Medicare/TMD

[niermanpm]

Hi Guest! We do not see many occlusal orthotic appliances covered by Medicare Part B. Some Medicare policies state that they may consider reimbursement based on coding of symptoms. Medicare also states Oral occlusal appliances used to treat temporomandibular joint (TMJ) disorders are coded D7880 – occlusal orthotic appliance. Claims for these devices should not be submitted to the DME MACs. Hope this helps! Hello, my elder sister lives in Florida and is enrolled in Medicare part B. She is suffering from TMD disorder. You said that Medicare policies state that they may consider reimbursement based on the coding of symptoms. So does that mean it is better not to rely on Medicare and rather shift to or to stay with Medicare?

[niermanpm]

Hi Guest! Great question. Unfortunately, if the patient has already been diagnosed with TMD, we generally see Medicare denying coverage for those services. If the patient is being evaluated for pain, then we do see reimbursement from Medicare Part B for services such as office visits and xrays. There may be some coverage available through the Medigap or secondary if available, but would certainly recommend performing a benefit verification to see first 🙂 Hope this helps!

[Jeremy Hobbs]

Billing

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