Hi guest!

Great question.

What we are finding is that the code that is most commonly accepted by medical insurers currently for TMD appliances since the S8262 discontinuation 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.

It may be best to look up the insurers medical policy for Temporomandibular disorders and check the coding section of the policy to see if a specific code they accept is listed. 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


I have seen offices attempt to code for a daytime/nighttime appliance either using 2 units of D7880, or using D7880 for first appliance and D7899 for second.
However, in my experience, th insurer usually will not pay for 2 appliances, and deem only 1 is "medically necessary". If the office is going to try to bill two (either an upper and lower or a daytime/nighttime), I would suggest a strong a narrative report that described why just 1 wouldn't do the trick for the patient and why it is medically necessary for both.

Hope this helps, have a great day!