MedicaidCoverageHigh impact
Treatment of Temporomandibular Joint Disorders (for Kansas Only)
UnitedHealthcare·KS · Oral & Maxillofacial Surgery, Dentistry, Physical Therapy +1 more·Medical Policy
Effective date
Dec 1, 2026
We identified it
Oct 3, 2026
Summary
UnitedHealthcare Community Plan of Kansas (Medicaid) is narrowing TMJ disorder coverage effective December 1, 2026. TMJ arthroplasty remains covered for adults and children, but arthroscopy, discectomy, and reconstruction procedures are no longer covered. Additionally, jaw mobility mechanical stretching devices (e.g., TheraBite, Jaw Dynasplint) are now classified as unproven and not medically necessary. Four CPT codes (21060, 21247, 29800, 29804) have been removed from applicable codes.
Action Required
By December 1, 2026: Billing team must update all billing systems and claim submission protocols to deny or reject claims for CPT codes 21060, 21247, 29800, and 29804 for UnitedHealthcare Community Plan of Kansas (Medicaid) members. Remove these codes from encounter forms and clinical templates used by providers treating TMJ disorders. Update internal coverage references to reflect that only TMJ arthroplasty (not arthroscopy, discectomy, or reconstruction) is medically necessary. Deny all claims for jaw mobility mechanical stretching devices (e.g., TheraBite, Jaw Dynasplint) as unproven for this plan. Notify providers and clinical staff of the changes to prevent claim denials. Communicate with patients in Kansas on this plan that these procedures are no longer covered effective December 1, 2026.