Temporomandibular disorders (TMDs) are a set of ailments that affect the temporomandibular joint (TMJ), muscles of mastication, and associated tissues. (Akshat Sachdeva, Sumit Bhateja, Geetika Arora, Brinda Khanna, Archika Singh, 2020) TMD affects a significant section of the world’s population, with 25% of adults reportedly having indications or symptoms. (Perez, C.V.; de Leeuw, R.; Okeson, J.P.; Carlson, C.R.; Li, H.-F.; Bush, H.M.; Falace, D.A., 2012) TMD affects women at a rate that is 1.5–2.5 times more than it does men. (Machado, L.P.e.S.; de Nery, C.G.; Leles, C.R.; de Nery, M.B.M.; Okeson, J.P, 2009)
People who need treatment for temporomandibular disorder (TMD)-related symptoms approach the healthcare system in several ways. Their experiences in finding medical providers who are familiar with TMDs and can offer high-quality care vary widely. A primary care physician or a general dentist will do the first examination and management for certain patients. Many different disciplines may be included in treating patients whose TMD condition is severe and does not improve with conservative treatment. Compared to males, women are more likely to seek therapy for orofacial structural dysfunction or abnormalities. (Machado, L.P.e.S.; de Nery, C.G.; Leles, C.R.; de Nery, M.B.M.; Okeson, J.P, 2009) The below section will tell you what treatments are covered by medical insurance for tmd/tmj.
What treatments are covered by medical insurance for tmd/tmj
Because “a joint [such as the TMJ] is a joint anyplace in the body, as is a muscle, tendons, and ligaments,” people with TMD mainly obtain benefits via medical insurance; however, dental insurance can cover additional treatment costs. (Medical Insurance Coverage for TMJ Disorders (TMD)) Based on the severity of TMD and the healthcare provider, persons are eligible for medical and dental care coverage. (TMJ Treatment Cost, 2018)
But there are three crucial considerations to bear in mind:
- Confirming that your patient’s medical plan covers TMD/TMJ during a benefit check is vital because not all patients’ medical plans do.
- The medical policies for treating temporomandibular disorders will identify the treatments considered medically required with a diagnosis of TMD (as well as the services that are not), so verify the medical policy when you start collaborating with a new healthcare insurer.
- Most insurers want an official TMD diagnosis to pay for these therapies when a claim is submitted.
Below is what would generally be covered if you are fortunate enough to possess insurance that covers TMJ therapy.
Non-surgical treatments
Aetna’s policy recognizes the following non-surgical procedures as being medically necessary: (unless contraindicated)
- Reversible intra-oral appliances: Over the past century, several dentists have employed oral appliances (OAs) as part of their therapeutic regimens when caring for patients with temporomandibular disorders (TMDs). By altering the strain placed on the TMJs, OAs reduce mechanical stress and joint inflammation.(Harold f Menchel, Charles S Greene, Kevin D. Huff, 2021) Oral appliances are covered for 6 months.
- Acupuncture and trigger point injections: Acupuncture has an immediate effect on mental tension and sleep quality, both of which have been linked to TMD.(Michele Noiman, Azriel Garty, Yair Maimon, Udi Miller, Shahar Lev-Ari, 2010)
In a study, pain relief by acupuncture for TMDs was reported by 32 (82%) of the 39 patients who received treatment. Significant pain relief (> 80%) was seen in 28 patients (71.7%), while the other four patients reported partial relief (30–80%). (Michele Noiman, Azriel Garty, Yair Maimon, Udi Miller, Shahar Lev-Ari, 2010)
- Physical therapy and Cognitive Behavioral Therapy: Temporomandibular disorders are the most prevalent oral and maxillofacial conditions that physical therapists address.(Janey Prodoehl, Emily Kahnert, 2022)
- Relaxation therapy: ROM and discomfort in TMD can be effectively treated with relaxation exercises for the masticatory muscles.(Youngsook Bae, Yongnam Park, 2013)
- Prostheses: Prostheses, also called “Dental restoration,” are a significant factor covered by insurance.
- Hydrotherapy
- Intra-articular injection of Hyaluronic acid: For treating internal TMJ dysfunction, intra-articular injections are becoming increasingly common, and medical insurance covers them for the treatment purpose of TMDs.
- Orthodontic fixed appliances
- TENS: TENS is abbreviated as Transcutaneous Electrical Nerve Stimulation and is a pain reliever for TMDs. This treatment employs low-level electrical currents to calm your jaw joint and face muscles to relieve discomfort.
- Prophylactic management of TMJ disorder, including occlusal adjustment
- Ultrasound: Applying deep heat to the joint might reduce pain or increase movement. For TMD sufferers, ultrasound has been demonstrated to help reduce discomfort and enhance jaw functioning.(Shuang Ba, Pin Zhou, and Ming Yu, 2021)
- Trigger-point injections: Pain medication or anesthesia is injected into tender facial muscles called “trigger points” to give relief.
Surgical procedures
The Aetna policy also includes a description of the surgical treatments that are deemed to be medically essential. For instance:
Replacement of the TMJ is required because of the degeneration of the mandible’s physiologic function and shape caused by intra-articular end-stage TMJ disease. (Siva Kumar Mamidi, Kristin Klutcharch, […], and Mathew T. Mathew, 2019)
- Arthroplasty (A surgical treatment called arthroplasty can be used to get a joint working again.)
- Meniscus or disc repositioning because the disc can be displaced in any direction, such as anteriorly, Medially, posteriorly, and laterally.
- Arthroscopy: (This unique instrument is equipped with a lens and a light. Your doctor can view your joint. To inspect your joint and the region around it, the doctor will first give you a general anesthetic before making a tiny cut in front of your ear and inserting the instrument.)
- Arthrocentesis (If your jaws are locked but don’t have a significant history of TMJ, arthrocentesis may be employed.)
- Cartilage and other tissue grafts: The physically demanding and physiologically complex TMJ may be able to have its damaged tissues repaired or even replaced with the help of tissue engineering.
Diagnostic procedure
- Lateral skull x-ray or cephalometric: Patients who may have TMDs can be identified using lateral cephalometry as an additional diagnostic technique.(Veena Sn, 2014)
- Sonogram: It will show a computerized picture of TMJ created by high-energy sound waves and is a painless procedure.
- Joint vibration analysis: Joint Vibration Analysis (JVA) is used to objectively evaluate TMJ function and determine how well TMDs are being treated. It is based on the straightforward concepts of motion and friction.(Magdalena Bakalczuk, Michał Ginszt, Monika Litko, Marcin Wójcicki, Agnieszka Wójtowicz, Jacek Szkutnik, 2018)
- Electromyography: Because surface EMG can detect electrical potentials, it is conceivable that it could be used to identify TMDs.(Liliana Szyszka-Sommerfeld, Monika Machoy, Mariusz Lipski and Krzysztof Woźniak, 2019)
- Standard dental radiographic procedures: It stimulates the joint, causing blood flow to rise and pain to decrease. Radiography is another diagnostic tool to identify TMD.
- Thermography: Thermograms taken repeatedly can provide valuable information on the accuracy and efficacy of the treatment techniques being used.(Maria-Daniela Craciun, G. Daniela, Oana Geman, 2019)
- Myofunctional therapy
Choose MedsDental billing company
As insurers require accurate coding of TMJ for covering the treatment of TMDs, any patient and healthcare provider must take the help of trustworthy billing and coding company. Therefore, MedsDental Dental Billing Company is always a reliable choice for you. Being involved in providing flawless billing services for many years, our team is extraordinary and experienced in accurate coding and submitting timely claims to your insurance company. For dentists, it would be an advantage to outsource the billing area of their clinic so that they can focus on their treatment, and we will deal with every step of coding, claim, etc., with professionalism. So, get the opportunity whether you are a patient who wants his correct billing for insurance coverage or a dentist who wants to run billing smoothly.
