MedicaidCoverageMedium impact
Temporomandibular Disorders - MEDICAID - MICHIGAN (New)
Humana·MI · Oral & Maxillofacial Surgery, Dentistry·Medicaid
Effective date
May 22, 2026
We identified it
Jun 24, 2026
Summary
New Humana Medicaid policy in Michigan establishes specific coverage criteria for temporomandibular disorder (TMD) surgical procedures. The policy requires documented symptoms, a minimum of 4 weeks of conservative treatment failure, and clinical evidence of internal derangement before covering TMD surgeries.
Action Required
Before May 22, 2026: Update billing protocols for Michigan Medicaid TMD cases. Ensure documentation includes specific symptoms from the approved list, proof of at least 4 weeks of failed conservative treatment, and clinical evidence of internal derangement before submitting claims for CPT codes 21050, 21060, or 21070. Claims without meeting all criteria will be denied.