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Guest
#1 Posted : Monday, January 16, 2017 5:42:54 PM(UTC)
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Guest

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We make the oral appliances for TMJ and bill medical insurance for them.
We called to verify benefits for the S8262 and we were told that that code expired back in 2015 and no longer is used.

Is there a better code to use for a mandibular orthopedic re-positioning device?

Thank you~!
courtneydsnow
#2 Posted : Tuesday, January 17, 2017 8:33:01 AM(UTC)
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courtneydsnow

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Hi Guest!

What we are finding is that the code that is most commonly accepted by medical insurers currently for TMD appliances since the S8262 discontinuation June of 2015 is D7880. However, some insurers are accepting the other codes listed below as well:

D7880 - occlusal orthotic device, by report

D7899 - unspecified TMD therapy, by report

Or, if the medical insurer says they won’t process the “D” codes (most will these days, but you will run into a few that won’t), you can try:

E1399 - Durable medical equipment, miscellaneous
21299 - Unlisted craniofacial and maxillofacial procedure
21499 - Unlisted musculoskeletal procedure, head

A narrative report explaining the treatment accompanying the claim is recommended since they are all "by report", “unlisted”, or "miscellaneous" codes.

For example, Aetna's medical policy for Temporomandibular disorders lists D7880 as an accepted HCPCS code is criteria is met: http://www.aetna.com/cpb/medical/data/1_99/0028.html

Hope this helps, have a great day!
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