CommercialCoverageHigh impact
Treatment of Temporomandibular Joint Disorders
UnitedHealthcare·Oral & Maxillofacial Surgery, Dentistry, PM&R (Physical Medicine & Rehab) +2 more·Medical Policy
Effective date
Oct 1, 2026
We identified it
Sep 2, 2026
Summary
UnitedHealthcare revised its TMJ disorder treatment policy to narrow surgical coverage to arthroplasty only (removing coverage references for arthroscopy, discectomy, and reconstruction). Four CPT codes (21060, 21247, 29800, 29804) were removed from the policy. Medical necessity for TMJ arthroplasty now requires InterQual® CP: Procedures, Arthroplasty, TMJ criteria. Effective October 1, 2026.
Action Required
By October 1, 2026: Billing team must immediately update billing system software to remove CPT codes 21060, 21247, 29800, and 29804 from UnitedHealthcare Commercial claims processing. Update prior authorization workflows to apply only InterQual® CP: Procedures, Arthroplasty, Temporomandibular Joint (TMJ) criteria for TMJ surgical procedures—do NOT process arthroplasty claims without this specific InterQual criteria reference. Providers and clinical staff must document medical necessity using the updated InterQual arthroplasty criteria only. Flag any existing claims pending for the removed codes and contact UnitedHealthcare for guidance. Failure to comply will result in claim denials for non-covered surgical procedures (arthroscopy, discectomy, reconstruction). Educate providers that only nonsurgical services (arthrocentesis, corticosteroid injections, trigger point injections, physical therapy, occlusal splints) and TMJ arthroplasty (with proper authorization) are covered; services like biofeedback, mechanical jaw devices, multiple splints, and epigenetic appliances remain non-covered.