MedicaidCoverageMedium impact
Temporomandibular Disorders - MEDICAID - SOUTH CAROLINA (New)
Humana·SC · Oral & Maxillofacial Surgery, Dentistry·Medicaid
Effective date
May 25, 2026
We identified it
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.
Action Required
Before May 25, 2026: Billing team must update prior authorization requirements for CPT codes 21050 and 21070 for South Carolina Medicaid patients. Ensure 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. Create checklist for providers to document required criteria. Claims will be denied without meeting these specific medical necessity requirements.