ModifiedUnitedHealthcarePolicy DENTAL 008.34

Treatment of Temporomandibular Joint Disorders (TMJ/TMD)

Defines UnitedHealthcare's coverage stance for non-surgical and surgical treatments of temporomandibular joint disorders, including which interventions are considered medically necessary, unproven, or subject to separate medical benefit drug policies. Applies to providers submitting claims for TMJ/TMD services.

Policy Summary

PayerUnitedHealthcare

PolicyTreatment of Temporomandibular Joint Disorders (TMJ/TMD)

Policy CodePolicy DENTAL 008.34

Change TypeRevisions to unproven/not medically necessary examplesinformational updates to multiple sections

Effective DateFeb 1, 2025

Next Review DateN/A

Key ActionCheck the member-specific benefit plan and prior authorization requirements before submitting claims or requesting services.

SourceLink

POLICY UPDATE CHANGES

Revised list of unproven and not medically necessary services: Replaced passive rehabilitation therapy devices (e.g., TheraBite, Jaw Dynasplinte) wording with 'jaw mobility mechanical stretching devices (e.g., Therabite Jaw Motion Rehabilitation Systeme, Jaw Dynasplinte System)'.

Revised list of examples of epigenetic appliances and added Advanced Lightwire Functional (ALF) appliances.

Updated Description of Services, Benefit Considerations, Clinical Evidence, and References sections to reflect the most current information.

SeveralNon-surgical proven

MultipleSurgical services

≥10Procedure codes

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SeveralUnproven interventions

48Occlusal splint RCTs

02/01/2025Policy revision date

Coverage Criteria for TMJ/TMD Treatments

inv-01: Non-surgical therapies - Medically Necessary

Covered when ALL of the following are met

Non-surgical proven therapies: Intra-articular injections of corticosteroids; physical therapy (including craniomandibular manual therapy and exercise-based programs); trigger point injections (including dry needling and injections for myofascial trigger points); and occlusal splints (stabilization and mandibular repositioning splints) are considered proven and medically necessary for treating temporomandibular joint disorders.

Refer to Benefit Considerations and Description of Services for definitions and context (see policy references).

inv-02: TMJ Surgical Services

Surgical services

Surgical procedures covered in certain circumstances: Arthroscopy, discectomy, arthroplasty, and reconstruction of the temporomandibular joint (TMJ) are considered proven and medically necessary in certain circumstances when clinical criteria for medical necessity are met.

For medical necessity clinical coverage criteria, refer to the referenced InterQual procedures (Arthroscopy, Discectomy, Arthroplasty, Reconstruction) and applicable procedure-specific policies.

inv-03: Unproven and Not Medically Necessary Services

Not medically necessary / unproven

Unproven therapies: The following services are considered unproven and not medically necessary due to insufficient evidence of efficacy: biofeedback; craniosacral manipulation/therapy; multiple concurrent occlusal splints (e.g., daytime and nighttime, maxillary and mandibular splints); jaw mobility mechanical stretching devices (e.g., Therabite Jaw Motion Rehabilitation Systeme, Jaw Dynasplinte System); and epigenetic appliances (e.g., Homeoblock DNAS, Advanced Lightwire Functional [ALF] appliances).

This list is not all-inclusive; see Benefit Considerations and policy revision notes for examples and details. FDA clearance/approval alone is not a basis for coverage.

inv-04: Conservative first‑line and surgical indication

Clinical practice guidance and surgical prerequisites

Conservative care before surgery: Unless specific indications exist, initial treatment of temporomandibular disorders should be conservative, reversible, and evidence‑based; non‑surgical therapies should be attempted prior to surgical intervention.

AADOCR and AAOMS recommendations cited (AADOCR NICDR 2015; AAOMS Parameters of Care 2017) state surgery is indicated only when nonsurgical therapy has been ineffective and dysfunction is moderate to severe; surgery is not indicated for asymptomatic or minimally symptomatic patients.

inv-05: Non‑surgical and minimally invasive therapy evidence

Evidence summary for non‑surgical and minimally invasive therapies (findings and quality of evidence)

Intra‑articular corticosteroid and hyaluronic acid injections: Systematic reviews and network meta-analyses report short‑term (≤5 months) and some intermediate‑term (≥6 months) pain reduction and improvement in mouth opening with intra‑articular corticosteroids or hyaluronic acid compared with control/placebo; overall quality of evidence is very low and indirectness limits conclusions.short term <=5 months; intermediate >=6 months

Al‑Moraissi et al. (2020a) and other reviews report very low quality evidence; arthrocentesis with corticosteroid shows no consistent advantage over other lavage agents in limited studies.

Trigger point and needling therapies: Network meta-analysis of RCTs (including PRP, local anesthetic, dry needling, botulinum toxin) indicates some short‑ and intermediate‑term benefits for myofascial pain (improvements in MMO and pain), but the quality of evidence is low to very low and heterogeneity/indirectness preclude definitive conclusions.short term 1–20 days; intermediate 1–6 months

Al‑Moraissi et al. (2020b) found low/very low quality evidence across 21 RCTs (959 participants); results suggest promise but are inconclusive.

Coverage for services to diagnose or treat temporomandibular joint (TMJ) disease is determined by the member‑specific benefit plan and any applicable federal or state mandates. Many benefit documents explicitly exclude TMJ services whether medical or dental in nature; providers should verify the member's benefit plan and prior authorization requirements before delivering care.

Craniosacral manipulation and intraoral “epigenetic” appliances are listed as unproven because the medical literature does not identify quality evidence that these interventions improve clinically meaningful TMJ outcomes. The effect of craniosacral therapy and of epigenetic appliances on health outcomes therefore cannot be established, and they are considered not medically necessary for TMJ disorders.

The policy's revised examples of services considered unproven or not medically necessary now specifically list jaw mobility mechanical stretching devices (for example, Therabite Jaw Motion Rehabilitation Systeme and Jaw Dynasplinte System). These devices, along with therapies such as craniosacral manipulation, certain multi‑splint regimens, and epigenetic appliances, are designated unproven due to limited or insufficient quality evidence.

Specific devices and therapies identified as unproven or not medically necessary include: biofeedback, craniosacral manipulation/therapy, multiple concurrent occlusal splints (daytime and nighttime), jaw mobility mechanical stretching devices (e.g., Therabite, Jaw Dynasplinte), and epigenetic appliances (examples cited in the policy). These interventions are listed because current evidence does not establish clinical benefit for TMD.

Jaw mobility mechanical stretching devices are considered unproven because the published literature is limited to small studies, short‑term follow‑up, or studies with large loss to follow‑up, and many findings are inconclusive or unfavorable. Reported low patient compliance further limits the ability to demonstrate consistent clinical benefit; therefore, efficacy and safety remain insufficiently established to support coverage.

FDA regulatory status is provided for information only and FDA approval alone is not a basis for coverage. Although certain TMJ devices have FDA classifications (for example, TMJ prostheses as Class III and continuous passive motion machines as Class II), the policy nonetheless lists specific devices (including jaw mobility mechanical stretching devices) as unproven and not medically necessary based on the available clinical evidence.

Applicable Procedure and Supply Codes

Applicable CPT/Procedure Codes (part 1)CPT

20552	Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s).
20553	Injection(s); single or multiple trigger point(s), 3 or more muscles.
20605	Arthrocentesis, aspiration and/or injection, intermediate joint or bursa; without ultrasound guidance.
20606	Arthrocentesis, aspiration and/or injection, intermediate joint or bursa; with ultrasound guidance, with permanent recording and reporting.
21010	Arthrotomy, temporomandibular joint.
21050	Condylectomy, temporomandibular joint (separate procedure).
21060	Meniscectomy, partial or complete, temporomandibular joint (separate procedure).
21070	Coronoidectomy (separate procedure).
21085	Impression and custom preparation; oral surgical splint.
21089	Unlisted maxillofacial prosthetic procedure.

1–10 of 18

1/2

Applicable CPT/HCPCS/DME Codes (part 2)mixed

29804	Arthroscopy, temporomandibular joint; surgical.
90901	Biofeedback training by any modality.
97039	Unlisted modality (specify type and time if constant attendance).
97139	Unlisted therapeutic procedure (specify).
E0746	Electromyography (EMG); biofeedback device.
E1399	Durable medical equipment; miscellaneous.
E1700	Jaw motion rehabilitation system.
E1701	Replacement cushions for jaw motion rehabilitation system, package of 6.
E1702	Replacement measuring scales for jaw motion rehabilitation system, package of 200.

Follow-up intervals and outcome measures used in cited evidence

Short-term follow-upEvaluations at 1, 2, 3 and up to ≤5 months (common outcomes: VAS pain, maximum mouth opening [MMO/MIO], functionality and psychosocial status).

Intermediate follow-upEvaluations at ≥6 months (up to 4 years reported in network meta-analyses) assessing sustained pain reduction and MMO.

Specific trial assessment pointsCorrea‑Silva (2024) assessed outcomes at 1, 2, 3, and 6 months for pain, functionality and psychosocial status.

Provider Responsibilities and Actionable Notes

Documentation Required

Coverage and Coding Reference

Check the member-specific benefit plan document and any applicable federal or state mandates before requesting services. Benefit documents may explicitly exclude TMJ diagnostic or treatment services (medical or dental). Coverage and payment are governed by the member's plan; a policy listing or code does not guarantee coverage or reimbursement.

Verify member benefits and applicable mandates before applying this policy
Listing of codes is for reference only and does not imply coverage or payment

Documentation Required

Benefit and Documentation Requirements

Services may be denied if the member's benefit document excludes the requested service or if required documentation is not provided. Medical records documentation may be required to assess whether clinical criteria for coverage are met; submission of records does not guarantee coverage.

Medical records may be requested to support medical necessity determinations
Benefit and coverage determined by the member-specific benefit plan document

Background on Temporomandibular Disorders

Temporomandibular disorders (TMD) are a heterogeneous group of conditions affecting the temporomandibular joint and the masticatory muscles, commonly presenting with jaw pain, limited mouth opening, and joint noises. Symptoms may be transient or recurrent; initial management is generally conservative and reversible (for example, occlusal splints, physical therapy, medications), with injections or surgery considered when conservative care fails or when dysfunction is moderate to severe.

Definitions and Device Classifications

Occlusal splint — definition and intended purpose

DefinitionAn occlusal splint is a stabilization (night guard) or mandibular repositioning device intended to reduce or eliminate clenching/bruxism and reposition the jaw to a more relaxed position.

Intended purposeReduce bruxism/clenching, relieve myofascial pain dysfunction, improve mouth opening and reduce TMJ symptoms when used alone or as part of multimodal therapy.

Evidence summaryNetwork meta-analysis of 48 RCTs found moderate to very low quality evidence that various splint types can reduce pain and improve mouth opening; multimodal therapy (counseling + splint) may produce maximal improvement.

Myofascial trigger point injection — definition and agents used

DefinitionMyofascial trigger point injection or dry needling targets focal knots in skeletal muscle to relax fibers, remove metabolites and break the pain–tension cycle.

Policy Summary

PayerUnitedHealthcare

PolicyTreatment of Temporomandibular Joint Disorders (TMJ/TMD)

Policy CodePolicy DENTAL 008.34

Change TypeRevisions to unproven/not medically necessary examplesinformational updates to multiple sections

Effective DateFeb 1, 2025

Next Review DateN/A

Key ActionCheck the member-specific benefit plan and prior authorization requirements before submitting claims or requesting services.

SourceLink

On This Page

Physical therapy and manual therapy: Randomized trials and systematic reviews show adding physical therapy (including craniomandibular manual therapy and exercise) to splint therapy improves pain and maximum mouth opening; manual therapy has medium‑term benefits that may diminish over time unless combined with exercise.follow-up commonly 3–6 months

Romeo et al. (2024) RCT and multiple systematic reviews (2020–2022) support benefit though evidence quality varies and longer follow-up data are limited.

Occlusal splints: Network meta‑analysis of 48 RCTs shows moderate to very low quality evidence that various splint types (stabilization splints, anterior splints) can reduce pain and improve mouth opening; multimodal therapy (education/counseling plus splint) may produce maximal improvement, with short‑term benefits more pronounced than long‑term differences.short term benefit noted; long-term effects may equalize with other modalities

AI‑Moraissi et al. (2020c), Kuzmanovic et al. (2017) report short‑term benefits with low to moderate quality evidence; long‑term outcomes often similar across therapies.

Biofeedback: Evidence for biofeedback is insufficient and of low quality to establish efficacy for TMD; small heterogeneous studies suggest possible reductions in masticatory muscle activity but definitive clinical benefit is unproven.

Systematic reviews highlight small study sizes and protocol variation limiting conclusions.

Jaw mobility mechanical stretching devices: Studies of jaw mobility mechanical stretching devices (e.g., TheraBite, Jaw Dynasplinte) are limited, small, or of low quality with mixed short‑term functional results and low compliance; overall clinical benefit is unestablished and devices are considered unproven.

Feasibility studies and some RCTs report short‑term functional benefit that often equalizes at longer follow‑up; compliance issues noted. Policy lists these devices as unproven/not medically necessary.

Prior Authorization

Surgical Indication Prerequisite

Surgical intervention for TMJ internal derangement or reconstruction is indicated only after nonsurgical therapy has been attempted and found ineffective, and when dysfunction or pain is moderate to severe. Surgery is not indicated for asymptomatic or minimally symptomatic patients or for preventive reasons.

Surgery indicated only after ineffective nonsurgical therapy
Require moderate to severe dysfunction or pain; not for asymptomatic/minimally symptomatic patients

Step Therapy

Conservative-First Approach

Conservative, reversible, evidence-based therapies should be tried first. Initial management of TMD should emphasize noninvasive treatments such as physical therapy, occlusal splints, intra-articular corticosteroid injections, trigger point injections, and other reversible modalities.

Emphasize conservative, reversible treatments before surgical options
Document trials of nonsurgical therapies and clinical response prior to surgery authorization

Step Therapy

Conservative First‑Line Approach

Prior to surgical or invasive procedures, ensure conservative first‑line therapies have been attempted and documented. Verify that those therapies were appropriate and that documentation supports lack of improvement.

Document duration and response to conservative first-line treatments (e.g., splints, PT, injections)
Ensure clinical rationale for escalation to surgery is clearly recorded

Prior Authorization

Coverage and Coding Reference — Prior Authorization

Check member-specific benefit plan for prior authorization requirements and applicable codes before submitting requests. Inclusion of codes in this policy is informational and does not replace plan-specific prior authorization or billing rules.

Confirm whether prior authorization is required for TMJ procedures
Use applicable procedure/diagnosis codes from member plan when submitting claims

Agents usedProcedures may be dry needling alone or injections using corticosteroid, dextrose, saline, local anesthetic (LA), platelet‑rich plasma (PRP), or botulinum toxin (BTX‑A) depending on study and indication.

Evidence characteristicsNetwork meta-analyses (21 RCTs, 959 participants) report short‑ and intermediate‑term improvements in MMO and pain but overall evidence quality is low or very low.

Jaw mobility devices — devices for passive rehabilitation and stretching examples

DefinitionJaw mobility devices are mechanical devices used for passive rehabilitation and prolonged stretching for mandibular hypomobility.

ExamplesExamples include Therabite Jaw Motion Rehabilitation System, Jaw Dynasplinte System, OraStretch Press Jaw Motion Rehab System, and Therapacer Jaw Mobilizer.

Coverage stanceConsidered unproven and not medically necessary due to insufficient quality evidence, low compliance, and mixed or inconclusive long‑term benefit data.

Epigenetic appliances — intraoral device definition and coverage stance

DefinitionEpigenetic appliances are intraoral devices similar in appearance to orthodontic retainers that purportedly alter jaw structure/function via non‑DNA sequence mechanisms when worn (often overnight).

Purported effectsManufacturers claim pressure applied to the jaws stimulates remodeling (osteoblast/osteoclast activity) to expand/alter jaw position and treat TMD, sleep apnea and headaches.

Coverage stanceLiterature review did not identify quality evidence supporting efficacy for TMJ disorders; considered unproven and not medically necessary per the policy.

Arthrogenous TMD — definition and relation to network meta-analyses

DefinitionArthrogenous TMD refers to temporomandibular disorders of joint origin (e.g., disc displacement, osteoarthritis) evaluated in trials and network meta‑analyses comparing injections, arthroscopy, arthrocentesis, splints and conservative therapies.

Evidence contextNetwork meta-analyses (for example Al‑Moraissi 2020a and Li et al. 2022) assessed multiple interventions for pain and maximum mouth opening (MMO) in arthrogenous TMD, reporting short‑term and intermediate‑term benefits for some minimally invasive procedures.

Quality caveatFindings are limited by indirectness and generally low to very low quality of evidence across studies included in network analyses.

Myofascial / myogenic TMD — definition and relation to needling/trigger point studies

DefinitionMyofascial/myogenic TMD refers to temporomandibular disorders primarily related to masticatory muscle pain and trigger points.

Evidence baseNeedling and trigger point injection studies (including PRP, local anesthetic, dry needling, botulinum toxin) were evaluated in network meta‑analyses showing some short‑ and intermediate‑term benefit for MMO and pain but with low or very low quality evidence.

ImplicationEffectiveness appears across needling types and substances, but conclusions are limited by study heterogeneity and low evidence quality.

TMJ prostheses device class — Class III requiring PMA

Device classTemporomandibular joint prostheses are regulated by the FDA as Class III devices requiring premarket approval (PMA).

Coverage noteFDA approval/status is informational only and not a basis for coverage determination; member‑specific benefit documents govern coverage decisions.

Regulatory contextPolicy references FDA classification for informational purposes and advises documentation may reference device regulatory status when relevant.

Continuous passive motion (CPM) machines device class — Class II

Device classContinuous passive motion (CPM) machines are regulated by the FDA as Class II devices (subject to general controls and performance standards).

Regulatory detailAdditional FDA product coding information is available (product code BXB) and the FDA classification is provided for informational purposes only.

Coverage noteFDA approval alone is not a basis for coverage; member‑specific benefit plan documents determine coverage eligibility.