MedicaidCoverageHigh impact
Treatment of Temporomandibular Joint Disorders
UnitedHealthcare·Oral & Maxillofacial Surgery, Dentistry, Pain Management·Medical Policy
Effective date
Dec 1, 2026
We identified it
Oct 3, 2026
Summary
UnitedHealthcare Community Plan (Medicaid) revised its TMJ disorder treatment policy effective December 1, 2026. The policy now covers TMJ arthroplasty as medically necessary (instead of arthroscopy, discectomy, and reconstruction) and removes CPT codes 21060, 21247, 29800, and 29804 from coverage. Billing teams must immediately identify and halt claims using the removed codes, update prior authorization criteria to reference InterQual arthroplasty guidelines, and verify medical necessity documentation for all TMJ surgical procedures.
Action Required
By November 30, 2026: Billing team must (1) immediately remove CPT codes 21060, 21247, 29800, and 29804 from active billing in all systems for UnitedHealthcare Community Plan Medicaid members to prevent claim denials; (2) update prior authorization workflows to require InterQual® CP: Procedures, Arthroplasty, Temporomandibular Joint (TMJ) criteria for any TMJ surgical procedures; (3) remove references to the old InterQual criteria (Arthroscopy, Discectomy, Reconstruction TMJ guidelines) from encounter templates and billing software; (4) audit recent claims (past 90 days) for the four removed codes and contact UHC for guidance on claim resubmission or adjustment; (5) notify providers and front-desk staff that TMJ arthroscopy, discectomy, and reconstruction procedures are no longer covered under this plan—only arthroplasty is covered when medically necessary. Failure to remove these codes will result in automatic claim denials on or after December 1, 2026.