic Surgery | Not recorded | Covered |
| Policy | Effective | Status of 21195 |
|---|---|---|
| Orthognathic Surgery | Feb 2, 2026 | Covered |
| Policy | Effective | Status of 21195 |
|---|---|---|
| Treatment of Temporomandibular Joint (TMJ) | Not recorded | Covered |