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Code for TMD/TMJ appliances (replacement for S8262)

CPT codes for billing TMD/TMJ appliances

A big area of confusion in the medical billing in dentistry field currently is what code is best to use to represent oral appliances being used to treat Temporomandibular Joint Disorders (TMD/TMJD).

Since the S8262 discontinuation June 2015 (S8262 was a code deleted from the coding system that was commonly used for several years to bill for TMD appliances) what we have found is that the code that is most commonly accepted by medical insurers for TMD appliances is D7880 (occlusal orthotic device, by report).

The following codes are being reported as accepted codes by different medical insurers:

21299 - Unlisted craniofacial and maxillofacial procedure with report (DentalWriter SOAP report of medical necessity)

D7880 – CDT dental code may be required on a medical claim in some instances.  Report of medical necessity will be required. 

21499 - Unlisted musculoskeletal procedure, head (rarely used any more)

E1399 - Durable medical equipment, miscellaneous  (only use when the insurers consider TMD as durable medical equipment which is rare)

A narrative report explaining the treatment accompanying the claim is recommended since they are all "by report", “unlisted”, or "miscellaneous" codes.

We have heard reports from some offices that they were advised by someone to use 21089, 21085, or 21110 – we do not recommend this as the description of these codes do not accurately describe the service.