Temporomandibular Disorders

Aetna covers medically necessary diagnostic evaluation and selected treatments for TMD/TMJ—including history/physical, single panoramic X‑ray, ultrasonography, and CT/MRI or additional X‑rays only when tied to anticipated surgical management—but some HMO plans may exclude TMD/TMJ treatment and bruxism appliances are typically excluded under medical plans (may be covered by dental). Key requirements: TMJ surgery requires review by Aetna’s Oral & Maxillofacial Surgery patient management unit; only one reversible intra‑oral appliance is considered medically necessary, prolonged (>6 months) appliance use requires individual case justification, and replacement for loss is not covered (repairs/replacements for other reasons subject to review).

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