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MA07.024g, Medical and Surgical Treatment of Temporomandibular Joint Disorder
Effective date
Feb 26, 2024
Identified
Jun 19, 2026
Summary
Independence Blue Cross updated MA07.024g to add Condylectomy as a covered surgical treatment for TMD, introduced new CPT codes (21050, 97799) and five ICD-10 diagnosis codes for unspecified TMD conditions, added a new section on Procedures That Alter Vertical Dimension, and removed HCPCS code D9940 (occlusal guard). The policy reissue on 08/06/2025 reaffirms the company's coverage position with these expanded surgical and diagnostic options.
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What to do
Action · 8 steps
01Before claims submission.
02Billing team must update billing system to recognize CPT 21050 (Condylectomy) and 97799 as covered codes for TMD under MA07.024g when medical necessity criteria are met.
03Add the five new ICD-10 codes (M26.609, M26.619, M26.629, M26.639, M26.649) to the system's accepted diagnosis code list for TMD claims.
04Remove HCPCS code D9940 from all billing workflows and deny claims submitted with this code, as it is no longer covered.
05Update encounter templates and prior authorization forms to include the new section on Procedures That Alter Vertical Dimension (codes D7880, D7881, D9942, D9950).
06Providers must document that surgical treatment candidates meet all four criteria: refractory to at least one medical therapy, clinically significant joint pain with worsening during jaw function, evidence of mandibular malfunction, and radiologic confirmation of joint pathology.
07Claims lacking this documentation will be denied.
08Train billing staff on these changes immediately to ensure accurate coding and claim processing.
Codes mentioned
2105097799M26.609M26.619M26.629M26.639M26.649D9940
Original notice
MA07.024g, Medical and Surgical Treatment of Temporomandibular Joint Disorder
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
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