MedicaidCoverageMedium impact
Temporomandibular Disorders - MEDICAID - FLORIDA (New)
Humana·FL · Oral & Maxillofacial Surgery, Dentistry·Medicaid
Effective date
Jun 22, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Florida has established a new policy for temporomandibular disorder (TMD) procedures, defining specific coverage criteria for CPT codes 21050 and 21070. Coverage requires documented symptoms, minimum 4 weeks of conservative treatment failure, and clinical evidence of internal derangement or specific TMJ conditions.
Action Required
Before June 22, 2026: Update prior authorization requirements for CPT 21050 and 21070 for Humana Medicaid Florida members. Ensure documentation includes specific TMD symptoms, proof of minimum 4 weeks conservative treatment failure, and clinical evidence of internal derangement. Train providers on new coverage criteria to prevent claim denials.