Temporomandibular Joint (TMJ) Disorders (TMJD)

This policy covers diagnostic, nonsurgical, and surgical evaluation and treatment of temporomandibular joint (TMJ) and craniomandibular disorders, including imaging and procedures for the TMJ, masticatory musculature, and related neurologic conditions when medically necessary. Coverage is subject to state‑specific mandates (e.g., HCSC members in Louisiana and Mississippi and Illinois policies amended/issued/renewed from 2025 for trauma‑related reconstructive services), member benefit and product eligibility, prior authorization/precertification requirements, restriction of CT/MRI mainly to pre‑surgical evaluation, diagnostic arthroscopy only after failed nonoperative care, and exclusion of several investigational tests.

"For HCSC members residing in Louisiana, diagnostic, therapeutic, and surgical procedures related to the temporomandibular joint (TMJ) and associated musculature and neurological conditions are requ..."