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GuestLV
#1 Posted : Monday, February 27, 2017 4:37:52 PM(UTC)
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Guest

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Is there new codes for Tmj Splint/orthotic to replace the S8262 "Mandibular Repositioning Device" code. I have tried both 21299 and 21089 both are Unlisted so Allowed fees are inconsistent. We were told by 1 insurance company to use 21110, but from what I have read different sources vary on 21110. Most say it is a surgical code but some say it can be used for oral appliances. What is the best replacement for S8262
courtneydsnow
#2 Posted : Tuesday, February 28, 2017 7:53:30 AM(UTC)
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courtneydsnow

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Hi Guest LV!

What we are finding is that the code that is most commonly accepted by medical insurers currently for TMD appliances since the S8262 discontinuation June 2015 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
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.

We do not recommend the use of 21110, as the description of this code is: Application of interdental fixation device for conditions other than fracture or dislocation, include removal

...and the appliances being used to treat TMD that most of our clients use are not interdental fixation devices, they are removable.

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

Hope this helps, have a great day!
Guest KB
#3 Posted : Friday, March 16, 2018 8:34:27 PM(UTC)
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Hi, I am looking for a MEDICAL code for LVI Dental treatment for TMJD, specifically, the orthotic that they use, my insurance does not cover TMJD as Dental, only MEDICAL.

Any CPT codes would be great to have.

Thank you
courtneydsnow
#4 Posted : Monday, March 19, 2018 8:49:25 AM(UTC)
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courtneydsnow

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Hi Guest KB!

Ever since the S8262 discontinuation June 2015 (which was a code used for several years to represent TMD appliances like the one used for LVI, the neuromuscular orthotic), 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

(21299 is the only CPT code if that is what the insurer is requiring, the other three are HCPCS codes)

A narrative report explaining the treatment accompanying the claim is recommended since they are all "by report", “unlisted”, or "miscellaneous" codes.

Hope this helps, have a great day!
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