Medicare AdvantageCoverageMedium impact
Temporomandibular Disorders - Medicare Advantage (Revised)
Humana·Oral & Maxillofacial Surgery, Dentistry, Radiology +1 more·Medicare Advantage
Effective date
Feb 2, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has established new medical necessity criteria for TMJ/TMD imaging and surgical procedures. The policy provides specific requirements for MRI coverage (CPT 70336) including minimum 4-week conservative treatment failure, and detailed criteria for various TMJ surgical procedures including arthroscopy, arthrotomy, and joint replacement.
Action Required
Before February 2, 2026: Review all TMJ/TMD cases to ensure documentation meets new Humana Medicare Advantage criteria. Update prior authorization requests for TMJ MRI (70336) to include required symptoms and proof of 4-week conservative treatment failure. For TMJ surgeries, ensure clinical documentation supports medical necessity criteria outlined in the policy. Train providers on new documentation requirements to prevent claim denials.