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Temporomandibular Joint Disorder
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Temporomandibular joint disorder (TMJD) benefits require prior authorization, effective 01/01/2014, and medical necessity documentation plus a treatment plan listing charges for each service must be submitted and approved before treatment starts. Diagnostic x-rays, tomograms, arthrograms, cephalograms and pantograms are medically necessary for diagnosis, and CT scan or MRI is generally reserved for pre-surgical evaluations. Electromyography, kinesiography, thermography, ultrasound imaging, joint vibration analysis and computerized mandibular scans are investigational for diagnosis.
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What to do
Action · 3 steps
01Billing team: Obtain prior authorization for TMJD benefits, and submit medical necessity documentation and a treatment plan, including charges for each service, for approval before treatment begins.
02Services for TMJD received from a non-network provider receive no benefits under this policy.
03Most member benefits have a dollar lifetime limit on TMJ services, which includes all services related to TMJ, including diagnosis and treatment.
Codes mentioned
7033670350703552101021050210852124021242212432980497110971129714097530D0330D5988D0368D0384
Original notice
Temporomandibular Joint Disorder
bcbsms.com · Always check the source before changing claims.