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Guest
#1 Posted : Wednesday, November 25, 2015 11:52:21 AM(UTC)
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Guest

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I was speaking to a potential patient who stated she was speaking with her insurance company and they told her there could be a better procedure code for TMJ oral appliances rather than using 21089. Do you know of anything better to use? She said that they cover TMJ and appliances, but not that code?
courtneydsnow
#2 Posted : Wednesday, November 25, 2015 1:14:03 PM(UTC)
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courtneydsnow

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Hi guest!

What we are finding is that the code that is most commonly accepted currently for TMD appliances since the S8262 discontinuation back in June of this year is D7880. However, some insurers are accepting D7899, 21499, or E1399.

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
21499 - Unlisted musculoskeletal procedure, head

A narrative report accompanying the claim is recommended since they are all "by report" or "miscellaneous" codes.

You can also check the insurers TMD medical policy on their website, and many of them will list accepted codes right in their policies. For example, here is a link to BCBS of MS's TMD medical policy that lists the currently accepted code as D7880 for TMD appliances in the coding section of the policy:
http://www.bcbsms.com/com/bcbsms/apps/PolicySearch/views/ViewPolicy.php?&noprint=yes&path=/policy/emed/Temporomandibular_Joint.html

Hope this helps, have a great day!
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