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UnitedHealthcareMedicaid · Coverage · Medical Policy · TN · Oral & Maxillofacial Surgery, Orthopedics, Dentistry +1 moreMedium impact

Treatment of Temporomandibular Joint Disorders (for Tennessee Only)

Effective date
Dec 1, 2026
Identified
Nov 7, 2026

Summary

UnitedHealthcare Community Plan of Tennessee revised its Treatment of Temporomandibular Joint Disorders medical policy for Tennessee Medicaid members, effective 2026-12-01. TMJ surgical services (arthroscopy, discectomy, reconstruction) are now assessed against the InterQual CP Arthroplasty TMJ criteria instead of the prior InterQual procedures reference, and CPT 21060, 21247, 29800 and 29804 were removed from the applicable codes list. Multiple occlusal splints, jaw mobility stretching devices and epigenetic appliances remain listed as not medically necessary.

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What to do

Action · 3 steps
01By 2026-12-01: Billing team should update charge entry and claim edits for Tennessee Medicaid members so CPT 21060, 21247, 29800 and 29804 are no longer selected for TMJ services under this policy, and use the InterQual CP Arthroplasty TMJ criteria when preparing documentation for TMJ arthroscopy, discectomy or reconstruction.
02Providers and front desk staff should be told before scheduling these procedures for these members, and surgical notes should document the clinical findings the InterQual criteria require.
03Claims for multiple occlusal splints or the listed jaw-stretching and epigenetic devices should not be set up for these members, because the policy lists them as not medically necessary, and the billing team should watch for the payer's next notice on these services.

Codes mentioned

21060212472980029804

Original notice

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

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Related policy hubs

UnitedHealthcare policiesTN policy changesOral & Maxillofacial SurgeryOrthopedicsDentistryENT (Ear, Nose & Throat)Code 21060Code 21247Code 29800Code 29804

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