Temporomandibular Joint (TMJ) Disorder Surgery - (0156)

Cigna covers surgical TMJ treatments—arthrocentesis, arthroscopy, arthrotomy/arthroplasty and total/partial prosthetic TMJ replacement—for TMJ disorder (not for non‑TMJ indications) and generally excludes dental/orthodontic adjuncts from the medical benefit. Key requirements: documented failure of conservative therapy (generally ≥6 weeks), clinical exam and diagnostic imaging confirming pathology (MRI/CT/corrected tomogram required for prostheses), a letter of medical necessity with history/imaging/prior treatments for all surgical requests, arthroscopy requires imaging showing internal joint pathology, arthrotomy is limited to cases where arthroscopy is not feasible or has failed, and prostheses are contraindicated with local infection, material allergy, head/neck malignancy/infection or severe postoperative bruxism; coverage may vary by plan.

"This Coverage Policy addresses surgical procedures for temporomandibular joint (TMJ) disorder."