Medicare AdvantageCoverageMedium impact
MA07.024g, Medical and Surgical Treatment of Temporomandibular Joint Disorder
Independence Blue Cross·Oral & Maxillofacial Surgery, ENT (Ear, Nose & Throat), Pain Management·Medical Policy
Effective date
Aug 6, 2025
We identified it
Jun 19, 2026
Summary
MA07.024g policy on medical and surgical treatment of temporomandibular joint disorder has been reissued effective 08/06/2025. This is a Medicare Advantage policy update that may affect TMJ disorder treatment authorization, coverage criteria, and billing requirements. The billing team must review the full policy text to identify specific coverage changes, prior authorization requirements, and any affected procedure codes.
Action Required
By 08/06/2025: Billing team must obtain and review the complete MA07.024g policy document from the provided URL to identify: (1) any new or modified prior authorization requirements for TMJ procedures, (2) specific CPT/HCPCS codes affected, (3) medical necessity documentation requirements, and (4) coverage limitations or exclusions. Update billing system rules, prior authorization workflows, and encounter templates accordingly. Providers treating TMJ disorders must be notified of any changes to documentation requirements or authorization procedures. Claims submitted without compliance to updated requirements will be subject to denial.