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Temporomandibular Disorders - MEDICAID - VIRGINIA (New)
Effective date
May 27, 2026
Identified
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.
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What to do
Action · 3 steps
01Before May 27, 2026: Billing team must update prior authorization requirements for TMD surgical procedures (CPT 21010, 21050, 21060, 21070) for Virginia Humana Medicaid members.
02Providers must document minimum 4 weeks of conservative treatment and evidence of internal derangement.
03Update encounter forms to include TMD symptom checklist and treatment history documentation requirements.
Codes mentioned
21010210502106021070
Original notice
Temporomandibular Disorders - MEDICAID - VIRGINIA (New)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Temporomandibular Disorders - Medicare Advantage (Revised)MediumEffective Feb 2, 2026 · Medicare AdvantageTemporomandibular Disorders - MEDICAID - MICHIGAN (New)MediumEffective May 22, 2026 · MedicaidTemporomandibular Disorders - MEDICAID - SOUTH CAROLINA (New)MediumEffective May 25, 2026 · MedicaidTemporomandibular Disorders - MEDICAID - FLORIDA (New)MediumEffective Jun 22, 2026 · MedicaidBrowse every Humana change in the policy list