Does Insurance Cover TMJ?

Does Insurance Cover TMJ Treatments?

To know about our insurance options at Koala Center For Sleep & TMJ Disorders, call us or visit us online to book an appointment. We have convenient locations across the U.S. in Bloomington IL, Peoria/Dunlap IL, Lafayette IN, Mishawaka IN, Kansas City MO, El Paso TX and Wausau WI.

Does Insurance Cover TMJ? - Koala Center for Sleep & Tmj Disorders in Bloomington IL, Peoria – Dunlap IL, Lafayette IN, Mishawaka IN, Kansas City MO, El Paso TX and Wausau WI.
Does Insurance Cover TMJ? - Koala Center for Sleep & Tmj Disorders in Bloomington IL, Peoria – Dunlap IL, Lafayette IN, Mishawaka IN, Kansas City MO, El Paso TX and Wausau WI.

Table of Contents:

Will insurance cover my TMJ treatment?
What treatments are covered by medical insurance for TMD/TMJ?
Is TMJ treatment covered by medical or dental insurance?

The temporomandibular joint, often simply referred to as the TMJ, is the joint that connects the lower jaw bone (the mandible) to the temporal bone in the skull, separated by an articular disc that provides cushion between the skull and lower jaw. The TMJ is arguably the most complex of all joints in the human body; it has several interworking parts that enable its elaborate functions such as chewing, talking, singing and yawning. It is considered both a synovial and a condylar joint; it is covered in a mucous membrane that enables its smooth, fluid motion.

Will insurance cover my TMJ treatment?

Some types of insurance plans provide coverage for TMJ disorder, but this can vary by state, cause of the condition, as well as if it is related to a workplace hazard. 20 different states have mandated that insurance companies provide coverage for TMJ disorder; these include:

– Arkansas
– Connecticut
– Florida
– Georgia
– Illinois
– Kentucky
– Maryland
– Minnesota
– Mississippi
– North Carolina
– North Dakota
– Nebraska
– New Mexico
– Nevada
– Texas
– Virginia
– Vermont
– Washington State
– Wisconsin
– West Virginia

Other states may also offer coverage for TMJ disorder, so it is important to check with your insurance provider beforehand.

Another way TMJ disorder is covered by insurance is if it was caused through a workplace injury or accident caused by a third party.

What treatments are covered by medical insurance for TMD/TMJ?

Several treatments for TMJ disorder are covered by medical insurance, although this varies by plan, location and other factors. It is important to keep in mind:

– Not all patient’s medical plans offer coverage for TMJ disorder; this must be verified during a benefit check. If you have medical insurance through your workplace, you might also check with your HR department and ask for a copy of your Certificate of Coverage which should provide you with your specific plan’s benefits and exclusions.

– The insurer will list the services considered medically necessary with a diagnosis of TMJ disorder in the medical policy for treatment of TMD; check the medical policy when working with a new medical insurer

– Most insurers will require an actual TMD diagnosis for these services to be covered when the claim is filed; this can be provided by a TMJ dentist

Insurance coverage may be provided for the following, unless contraindicated:

– Reversible Intra-Oral Appliances
– Physical Therapy
– Relaxation Therapy and Cognitive Behavioral Therapy (CBT)
– Acupuncture and Trigger Point Injections
– Manipulation for reduction of fracture or dislocation

Other nonsurgical treatments may include:

– Botulinum toxin (type A or type B)
– Continuous passive motion
– Cranial (craniosacral) manipulation
– Dental restorations/prostheses
– Diathermy, infrared, and ultrasound treatments
– Dry needling
– Hydrotherapy (immersion therapy, whirlpool baths)
– Iontophoresis
– Intra-articular injection of hyaluronic acid (viscosupplementation)
– Intraoral appliances for headache or trigeminal neuralgia
– Irreversible occlusion therapy
– Low level (cold) laser
– Myofunctional therapy
– Myomonitor treatment
– Neuromuscular re-education
– Orthodontic/bite adjustment services
– Orthodontic fixed appliances
– Prophylactic management of TMJ disorder
– Transcutaneous electrical nerve stimulation (TENS)

For more information about what treatments or procedures are covered under insurance for TMJ disorder, please call your insurance provider.

Is TMJ treatment covered by medical or dental insurance?

TMJ disorder is typically covered by medical insurance; although dentists are the primary professional to treat the disorder, most dental insurances do not provide coverage for TMD. This has produced much debate over whether TMJ disorder is a medical or dental condition. Our skilled Koala providers offer a dental solution for the medical condition, TMD. We will help you to understand your medical benefits and submit claims to your medical insurance carrier on your behalf.

If you are looking for affordable and quality care for your TMJ disorder, the staff at Koala® Centers For Sleep & TMJ Disorders can help. Call us today to book an appointment with our TMJ disorder specialist, or visit one of our locations: We serve patients from all across the United States and look forward to serving you!

Our Locations

El Paso

  • 6901 Helen of Troy, Ste D-2 El Paso, TX 79911
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Kansas City

Bloomington

  • 309 E. Empire St. Ste 500, Bloomington, IL 61704
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Lafayette

Peoria

  • 11825 N. State Rt 40, Ste 100, Dunlap, IL 61525
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Mishawaka

  • 230 E. Day Rd., Suite 150, Mishawaka, IN 46545
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Wausau

  • 413 North 17th Avenue Ste. #100, Wausau, WI. 54401
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