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Guest
#1 Posted : Thursday, January 28, 2021 10:01:27 AM(UTC)
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Guest

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I was recently diagnosed with TMJ. The treatment is a very expensive orthotic. I've called my medical insurance (dental doesn't cover TMJ but medical does) and they don't understand the code. What I need is a medical code for "occlusal orthotic device" which apparently has a dental code of D7880. I've seen the D7880 on this forum but the recommended medical codes didn't seem to match up to the definition so I figured I'd ask using the exact working from the dental code book.
courtneydsnow
#2 Posted : Monday, February 1, 2021 12:55:40 PM(UTC)
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courtneydsnow

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Hi Guest!

Great question. Ever since the medical S8262 code discontinuation several years ago (which was a code that was commonly used to represent appliances/orthotics being used to treat TMJ disorders for several years), what we have found is that the two codes that are currently most commonly accepted by medical insurers for TMJD appliances are:
D7880 - occlusal orthotic device, by report
21299 - Unlisted craniofacial and maxillofacial procedure


We do run into some medical insurers that will say they won't process codes beginning with a "D" (D7880), but many do.

The wording you want to use is typically is "removable intra-oral appliance/device to treat TMJ disorder".

For example, here is a link to Aetna's medical policy for TMJ disorders:
http://www.aetna.com/cpb/medical/data/1_99/0028.html

In this policy, their wording states:

"Reversible Intra-Oral Appliances:

(i.e., removable occlusal orthopedic appliances-orthotics, stabilization appliances, occlusal splints, bite appliances/planes/splints, mandibular occlusal repositioning appliances [MORAs])"

Hope this helps!
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