Temporomandibular Joint Disorders - UHCprovider.com

CT scans, and/or MRI Treating physician’s plan of care, including surgical treatment objectives, which must include the expected outcome for the improvement of the functional deficit History of previous non -surgical and surgical treatment Outpatient Surgical Procedures – Site of Service 20552, 20553, 20605, 20606, 21010, 21070,

  Scan, Ct scan