Hi Guest!

Yes we do not recommend using 21110 or 21089 for appliances used to treat TMD, as these codes do fall into the surgical category of CPT coding.

21110 stands for: Application of interdental fixation device for conditions other than fracture or dislocation, include removal

21089 stands for: Unlisted maxillofacial prosthetic procedure

Although we have had several report of insurers telling practices to use one of the codes listed above as what happened in your case. The request for additional documentation you listed in your post does seem to be geared toward a surgical service. If 21089 is in fact the code that your insurer requires an office to bill for a TMD appliance, the office should be able to send along their clinical documentation which will describe the exact procedures/services rendered.

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 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

If you would like to tell me the name of your insurance company, I would be happy to locate the medical policy online if it is available and see if there is a specific code listed in their policy like Aetna's.

Hope this helps!

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 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, Anthem of CA's medical policy for Temporomandibular disorders lists D7880 as an accepted HCPCS code is criteria is met:
https://www11.anthem.com...lines/gl_pw_a051149.htm

Hope this help!

In addition to the above question: The final phase of treatment is as described by doctor, "permanently set jaw/teeth to the corrected bite by crowning all of the teeth. This will allow some teeth to be built up to the corrected bite and will in turn set the whole jaw to its corrected alignment." Do you know what codes Cigna will require for this final phase? I'm about 6 months past where I should be due to the hold up with insurance. I'm in pain and cannot sleep. Thank you for your help!!

We recently got contracted with Medicare and are trying to bill medical insurance for procedures covered by medical insurance. My question is can a General Dentist bill Medicare for an TMD device and would the 21110 be a code to use?

We are trying to bill to BCBS MA Medical HMO Blue for an NTI device. The NTI website, seminar documents and paperwork recommends that the CPT code to use is 21110-52. I am reading through this thread and it appears that Dentists are not having luck with that code. I have not yet asked the Insurance provider support line if that code is payable. When I initially contacted the insurer they asked if this was MORA and told me the benefits for a MORA appliance. I'm hearing that an NTI device is not exactly a MORA which as a front desk Insurance coordinator, I honestly don't understand this and the Dentist doesn't get involved with splitting hairs with coding. Pretty much for Sleep Apnea and NTI devices since our general dentist not on the special provider list he is not considered an In Network BCBS provider so he is not going to get paid unless we get a network exception form filled out by the Patient's PCP. The PCP has agreed to write the exception letter for us but needs to have the code before writing the exception letter. I therefore do not want to have that PCP exception letter have a non payable code on it. I would greatly appreciate some guidance as to whether BCBS MA HMOBLUE MEdical will accept the 21110-52 code or if we should use a CDT Code either D9940 or D7880 to bill to Medical. Thank you so much for your time.

I am attempting to submit to HealthPartners and they state I need to include diagnosis code.....would that be M26.60 and can I submit that w/D7880. Ran in to the same thing with Medica.....needing diagnosis code??? Any help would be amazing!!

Thank you!

Hello! I have been looking through the replies on this thread and we are also having trouble with Humana medical and getting TMJ splints authorized. They are advising us to use code 21089 but I have read in this thread that that code is not appropriate. We have used 21085 in the past but Humana is giving us a hard time with this code.

I am concerned with using unlisted codes because we have no idea what reimbursement will be. Are there any options outside of unlisted codes?

I'm the BCBSMA question above. Thank you so much for your prompt answers. I called BCBSMA and asked if any of the following codes were payable under their contract and the answer was NO
D7880
D7899
21299
21110-52

I'm not going to use the DME code, the E1399 because they already told me it is not under the DME policy, it is under TMJ treatment which is payable with just a copay of $40 but noone can tell me what code is payable. Its like playing Chutes and Ladders but its not feeling like a fun game.

EDIT: Just on the phone with BCBSMA for an hour and the rep did an exhaustive look into policy and codes and told me it is a complete discrepancy that he doesn't know what code to be used and that I need to do more research and try calling the clinical line, so I will update this as I hear more but I would also love to hear back from anyone else that has had success with BCBSMA Medical

Edited by user Wednesday, March 14, 2018 10:27:08 AM(UTC)  | Reason: Not specified