PURPOSE
This policy establishes a basis for determining appropriate testing and treatment of individuals with temporomandibular joint (TMJ) disorders.
DESCRIPTION
The temporomandibular joint (TMJ) is located in front of the ear where the skull and mandible meet. The joint allows the mandible to move during mastication. Causes offered for TMJ disorders include: arthritis, injury, and grinding of the teeth at night. Displacement or dislocation of the disc that is located between the jawbone and the socket may also be a cause of TMJ disorders.
TMJ disorders have a variety of symptoms, according to The TMJ Association, LTD. Symptoms may include:
Facial pain; jaw joint pain; often in combination with neck, shoulder, back pain and/or headaches
Popping, grating or clicking sounds with movement of the jaw joint
Pain in the joints of the face when opening or closing the mouth, yawning, or chewing
Swelling on the side of the face and/or mouth
A bite that feels uncomfortable, "off," or as if it is continually changing
Limited opening or inability to open the mouth comfortably
Deviation of the jaw to one side
The jaw locking open or closed
Swallowing difficulties
Treatment of temporomandibular joint disorders are divided into two categories:
Phase I therapy, which includes:
Appliances, removable or fixed (which are designed primarily to stabilize the jaw joint and muscles and not to permanently alter the teeth)
Physical medicine procedures
Phase II therapy, considered Dental treatment/intervention that permanently alters the teeth or dental occlusion, which includes: (See separate Dental policies).
Orthodontic treatment (e.g., braces)
Prosthodontic treatments (e.g., dentures, bridges)
Restorative treatment (e.g., fillings, crowns)
Full mouth rehabilitation (e.g., restorations, extractions)
POLICY
BlueCross BlueShield of Tennessee recognizes the need for consistency in the determination of medical appropriateness for the testing and treatment of Temporomandibular Joint Disorders.
Services will be considered medically appropriate only if they have met BlueCross BlueShield of Tennessee's technology evaluation criteria.
|
*** |
THE FOLLOWING POLICIES HAVE BEEN |
*** |
|
|
REVIEWED. PLEASE REFER TO THE POLICY |
|
|
*** |
TO DETERMINE MEDICAL APPROPRIATENESS. |
*** |
DIAGNOSTICS:
THERAPEUTICS:
Modified Condylotomy for Treatment of Temporomandibular Joint (TMJ) Disorders
Oral Appliances for Management of Mild to Moderate Obstructive Sleep Apnea (OSA)
ORIGINAL EFFECTIVE DATE: 12/1/1986
MOST RECENT REVIEW DATE: 3/14/2011
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.