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#1 Posted : Wednesday, March 17, 2021 12:44:08 PM(UTC)

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Hello, I sometimes get patients with TMJ pain or some other facial pain.I would like to perform some PT like stretching or heat therapy on them but not sure what I can bill out? Thanks
#2 Posted : Monday, March 29, 2021 11:12:34 AM(UTC)

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Hi Guest!

Great question. Here's the up and downside:

1) the upside is most medical policies do indicate coverage for physical therapy service to treat TMJ disorders! (when TMJ disorders are a covered benefit of the policy, of course).

2) the downside is there are many medical insurers that require these services are rendered by a registered physical therapist, so these services may be denied for reimbursement when performed by a DDS/DMD

For example, Aetna's medical policy for TMJ disorders states:

"Physical Therapy:

Aetna considers physical therapy to be a medically necessary conservative method of TMD/TMJ treatment. Therapy may include repetitive active or passive jaw exercises, thermal modalities (e.g., hot or cold packs), manipulation, vapor coolant spray-and-stretch technique, and electro-galvanic stimulation. See CPB 0325 - Physical Therapy for medical necessity criteria and documentation requirements for physical therapy. For manipulation under anesthesia for TMD/TMJ, see CPB 0204 - Manipulation Under General Anesthesia"

Then, in the physical therapy policy mentioned in the statement above, it states:
"PT services must be ordered by a physician or other licensed health care practitioner and performed by a duly licensed and certified, if applicable, PT provider. All services provided must be within the applicable scope of practice for the provider in their licensed jurisdiction where the services are provided;..."

Hope this helps!

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