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UnitedHealthcareMedicaid · Coverage · Medical Policy · KY · Oral & Maxillofacial Surgery, Dentistry, OrthopedicsMedium impact

Treatment of Temporomandibular Joint Disorders (for Kentucky Only)

Effective date
Dec 1, 2026
Identified
Nov 7, 2026

Summary

UnitedHealthcare Community Plan of Kentucky revised its Medicaid medical policy on treatment of temporomandibular joint disorders, effective 2026-12-01. For members 18 and older and under 18, TMJ arthroplasty is now the only surgical service described as proven and medically necessary in certain circumstances, with InterQual criteria cited for each age group. Jaw mobility stretching devices were added to the unproven list, and CPT codes 21060, 21247, 29800, and 29804 were removed from the applicable codes.

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What to do

Action · 3 steps
01By 2026-12-01: Billing team should remove CPT 21060, 21247, 29800, and 29804 from the TMJ procedure list in charge entry for Kentucky UnitedHealthcare Community Plan members, and check TMJ arthroplasty cases against the InterQual Arthroplasty, Temporomandibular Joint criteria before scheduling.
02Providers and front desk staff should be told that arthroscopy and discectomy of the TMJ are no longer described as proven for these members, that jaw mobility stretching devices (e.g., TheraBite, Jaw Dynasplint) are listed as unproven, and that multiple occlusal splints are listed as unproven.
03Claims for services on the unproven list will be denied, so billing should confirm these services are not billed to this plan without documentation supporting an exception.

Codes mentioned

21060212472980029804

Original notice

Treatment of Temporomandibular Joint Disorders (for Kentucky Only)
uhcprovider.com · Always check the source before changing claims.
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Related changes

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Related policy hubs

UnitedHealthcare policiesKY policy changesOral & Maxillofacial SurgeryDentistryOrthopedicsCode 21060Code 21247Code 29800Code 29804

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