Hi lemieuxsamantha!

Yes you are correct, "Dx" stands for diagnosis. That is interesting that the rep told you it must be filed to dental first though! Many medical insurers list the diagnosis codes M26.601-M26.69 as covered for medically necessary services in their TMD medical policies, as treatment of Temporomandibular Disorders is considered medical.

For example - here is a link to Anthem's medical policy for treatment of Temporomandibular Disorders:
https://www.anthem.com/medicalpolicies/guidelines/gl_pw_a051149.htm


Generally a medical insurer will start to offer coverage for services when there is enough peer reviewed clinical research available that proves it's efficacy. You could certainly attempt to appeal the denial of the claim and explain the services you have been receiving and the improvement in your symptoms/condition. However, if the rep at Anthem BCBS said if you file to dental first and receive a denial that they will then review it for medical coverage, that may be the best route to take.

Hi Guest!

The codes you listed below are actually valid ICD-10 (diagnosis) codes, not dental codes!

Dental codes generally begin with a "D" - for example, D7880 stands for: occlusal orthotic device, by report
and D7899 stands for: unspecified TMD therapy, by report

However, if your diagnosis is a Temporomandibular Joint Disorder (TMD/TMJD), many medical insurers do list in their TMD medical policies that myofunctional therapy is currently considered experimental & investigational and therfor not a covered service.

If you would like to tell me the name of your insurance company, I would be happy to look of their coverage policy and see if they have it listed as non-covered or not.

Hope this helps!