What insurance policy changes affect CPT 21247?

There are 14 tracked policy changes affecting CPT 21247, including updates from UnitedHealthcare, Humana. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 21247?

Payers that have issued tracked updates for CPT 21247 include: UnitedHealthcare, Humana.

How do I get notified when CPT 21247 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 21247. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 21247?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

21247 — Surgical repair or rebuild of the lower jawbone to restore its structure and function.: Insurance Policy Changes

21247 Insurance Policy Changes

CPT 21247, in plain terms, covers Surgical repair or rebuild of the lower jawbone to restore its structure and function. CPT 21247 is referenced in 14 tracked payer policy changes from UnitedHealthcare and Humana. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 21247 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact

Treatment of Temporomandibular Joint Disorders

UnitedHealthcare·Effective Oct 1, 2026

UnitedHealthcare Surest narrowed TMJ disorder coverage to focus exclusively on arthroplasty as the primary surgical intervention, removing coverage references for arthroscopy, discectomy, and reconstruction procedures. Four specific CPT codes (21060, 21247, 29800, 29804) have been removed from the applicable codes list, and all TMJ surgical medical necessity reviews now require the InterQual CP: Procedures, Arthroplasty, Temporomandibular Joint (TMJ) criteria. Nonsurgical treatments (arthrocentesis, intra-articular injections, trigger point injections, occlusal splints) remain covered.

21247 Insurance Policy Changes

Treatment of Temporomandibular Joint Disorders (for New Jersey Only)

Treatment of Temporomandibular Joint Disorders (for Nebraska Only)

Treatment of Temporomandibular Joint Disorders (for Kansas Only)

Treatment of Temporomandibular Joint Disorders (for Indiana Only)

Treatment of Temporomandibular Joint Disorders

Treatment of Temporomandibular Joint Disorders

Treatment of Temporomandibular Joint Disorders

Treatment of Temporomandibular Joint Disorders

Treatment of Temporomandibular Joint Disorders

Orthognathic Surgery - MEDICAID - VIRGINIA (New)

Orthognathic Surgery - MEDICAID - FLORIDA (New)

Orthognathic Surgery - MEDICAID - SOUTH CAROLINA (New)

Orthognathic Surgery - MEDICAID - MICHIGAN (New)

Orthognathic Surgery - Medicare Advantage (Revised)