Hi Guest!

Great question. 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

It seems the blues are tending to prefer 21299 with a narrative more recently based on reports from our clients.

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

As for a code for study models - there is not specific CPT code for them, many times the casts are considered included for the reimbursement of the appliance. But, some practices we work with will bill them out with 99070, which is not any more of a specific code than 99199 is, because 99070 stands for: Supplies and materials (except spectacles), provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided)

Hope this helps!

Hi guest!

Do you mean you submitted for D7899 (Unspecified tmd therapy, by report)?

Hi guest!

Yes it looks like D7880 is an accepted code for TMD appliances for Blue Shield of California. I found BS of CA's medical policy titled "Temporomandibular Joint Dysfunction", here is the link to it:

https://www.blueshieldca.com/provider/content_assets/documents/download/public/bscpolicy/TMJ_Dysfunction.pdf

If you look on page 13 of the policy, you will see D7880 list in the HCPCS section for codes that may be medically necessary if coverage criteria is met. D7899 is also listed, which stands for: "Unspecified temporomandibular joint therapy by report"

Hope this helps!

Yes, it can be challenging to find a Medicare covered code for TMJ treatment. I have some information based on their written policies.

For the ICD Code, Medicare's policy states that they may consider reimbursement based on the coding of symptoms.

Also, Medicare has stated that the billing code for a TMJ appliance is D7880.

I hope this helps!



Rose Nierman, CEO of Nierman Practice Management

Our seminars on CrossCoding - Medical insurance in dentistry covers TMD, Dental Sleep appliance, Oral surgeries, CT scan (cone bean).

Here's a link to Dental CE: http://www.dentalwriter....ducational_seminars.aspx

Do you know if Medicare part B will accept the D7880 code? We are having trouble using the alternative 21089 and I am worried using a D code will cause problems with them.