MedicaidCoverageHigh impact
Treatment of Temporomandibular Joint Disorders (for New Jersey Only)
UnitedHealthcare·NJ · Oral & Maxillofacial Surgery, Pain Management, Physical Therapy +1 more·Medical Policy
Effective date
Dec 1, 2026
We identified it
Oct 3, 2026
Summary
UnitedHealthcare Community Plan of New Jersey has narrowed TMJ surgical coverage to only arthroplasty (removing arthroscopy, discectomy, and reconstruction from covered services) and updated clinical coverage criteria references for Medicaid beneficiaries in New Jersey. Four CPT codes (21060, 21247, 29800, 29804) have been removed from applicable codes, effective December 1, 2026.
Action Required
By November 30, 2026: Billing team must immediately update billing system rules and denial logic for New Jersey Medicaid claims. Remove CPT codes 21060, 21247, 29800, and 29804 from the list of covered TMJ procedures. Update authorization workflows to route all TMJ arthroplasty claims through InterQual® CP: Procedures, Arthroplasty, Temporomandibular Joint (TMJ) criteria for medical necessity review. Remove any standing authorizations or pre-approvals for the four deleted codes. Brief providers and surgical schedulers that TMJ arthroscopy, discectomy, and reconstruction procedures are no longer covered for NJ Medicaid patients and will be denied. Update encounter forms and pre-authorization request templates to reflect that only arthroplasty is covered. Failure to implement these changes will result in claim denials and patient billing complications.