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We were informed today by BlueCross BlueShield that our cross code of S8262 (for the dental code D7880) expired on 6/30/15. Wanted to know if this was correct and if so what would be the new code that we would use for a TMD appliance?
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Hi jbublik! Great question. Yes that is correct - here is a link to our news page that covers the discontinuation of S8262 and some alternate code suggestions!
https://www.dentalwriter...s_view.aspx?articleid=76Please let us know if oyu have any further questions!
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Just to clarify on the attached information, so will all medical insurance companies now accept the D7880 on the medical 1500 form for claims?
Thanks!
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Hi jbublik!
Great question! Not necessarily. From the policies I have researched in the last few weeks different insurers will list different codes in their medical policies currently. If you have a particular insurer (or a few) you are looking at, I am happy to check out their medical policy for you to see if they specify the code in their TMD medical policy!
Thanks and have a good one.
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Do you know if Medicare part B will accept the D7880 code? We are having trouble using the alternative 21089 and I am worried using a D code will cause problems with them.
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Hi! We are also having a difficult time finding a billable code for Medicare part b. Any suggestions?
Thanks
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Originally Posted by: Guest  Hi! We are also having a difficult time finding a billable code for Medicare part b. Any suggestions?
Thanks Yes, it can be challenging to find a Medicare covered code for TMJ treatment. I have some information based on their written policies.
For the ICD Code, Medicare's policy states that they may consider reimbursement based on the coding of symptoms.
Also, Medicare has stated that the billing code for a TMJ appliance is D7880.
I hope this helps!
Rose Nierman, CEO of Nierman Practice Management
Our seminars on CrossCoding - Medical insurance in dentistry covers TMD, Dental Sleep appliance, Oral surgeries, CT scan (cone bean).
Here's a link to Dental CE: http://www.dentalwriter....ducational_seminars.aspx
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Hi there for the Nightguard code S8262 since this code is now invalid for Insurance Blue Shield of California/Covered California which code should i use? Would the D7880 code work for this insurance?
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Hi guest! Yes it looks like D7880 is an accepted code for TMD appliances for Blue Shield of California. I found BS of CA's medical policy titled "Temporomandibular Joint Dysfunction", here is the link to it: https://www.blueshieldca.com/provider/content_assets/documents/download/public/bscpolicy/TMJ_Dysfunction.pdfIf you look on page 13 of the policy, you will see D7880 list in the HCPCS section for codes that may be medically necessary if coverage criteria is met. D7899 is also listed, which stands for: "Unspecified temporomandibular joint therapy by report" Hope this helps!
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Hello,
I am looking for a procedure code for a removable oral appliance to treat TMJ. The appliance facilitates movement but does not reposition the jaw so . I submitted a claim using CDT D7889 but it was denied stating it needed a modifier. Does anyone have any suggestions on how I can try to get this claim approved?
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Hi guest!
Do you mean you submitted for D7899 (Unspecified tmd therapy, by report)?
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Hi I am with Blue shield medical PPO and they are telling me code D7880 is a dental code and it cannot be used for medical services. Do you know if this is accurate? Do you know if there is another code that can be used for the TMD occlusal orthotic device and therapy?
THey are also telling me that 99199 (Articulates study casts) is not a listed code because it is not specific enough. Do you know if there is an alternate code that I can use?
Thank you
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Hi Guest!
Great question. Ever since the S8262 discontinuation June 2015 (which was a code used for several years to represent TMD appliances), what we have found is that the code that is most commonly accepted by medical insurers for TMD appliances is D7880. However, some insurers are accepting the other codes listed below as well:
D7899 - unspecified TMD therapy, by report
21299 - Unlisted craniofacial and maxillofacial procedure
E1399 - Durable medical equipment, miscellaneous
It seems the blues are tending to prefer 21299 with a narrative more recently based on reports from our clients.
A narrative report explaining the treatment accompanying the claim is recommended since they are all "by report", “unlisted”, or "miscellaneous" codes.
As for a code for study models - there is not specific CPT code for them, many times the casts are considered included for the reimbursement of the appliance. But, some practices we work with will bill them out with 99070, which is not any more of a specific code than 99199 is, because 99070 stands for: Supplies and materials (except spectacles), provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided)
Hope this helps!
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