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Independence Blue CrossCommercial · Billing Codes · Medical Policy · PA · Oral & Maxillofacial Surgery, Physical Therapy, DentistryMedium impact

07.08.03i, Medical and Surgical Treatment of Temporomandibular Joint Disorder

Act
by Mar 31, 2024
Effective date
Feb 26, 2024
Identified
Jun 19, 2026

Summary

Independence Blue Cross reissued TMD policy 07.08.03i effective 02/26/2024, adding condylectomy as a covered surgical procedure, introducing new CPT codes (21050, 97799), adding five ICD-10 diagnosis codes for TMD variants, removing HCPCS code D9940 (occlusal guard), and reorganizing medical necessity criteria under a new 'Procedures That Alter Vertical Dimension' heading.

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What to do

by Mar 31, 2024 · 5 steps
01Billing team must add CPT codes 21050 and 97799 to billing system and fee schedules for TMD surgical procedures.
02Update claim scrubbing rules to recognize five new ICD-10 codes (M26.609, M26.619, M26.629, M26.639, M26.649) as valid TMD diagnoses for authorization and claims processing.
03Remove HCPCS code D9940 from all active billing templates and system configurations—this code is no longer covered; route any existing claims with D9940 for manual review and potential denial/correction.
04Providers must update documentation templates to align with 'Procedures That Alter Vertical Dimension' section for vertical dimension cases.
05Update internal policy reference materials and train billing staff on condylectomy coverage criteria.
If missed: Failure to implement will result in claim denials for new codes and incorrect reimbursement for removed codes.

Codes mentioned

2105097799M26.609M26.619M26.629M26.639M26.649D9940

Original notice

07.08.03i, Medical and Surgical Treatment of Temporomandibular Joint Disorder
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

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MA07.024g, Medical and Surgical Treatment of Temporomandibular Joint DisorderMediumEffective Feb 26, 2024 · Medical PolicyMA07.024g, Medical and Surgical Treatment of Temporomandibular Joint DisorderLowEffective Feb 26, 2024 · Medical Policy07.08.03i, Medical and Surgical Treatment of Temporomandibular Joint DisorderLowEffective Feb 26, 2024 · Medical Policy11.14.02s, Trigger Point InjectionsMediumEffective Apr 1, 2025 · PharmacyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesPA policy changesOral & Maxillofacial SurgeryPhysical TherapyDentistryCode 21050Code 97799Code M26.609Code M26.619Code M26.629Code M26.639Code M26.649Code D9940

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