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Message was deleted by a Moderator. | Reason: Not specified
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Hi Guest!
Wow yes they are certainly putting you through the ringer on what code to use! When their own rep can't figure it out - it is no wonder the entire industry is not clear on it either!
The only other code I have seen reported as successful (that i am even decently comfortable with the description on) that you didn't mention above is 21499.
Thanks for the updated info, and would love to hear how this one turns out!
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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
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Hi Guest!
Great question. While 21089 is not necessarily one of codes we suggest (based on the description of it and other codes that are available and being accepted by some medical insurers) - if the medical insurer instructs you to use it - that may be your best option!
The description of 21089 is: Unlisted maxillofacial prosthetic procedure
However - no there are no other codes we are aware of currently that are specific codes that are being used to represent appliances being used to treat TMD - they are all "unlisted" or "misc" codes:
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
A narrative report explaining the treatment accompanying the claim is recommended since they are all "by report", “unlisted”, or "miscellaneous" codes.
But, as you mentioned, the allowed amount can vary significantly with these codes as they are unspecific codes.
Hope this helps!
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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?
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Hi Guest!
Yes every medical claim requires at least 1 diagnosis code, and up to 12 can be listed.
M26.60 is no longer a "billable" diagnosis code, because there are more specific diagnosis codes available now to describe temporomandibular disorders (TMD). There are of course other diagnostic codes that may be used as well to describe symptoms/pain associated with the TMD. Below are the TMD diagnosis coding options:
M26.601 Right temporomandibular joint disorder, unspecified
M26.602 Left temporomandibular joint disorder, unspecified
M26.603 Bilateral temporomandibular joint disorder, unspecified
M26.609 Unspecified temporomandibular joint disorder, unspecified side
M26.611 Adhesions and ankylosis of right temporomandibular joint
M26.612 Adhesions and ankylosis of left temporomandibular joint
M26.613 Adhesions and ankylosis of bilateral temporomandibular joint
M26.619 Adhesions and ankylosis of temporomandibular joint, unspecified side
M26.621 Arthralgia of right temporomandibular joint
M26.622 Arthralgia of left temporomandibular joint
M26.623 Arthralgia of bilateral temporomandibular joint
M26.629 Arthralgia of temporomandibular joint, unspecified side
M26.631 Articular disc disorder of right temporomandibular joint
M26.632 Articular disc disorder of left temporomandibular joint
M26.633 Articular disc disorder of bilateral temporomandibular joint
M26.639 Articular disc disorder of temporomandibular joint, unspecified side
M26.69 Other specified disorders of temporomandibular joint
Hope this helps!
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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!
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Hi Guest!
Great question. Unfortunately, there is not 1 straightforward answer at this time for the question "What code is best to use for an oral appliance being used to treat temporomandibular disorder (TMD/TMJD)?"
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
A narrative report explaining the treatment accompanying the claim is recommended since they are all "by report", “unlisted”, or "miscellaneous" codes.
Note: we do tend to find BCBS many times does not want to process the "D" codes as another insurers do....
Hope this helps, have a great day!
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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.
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Hi Guest!
Great question. To our knowledge, Medicare does not offer coverage for oral appliance used to treat TMD.
21110 is not an appropriate code for TMD appliances, as the description for 21110 is: Application of interdental fixation device for conditions other than fracture or dislocation, include removal
Medicare states in their LCD for oral appliances for OSA, that appliance used to treat TMD should be coded D7880.
Hope this helps!
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