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I am seeing a myofunctional therapist who is also a registered dental hygienist.She does not work with insurance so the codes she provided me apparently won't work under a medical claim, which is the direction I need to go in order to receive reimbursement.
Here are the dental codes I have that I need someone to help me find the medical equivalent for.
M26.601 Right temporomandibular joint disorder, unspecified
M26.602 Left temporomandibular joint disorder, unspecified
M26.603 Bilateral temporomandibular joint disorder, unspecified
M26.609 Unspecified TMJ joint disorder, unspecified side
M26.59 "Other dentofacial functional abnormalities
M26.51 Abnormal jaw closure
M26.52 Limited mandibular range of motion
M26.53 Deviation in opening and closing of the mandible
M6240 Contracture of muscle, unspecified site
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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!
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Rank: New Member
Joined: 3/27/2017(UTC)
Posts: 1
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Originally Posted by: courtneydsnow  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! Hi there, thank you for replying to this. The verbiage I received from a point of contact I have with Anthem BCBS said: "DX (I'm assuming she means diagnosis code) that starts with M at the beginning are dental Diagnosis and dental would have to deny the services first and we can send to review when the claims comes in from the Local Blue Cross." I understand it's a long shot to get coverage for myofunctional therapy, but what if it it is actually working to heal my TMJ pains? How can I communicate to the billing underwriters that this is something worthy of coverage? Any advice you have is much appreciated. Thanks!
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Rank: Administration
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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.htmGenerally 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.
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