Transcription of Temporomandibular Joint Disorders - UHCprovider.com
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Temporomandibular Joint Disorders - UHCprovider.com
Temporomandibular Joint Disorders Page 1 of 13 UnitedHealthcare Commercial Medical Policy Effective 03/01/2022 Proprietary Information of UnitedHealthcare. Copyright 2022 United HealthCare Services, Inc. UnitedHealthcare Commercial Medica l Policy Temporomandibular Joint Disorders Policy Number: 2022T0079GG Effective Date: March 1, 2022 Instructions for Use Table of Contents Page Coverage Rationale .. 1 Documentation Requirements .. 2 Definitions .. 2 Applicable Codes .. 3 Description of Services .. 4 Benefit Considerations .. 4 Clinical Evidence .. 4 Food and Drug Administration .. 11 References .. 11 Policy History/Revision Information .. 12 Instructions for Use .. 13 Coverage Rationale See Benefit Considerations The following services are proven and medically necessary for treating Disorders of the Temporomandibular Joint (TMJ): Arthrocentesis Arthroscopy Intra-articular injections of corticosteroids Trigger point injections Physical therapy Occlusal splint (stabilization and repositioning splints) Partial or total Joint replacement For medical necessity clinical coverage criteria, refer to the: InterQual 2021, Apr.
• Partial or total joint replacement ... Arthroplasty : Surgery to relieve pain and restore range of motion by realigning or reconstructing a joint (Medical Dictionary for ... acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance : 20606 .
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