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Temporomandibular Disorders - MEDICAID - SOUTH CAROLINA (New)
Effective date
May 25, 2026
Identified
Jun 24, 2026
Summary
Humana South Carolina Medicaid has established a new policy for temporomandibular disorder (TMD) procedures effective May 25, 2026. The policy covers specific surgical procedures (condylectomy and coronoidectomy) only after patients have failed at least 4 weeks of conservative treatment and meet specific clinical criteria.
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What to do
Action · 4 steps
01Before May 25, 2026: Billing team must update prior authorization requirements for CPT codes 21050 and 21070 for South Carolina Medicaid patients.
02Ensure documentation includes: patient symptoms, minimum 4 weeks of failed conservative treatment (education, medications, physical therapy, orthotics, or behavior therapy), and clinical evidence of internal derangement or structural abnormalities.
03Create checklist for providers to document required criteria.
04Claims will be denied without meeting these specific medical necessity requirements.
Codes mentioned
2105021070
Original notice
Temporomandibular Disorders - MEDICAID - SOUTH CAROLINA (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 - VIRGINIA (New)MediumEffective May 27, 2026 · MedicaidTemporomandibular Disorders - MEDICAID - FLORIDA (New)MediumEffective Jun 22, 2026 · MedicaidBrowse every Humana change in the policy list