MedicaidCoverageMedium impact
Temporomandibular Disorders - MEDICAID - VIRGINIA (New)
Humana·VA · Oral & Maxillofacial Surgery, Orthopedics, General Surgery·Medicaid
Effective date
May 27, 2026
We identified it
Jun 24, 2026
Summary
Humana has established a new Medicaid policy for Virginia covering temporomandibular disorder (TMD) surgical procedures including arthrotomy, condylectomy, meniscectomy, and coronoidectomy. The policy requires specific symptom criteria, minimum 4 weeks of conservative treatment, and evidence of internal derangement or structural abnormalities for coverage.
Action Required
Before May 27, 2026: Billing team must update prior authorization requirements for TMD surgical procedures (CPT 21010, 21050, 21060, 21070) for Virginia Humana Medicaid members. Providers must document minimum 4 weeks of conservative treatment and evidence of internal derangement. Update encounter forms to include TMD symptom checklist and treatment history documentation requirements.