Skip to Main Content

Search in Medicare Advantage

The search's minimum of 4 and maximum of 60 characters. To search for information outside the provider manual or to find a specific provider communication by the assigned material number, use the search bar located at the top right corner of this page.

Please wait while we retrive the findings...

Search Results for:

Displaying 0 of 0 results...

TMJ

Provider Type

  • Physicians
  • Participating Physician Groups (PPG)
  • Ancillary

Temporomandibular joint (also known as TMD or TMJ) disorder commonly causes headaches, tenderness of the jaw muscles, tinnitus, or facial pain. These symptoms often occur when chewing muscles and jaw joints do not align correctly. When medically necessary and prior authorized, treatment of TMJ is covered.

Covered Services

Coverage of TMJ is limited to the following:

  • Surgical procedures to correct abnormally positioned or improperly developed bones of the upper or lower jaw when such procedures are medically necessary.
  • Custom-made oral appliances (intra-oral splint or occlusal splint) and surgical procedures to correct TMD or TMJ disorders are covered if medically necessary.

Health Net of California Inc. covers orthognathic surgery for specific conditions. Refer to the National Medical Policy on Orthognathic Surgery on the Health Net provider website for additional information.

Exclusions and Limitations

Spot grinding, restorative or mechanical devices, orthodontics, inlays or onlays, crowns, bridgework, dental splints, dental implants, or other dental appliances to treat dental conditions or dental conditions related to TMD or TMJ disorders are not covered.

For more information, select any subject below:

Last Updated: 07/01/2024