Billing Medical and Dental for Invisalign

[Jeremy Hobbs]

Can both Medical and Dental INS be billed for same appliance

[niermanpm]

Hi StacyM! Great question. It is not recommended to bill both dental & medical insurance at the same time for the same service. If you bill it to one of the insurers first and it is denied, then you can bill it to the other insurer and provide a copy of the denial (typically, you would bill medical insurance first and only bill it to dental if medical denies it because it is not medically necessary or a non-covered service/benefit). Having said that, typically medical insurers do not consider orthodontic services to treat TMJ disorders as medically necessary, it is commonly found on the “experimental & investigational” list of medical coverage policies. However, many medical insurers will cover services to diagnose & treat TMJ disorders that they consider medically necessary such as exams, xrays, removable intra-oral appliances, and trigger point injections. Hope this helps!

[niermanpm]

Is it possible to bill medical insurance for TMJ therapy and bill dental insurance for orthodontics using Invisalign to treat both conditions? If so, how is this done, and what codes would be used. Thank you.

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