Myofunctional Therapy Coding

This article will go over the diagnosis and procedure codes to use when billing out for Myofunctional Therapy.

Myofunctional Therapy is used to help train your muscles of the head and neck to help with breathing, talking and eating. Below you will find the common ICD diagnosis codes and CPT procedure codes to use when billing medical insurance. 

Diagnosis codes:  

 Anomalies of Jaw Size (Craniofacial Anomalies that Obstruct the Upper Airway) 

  M26.01 – Maxillary hyperplasia 

  M26.02 – Maxillary hypoplasia 

  M26.09 – Other specified anomalies of jaw size 

Anomalies of Jaw-Cranial Base Relationship (Craniofacial Anomalies that Obstruct the Upper Airway) 

  M26.11 – Maxillary asymmetry 

  M26.12 – Other jaw asymmetry 

  M26.19 – Other specified anomalies of jaw-cranial base relationship 

Childhood Articulation Problems 

  F80.0 – Phonological disorder 

  R47.9 – Unspecified speech disturbances 

  F80.9 – Developmental disorder of speech and language, unspecified 

Symptoms  

  G50.1– Atypical Facial Pain,  

  R51.9– Headache, Unspecified, 

  M54.2– Cervicalgia - Neck Pain 

  R68.84– Jaw Pain (excludes TM joint pain) 

  M79.11– Myalgia of Muscles of Mastication  

  M79.12– Myalgia of Auxiliary Muscles of Head & Neck 

Sleep 

  G47.33 – Obstructive Sleep Apnea (adult)(pediatric) 

Procedure codes: 

Myofunctional Therapy 

97530 – Functional exercises Units: ________ (units of 15 min) 

97110– Therapeutic Exercises Units: ________ (units of 15 min) 

 Note: Insurer may require a registered physical or speech therapist for myofunctional reimbursement 

Remote Therapy codes  

98975 – Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment. This is a one-time billable code for the initial set-up and requires 16 days of collected data/measures which can be self-reported. 

98980 – Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes.  This is a time-based code, billable once every 30 days, that covers the first 20 minutes of care management and interactive communication by clinical staff, MD or QHCP.  

98981 – Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes (list separately in addition to code for primary procedure). This is a time-based code that covers every additional 20 minutes of care management and interactive communication by clinical staff, MD or QHCP.  

Note: – Remote therapy codes are recently introduced, and coverage is still being established by some insurers        

Note: Always perform a benefits verification to see if these codes are a covered benefit with the patient's plan before beginning treatment. You can also check the medical insurance company's policy to see if it is a medically necessary procedure that may be covered.