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Treatment of Temporomandibular Joint Disorders (for Idaho Only)
Effective date
Dec 1, 2026
Identified
Nov 7, 2026
Summary
UnitedHealthcare Community Plan of Idaho revised its Medicaid medical policy on treatment of temporomandibular joint (TMJ) disorders, effective 2026-12-01. TMJ arthroplasty is now the only TMJ surgical service described as proven and medically necessary in certain circumstances, with medical necessity criteria pointing to InterQual CP: Procedures, Arthroplasty, Temporomandibular Joint (TMJ) (Custom) - UHG; arthroscopy and discectomy criteria were removed. CPT codes 21060, 21247, 29800, and 29804 were removed from the applicable codes list.
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What to do
Action · 4 steps
01Before 2026-12-01: Billing team should stop scheduling and billing TMJ arthroscopy and discectomy for Idaho Community Plan members under the removed services, and update charge entry so CPT 21060, 21247, 29800, and 29804 are no longer selected for these members.
02Providers and front desk staff should be told that TMJ arthroplasty is the surgical option still described as medically necessary in certain circumstances, and that its criteria are in InterQual CP: Procedures, Arthroplasty, Temporomandibular Joint (TMJ) (Custom) - UHG.
03Billing team should obtain prior authorization and attach supporting documentation that meets those criteria before scheduling arthroplasty for these members, since claims lacking required review may be denied.
04Nonsurgical services (arthrocentesis, intra-articular corticosteroid injections, trigger point injections, physical therapy, occlusal splints) remain described as medically necessary, and the front desk should be told that biofeedback, jaw mobility stretching devices, multiple occlusal splints, and epigenetic appliances are described as not medically necessary for TMJ disorders.
Codes mentioned
21060212472980029804
Original notice
Treatment of Temporomandibular Joint Disorders (for Idaho Only)
uhcprovider.com · Always check the source before changing claims.
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