S8262, Mandibular orthopedic repositioning device, each
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- Surgical procedures areconsideredmedically necessaryfor the treatment of temporomandibular disorderswhen the following criteria are met (AandB):
- Temporomandibular joint internal derangement or other structural joint disorder is documented as evidenced by the following:Radiographic documentation of temporomandibular joint pathology(for example, arthritis, bone cyst, fracture, meniscal abnormality, or tumors);andFor individuals under the age of 18 years: documentation of completion of skeletal growth by either:Long bone x-ray;orSerial cephalometrics showing no change in facial bone relationships over the last 3- to 6- month period;and
- Radiographic documentation of temporomandibular joint pathology(for example, arthritis, bone cyst, fracture, meniscal abnormality, or tumors);and
- For individuals under the age of 18 years: documentation of completion of skeletal growth by either:Long bone x-ray;orSerial cephalometrics showing no change in facial bone relationships over the last 3- to 6- month period;and
- Long bone x-ray;or
- Serial cephalometrics showing no change in facial bone relationships over the last 3- to 6- month period;and
1 Active Policy
ANTHEM-GL-A051149, CPT
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.