Medical Policy: 02.01.21 

Original Effective Date: October 1995 

Reviewed: January 2020 

Revised: January 2020 

 

Notice:

This policy contains information which is clinical in nature. The policy is not medical advice. The information in this policy is used by Wellmark to make determinations whether medical treatment is covered under the terms of a Wellmark member's health benefit plan. Physicians and other health care providers are responsible for medical advice and treatment. If you have specific health care needs, you should consult an appropriate health care professional. If you would like to request an accessible version of this document, please contact customer service at 800-524-9242.

 

Benefit Application:

Benefit determinations are based on the applicable contract language in effect at the time the services were rendered. Exclusions, limitations or exceptions may apply. Benefits may vary based on contract, and individual member benefits must be verified. Wellmark determines medical necessity only if the benefit exists and no contract exclusions are applicable. This medical policy may not apply to FEP. Benefits are determined by the Federal Employee Program.

 

This Medical Policy document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy will be reviewed regularly and be updated as scientific and medical literature becomes available.

 

Description:

Temporomandibular joint dysfunction (TMJ), also known as TMD, craniomandibular jaw disorder (CMJ) or craniomandibular disorder (CMD), refers to a group of conditions associated with pain and dysfunction of the masticatory system. Symptoms attributed to TMJ dysfunction are varied and include, but not limited to: clicking sounds in the jaw, headaches, closing or locking of the jaw due to muscle spasm (trismus) or displaced disc, pain in the ears, neck, arms and spine, tinnitus, and bruxism (clenching or grinding of teeth).

 

There are no widely accepted, standard tests available to correctly diagnose TMJ disorders. Because the exact causes and symptoms are not clear, identifying these disorders can be difficult and confusing. The diagnosis of TMJ is largely based upon the symptoms of pain and biologic variables, (e.g. joint sounds, variations from ideal disc position, clicking). These conditions may also be found in large segments of the general populations without evidence of impairment of dysfunction that require treatment. The most common cause of temporomandibular joint disorders is the result of jaw muscle related pain and problems with normal jaw functions. These conditions typically require only non-invasive management.

 

For many patients, symptoms of TMJ dysfunction are short-term and self-limiting. Frequently, the symptoms causing pain in the area of the jaw joint or muscles do not signal a serious problem. Conservative treatments, such as eating soft foods, rest, heat, ice, and avoiding extreme jaw movements, and anti-inflammatory medication, are recommended prior to consideration of more invasive and/or permanent therapies, such as surgery.

 

Arthrocentesis: This is a minimally invasive procedure that involves insertion of one or two needles into the joint (no skin incisions are made). The joint is washed to remove debris and inflammatory byproducts. Some surgeons will also manipulate the joint under anesthesia and/or inject a therapeutic medication in the joint. The procedure is intended to increase range of motion and function and reduce pain.
Arthroscopy: Arthroscopy of the TMJ is a surgical procedure that provides direct visualization of joint function and allows confirmation of intra-articular pathology that cannot be confirmed by other means of evaluation. It is intended to reduce pain and increase mandibular range of motion.
Arthrotomy: Arthrotomy is the most invasive surgical technique used to treat TMD. Arthrotomy is performed under general anesthesia, usually on an inpatient basis. The following surgical procedures are carried out through arthrotomy:

  • Disc Surgery: In cases where the joint problem is in the disc itself, your surgeon may recommend a procedure to reposition (disc plication), remove (diskectomy), or replace (disk replacement) the diseased cartilage.
  • Arthroplasty: procedure aimed to remove adhesions, bone spurs and other growths in the jaw that are causing joint dysfunction and pain.
  • Joint Replacement: The TMJ can be replaced partially or completely. Individuals with end-stage pathology and severe physiologic dysfunction benefit most from partial or total joint replacement.

 

Guidelines and Position Statements

American Association of Oral and Maxillofacial Surgeons (AAOMS) (2017)

The AAOMS Clinical Condition Statements on Temporomandibular Disorders was updated in 2017. The statement lists the following:

  • Non-surgical management:
    • Medication (e.g., NSAIDs)
    • Orthotic appliance
    • Physical therapy
  • Surgical treatment:
    • Manipulation under anesthesia (e.g., brisement)
    • Arthrocentesis
    • Non-arthroscopic lysis and lavage and manipulation
    • Arthroscopic surgery
    • Diagnostic
    • Operative
    • Open arthroplasty with or without autograft
    • Open arthroplasty with alloplast
    • Disc repair or removal, with or without replacement
    • Coronoidectomy
    • Condylectomy
    • Mandibular Condylotomy
    • Myotomy
    • Orthognathic Surgery
    • Partial or total joint reconstruction (e.g., autogenous graft, allogeneic graft and alloplastic implant)
  • Favorable therapeutic outcomes:
    • Level of pain that is of little or no concern to the patient
    • Improved jaw function
    • Improved ability to masticate food
    • Functional and stable occlusion
    • In a growing child, continued symmetrical growth of the mandible in proper relationship to the midface
    • Limited period of disability
    • Acceptable clinical appearance
    • Absence of recurrent jaw locking or dislocation
    • Limited progression of the disease

 

The AAOMS 2017 Parameters of Care: Clinical Practice Guidelines for Oral and Maxillofacial Surgery (Temporomandibular Joint Surgery) state that temporomandibular joint (TMJ) surgery is indicated for the treatment of a wide range of pathologic conditions. The guideline details indications for therapy, therapeutic goals, and specific factors affecting risk, therapeutic parameters, and outcome assessment indices for multiple conditions. The authors’ state that surgical intervention for internal derangement arthritic conditions, degenerative joint disease infectious arthritis and ankylosis/restricted jaw motion is indicated only when nonsurgical therapy has been ineffective, and pain and/or dysfunction are moderate to severe.

 

American Association for Dental Research: A policy statement, reaffirmed in 2015

  1. It is recommended that the differential diagnosis of TMDs or related orofacial pain conditions should be based primarily on information obtained from the patient's history, clinical examination, and when indicated TMJ radiology or other imaging procedures. The choice of adjunctive diagnostic procedures should be based upon published, peer-reviewed data showing diagnostic efficacy and safety. However, the consensus of recent scientific literature about currently available technological diagnostic devices for TMDs is that except for various imaging modalities, none of them shows the sensitivity and specificity required to separate normal subjects from TMD patients or to distinguish among TMD subgroups. Currently, standard medical diagnostic or laboratory tests that are used for evaluating similar orthopedic, rheumatological and neurological disorders may also be utilized when indicated with TMD patients. In addition, various standardized and validated psychometric tests may be used to assess the psychosocial dimensions of each patient’s TMD problem.
  2. It is strongly recommended that, unless there are specific and justifiable indications to the contrary, treatment of TMD patients initially should be based on the use of conservative, reversible and evidence-based therapeutic modalities. Studies of the natural history of many TMDs suggest that they tend to improve or resolve over time. While no specific therapies have been proven to be uniformly effective, many of the conservative modalities have proven to be at least as effective in providing symptomatic relief as most forms of invasive treatment. Because those modalities do not produce irreversible changes, they present much less risk of producing harm. Professional treatment should be augmented with a home care program, in which patients are taught about their disorder and how to manage their symptoms.

 

American Society of Temporomandibular Joint Surgeons (ASTMJS) Consensus Clinical Guidelines (2001 and currently under revision)

Nonsurgical treatment should be considered first for all symptomatic patients with this condition. Recommended treatment options include change in diet, nonsteroidal anti-inflammatory drugs, maxillomandibular appliances, physical therapy, and injections of corticosteroids.

 

TMJ Association (TMJA)(2012)

Surgical treatments are controversial and should be avoided when possible. There have been no long-term clinical trials to study the safety and effectiveness of surgical treatments for TMD, nor are there criteria to identify people who would most likely benefit from surgery.

 

Replacement of the temporomandibular joint with an artificial implant should be considered a last resort. When used in patients who have had multiple prior jaw surgeries it may improve function, but studies have shown that it generally does not significantly reduce pain. Before undergoing such surgery on the jaw joint, it is extremely important to get other independent opinions and to fully understand the benefits and risks (TMJ Association website).

 

American Dental Association (2015)

Selected statements from the American Dental Association’s practice parameters for temporomandibular disorders, reaffirmed in 2015 are:

  • "The key element in the design of this set of parameters for temporomandibular (TM) disorders is the professional judgment of the attending dentist, for a specific patient, at a specific time."
  • "Initially the dentist should select the least invasive and most reversible therapy that may ameliorate the patient’s pain and/or functional impairment."
  • "Any treatment performed should be with the concurrence of the patient and the dentist.…"
  • "The dentist should evaluate the effectiveness of initial therapy prior to considering more invasive and/or irreversible therapy."
  • "The dentist should counsel the patient that TM disorders are often managed, rather than resolved, and that symptoms of TM disorders may persist, change, or recur intermittently."
  • "The patient should be informed that the success of treatment is often dependent upon patient compliance with prescribed treatment and recommendations for behavioral modifications. Lack of compliance should be recorded."
  • "When articular derangement and/or condylar dislocation has been determined to be the etiology of the patient’s pain and/or functional impairment, manual manipulation of the mandible may be performed by the dentist."
  • "Oral orthotics (guards/splints) may be used by the dentist to enhance diagnosis, facilitate treatment or reduce symptoms."
  • "The dentist should periodically evaluate oral orthotics (guards/splints) for their effectiveness, appropriateness and possible risks associated with continued use."
  • "Before restorative and/or occlusal therapy is performed, the dentist should attempt to reduce, through the use of reversible modalities, the neuromuscular, myofascial and temporomandibular joint symptoms."
  • "The dentist may replace teeth, alter tooth morphology and/or position by modifying occluding, articulating, adjacent or approximating surfaces, and by placing or replacing restorations (prostheses) to facilitate treatment."
  • "Transitional or provisional restorations (prostheses) may be utilized by the dentist to facilitate treatment."
  • "Intracapsular and/or intramuscular injection, and/or arthrocentesis may be performed for diagnostic and/or therapeutic purposes."
  • "Orthodontic therapy may be utilized to facilitate treatment."
  • "Orthognathic surgery may be performed to facilitate treatment."
  • "When internal derangement or pathosis has been determined to be the cause of the patient’s pain and/or functional impairment, arthroscopic or open resective or reconstructive surgical procedures may be performed by the dentist." 

 

Choosing Wisely (2016)

Avoid routinely using irreversible surgical procedures such as braces, occlusal equilibration and restorations as the first treatment of choice in the management of temporomandibular joint disorders.

 

There is a lack of evidence that temporomandibular joint disorders (TMD) (defined as musculo-skeletal disorders, not the lesion of traumatic occlusion) are always progressive, and evidence exists that in many instances, patients with TMD have spontaneous remissions without treatment. Therefore, management is generally conservative and includes reversible strategies such as patient education, medications, physical therapy and/or the use of occlusal appliances that do not alter the shape or position of the teeth or the alignment of the jaws.

 

National Institute of Dental and Craniofacial Research (NIDCR)

There are several treatments for TMJ disorders. This step-by-step plan from the National Institute of Dental and Craniofacial Research allows you to try simple treatment before moving on to more involved treatment. Even if symptoms become significant and persistent, most people still do not need aggressive types of treatment. The NIDCR also recommends a “less is often best” approach in treating TMJ disorders, which includes:

  • eating softer foods
  • avoiding chewing gum and biting your nails
  • modifying the pain with heat or ice packs
  • practicing relaxation techniques to control jaw tension, such as meditation or biofeedback.

 

If necessary, for your symptoms, the following treatments may be advised:

  • exercises to strengthen your jaw muscles
  • medications prescribed by your dentist; for example, muscle relaxants, analgesics, anti-anxiety drugs or anti-inflammatory medications
  • a night guard or bite plate to decrease clenching or grinding of teeth.

 

Few conclusive studies are available on the safety and effectiveness of TMD treatments. However, the available published peer-reviewed literature indicates that conservative management should be the initial approach. Self-care practices (e.g., eating soft food, learning stress reduction techniques, and practicing jaw exercises), pharmacological therapy (e.g., analgesics and/or nonsteroidal anti-inflammatory drugs [NSAIDs]), physical, or intraoral appliances are all reversible treatments that are considered first-line management. According to the TMJ Association and the NIH, treatments that cause permanent changes in the bite or jaw should be avoided, including crown and bridge work and occlusal adjustment and repositioning splints that permanently change the bite.

 

The Guidelines of the Royal College of Dental Surgeons of Ontario

The concept of routine irreversible alteration of the patient’s temporomandibular joints, jaws, occlusion or dentition, is not supported by sound scientific studies. Such modalities of treatment can only be justified in selected cases where a non-functional occlusion (e.g. loss of posterior support, severe lack of adequate inter-arch dental contact) has been clearly and irrefutably demonstrated to be related to the etiology, when conservative methods of treatment have failed, and if the patient’s signs and symptoms justify such an approach. Itis important to recognize that failure to manage a patient’s symptoms with a conservative method does not necessarily imply nor guarantee the success of another more invasive technique.

 

Generally, all appropriate conservative treatment modalities should havebeen prescribed over a suit-able period of time and before considering surgical intervention. It must be appreciated that where conservative therapy has failed to modify the patient’s TMD (internal derangement), it does not necessarily follow that surgical intervention will result in a positive therapeutic effect. Furthermore, in those situations, surgical intervention is generally part of a process of management rather than a cure, with some notable exceptions (such as closed lock of the mandible).

 

Where in certain special situations, there is no obvious causal relationship between the patient’s complaints and the anatomical, clinical, or pathological abnormality of TMD, surgery cannot, with reasonable certainty, be expected to be helpful and, indeed, could be harmful.

 

Prior Approval:

Not applicable

 

Policy:

Diagnostic

The following diagnostic procedures are considered investigational services for treatment of TMD:

  • Electromyography (EMG)
  • Neuromuscular junction testing
  • Somatosensory testing
  • Muscle testing
  • Standard dental radiographic procedures
  • Range of motion measurements
  • Arthroscopy for diagnosis
  • Joint vibration analysis
  • Thermographic testing
  • Bruxism device (e.g. Bruxoff, Grindcare)

 

The following non-surgical treatments are considered investigational for the treatment of TMD:

  • Biofeedback (see policy 02.01.05)
  • Low-load prolonged-duration stretch (LLPS) devices such as the Dynasplint system
  • Passive Rehabilitation Therapy such as the Therabite
  • Low-level laser Therapy
  • Bruxism Monitor
  • Ionphoresis
  • Manipulation under anesthesia, outside of dislocation and fracture
  • Dry Needling
  • Neuromuscular Re-education
  • Neuromuscular Dentistry
  • Botulinum toxin (see pharmacy policy 05.01.02 Neuromuscular Blocking Agents)
  • Continuous Passive Motion (see policy 01.01.04)
  • Viscosupplementation (see pharmacy policy 02.01.12 Viscosupplementation for Osteoarthritis)

 

Surgical

The following surgical treatments:

  • Arthrocentesis
  • Arthroplasty
  • Arthroscopy
  • Condylectomy
  • Arthrotomy

 

Are considered medically necessary only when all of the following conservative treatments have been unsuccessful in relieving pain or hypomobility of TMD:

  • NSAID use for at least 4 weeks
  • Corticosteroid injections are ineffective or contraindicated
  • Soft diet for at least 3 months
  • Orthotic (night guards or bite plates) use is consistent for at least 3 months
  • Physical therapy regularly (at a minimum weekly) for a minimum of 3 months

 

AND at least one of the following is present:

  • Imaging evidence of disc displacement and/or perforation; or
  • Evidence of internal joint derangement; or
  • Tumor; or
  • Cyst

 

The following surgical treatments are considered investigational in the treatment of TMJ:

  • Total joint replacement with the TMJ Fossa-Eminence/Condylar Prosthesis System™
  • Partial joint replacement with the TMJ Fossa-Eminence Prosthesis™
  • Joint replacement with non FDA approved products (availability of FDA approval information can be found at: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMA/pma.cfm)
  • Manipulation under anesthesia (see policy 08.01.20)

 

At the present time, there is insufficient evidence in the published medical literature to demonstrate the safety, efficacy and long-term outcomes of the TMJ Fossa-Eminence/Condylar Prosthesis System™ for total joint replacement or the TMJ Fossa-Eminence Prosthesis™ for partial joint replacement.

 

Procedure Codes and Billing Guidelines:

To report provider services, use appropriate CPT* codes, Modifiers, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or diagnosis codes.

  • 20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance
  • 20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance 
  • 20999 Unlisted procedure, musculoskeletal system, general
  • 21010 Arthrotomy, temporomandibular joint 
  • 21050 Condylectomy, temporomandibular joint (separate procedure)
  • 21060 Meniscectomy, partial or complete, temporomandibular joint
  • 21073 Manipulation of temporomandibular joint, therapeutic, requiring an anesthesia service
  • 21240 Arthroplasty, temporomandibular joint, with or without autograft (includes obtaining graft)
  • 21242 Arthroplasty, temporomandibular joint, with allograft 
  • 21243 Arthroplasty, temporomandibular joint, with prosthetic joint replacement
  • 21299 Unlisted craniofacial and maxillofacial procedure
  • 29800 Arthroscopy, temporomandibular joint, diagnostic, with or without synovial biopsy (separate procedure)
  • 29804 Arthroscopy, temporomandibular joint, surgical
  • 70250 Radiologic examination, skull; less than 4 views
  • 70260 Radiologic examination, skull; complete, minimum of 4 views
  • 70300 Radiologic examination, teeth; single view
  • 70310 Radiologic examination, teeth; partial examination, less than full mouth
  • 70320 Radiologic examination, teeth; complete, full mouth
  • 76499 Unlisted diagnostic radiographic procedure
  • 77077 Joint survey, single view, 2 or more joints (specify)
  • 90875 Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 30 minutes
  • 90876 Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 45 minutes
  • 95867 Needle electromyography; cranial nerve supplied muscle(s), unilateral
  • 95868 Needle electromyography; cranial nerve supplied muscles, bilateral 
  • 95937 Neuromuscular junction testing (repetitive stimulation, paired stimuli), each nerve, any 1 method
  • 95927 Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in the trunk or head
  • 95851 Range of motion measurements and report (separate procedure); each extremity (excluding hand) or each trunk section (spine)
  • 97033 Application of a modality to one or more areas; iontophoresis, each 15 minutes
  • 97112 Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities
  • S8948 Application of a modality (requiring constant provider attendance) to one or more areas; low-level laser; each 15 minutes
  • E0746 Electromyography (EMG), biofeedback device
  • E1399 Durable medical equipment, miscellaneous
  • E1700 Jaw motion rehabilitation system
  • E1701 Replacement cushions for jaw motion rehabilitation system, package of 6
  • E1702 Replacement measuring scales for jaw motion rehabilitation system, package of 200                 

 

Selected References:

  • National Institutes of Health Technology Assessment Statement- Management of Temporomandibular Disorders- April 1996.
  • Iglarsh, ZA Temporomandibular Joint Dysfunction:  Presented in the Guide to Physical Therapist Practice as found in Orthopaedic Physical Therapy Clinics of North America Issue on Upper Quadrant: Evidence-Based Description of Clinical Practice (Ed by JJ Godges and GD Deyle) 1999 March 8(1), pp 69—82.
  • ECRI Temporomandibular Articular Disorders: Selected Treatments (TMJ). Plymouth Meeting (PA): Technology Assessment Report. March 2001. 269 p.
  • ECRI Temporomandibular Joint Arthroscopy. Plymouth Meeting (PA): ECRI Health Technology Information Service; 2005 March 23. 8 p. (ECRI Hotline Response).
  • American Society of Temporomandibular Joint Surgeons Guidelines for Diagnosis and Management of Disorders Involving the Temporomandibular Joint and Related Musculoskeletal Structures. Accessed on August 4, 2008.
  • Wellmark Physical Medicine Guide ( January 2008 Edition).  Wellmark Blue Cross Blue Shield
  • ECRI Efficacy of Treatments for Temporomandibular Joint Disorders. Plymouth Meeting (PA): ECRI Health Technology Information Service; 2011 October 3. (Hotline Response).
  • ECRI. Mechanical Stretching Devices (Therabite and Other Devices) for Limited Jaw Mobility. Plymouth Meeting (PA): ECRI Health Technology Information Service 2011 March 23. (Hotline Response).
  • Dym, H & Israel, H. Diagnosis and treatment of temporomandibular disorders. Dent Clin North Am 2012 Jan;56(1):149-61. 
  • American Association for Dental Research (AADR). Policy Statement: Temporomandibular joint disorders (TMJ).
  • Vos LM, Huddleston Slater JJ, Stegenga B. Lavage therapy versus nonsurgical therapy for the treatment of arthralgia of the temporomandibular joint: a systematic review of randomized controlled trials. J Orofac Pain 2013; 27(2):171-9.
  • American Dental Association Temporomandibular (Craniomandibular) Disorders. Practice Parameters. Revised1997. TMJ Association
  • American Society of Temporomandibular Joint Surgeons Guidelines for diagnosis and management of disorders involving the temporomandibular joint and related musculoskeletal structures.
  • Ebrahim S, Montoya L, Busse JW, et al. The effectiveness of splint therapy in patients with temporomandibular disorders: a systematic review and meta-analysis. J Am Dent Assoc. Aug 2012;143(8):847-857. PMID 22855899
  • Sharma S, Crow HC, McCall WD Jr, Gonzalez YM. Systematic review of reliability and diagnostic validity of joint vibration analysis for diagnosis of temporomandibular disorders. J Orofac Pain. 2013;27(1):51-60.
  • National Institute for Health and Clinical Excellence (NICE). Total prosthetic replacement of the temporomandibular joint. Interventional Procedure Guidance 329. London, UK: NICE; December 2009.
  • American Association for Dental Research (AADR). Policy Statement: Temporomandibular disorders (TMD).
  • Luther F, Layton S, McDonald F. Orthodontics for treating temporomandibular joint (TMJ) disorders. Cochrane Database Syst Rev. 2010;(7):CD006541. 
  • National Institute of Dental and Craniofacial Research (NIDCR). Oral health topics.
  • Choosing Wisely (2016) American Dental Association.  
  • Goiato MC, da Silva EV, de Medeiros RA, et al. Are intra-articular injections of hyaluronic acid effective for the treatment of temporomandibular disorders? A systematic review. Int J Oral Maxillofac Surg. 2016;45(12):1531-1537. 
  • American Association of Oral and Maxillofacial Surgeons. Clinical Condition Statements. Temporomandibular Disorders. 2017. Accessed Nov 2017.
  • Scrivani SJ, Mehta NR. Temporomandibular disorders in adults. UpToDate.
  • Zou L, He D, Ellis E. A Comparison of Clinical Follow-Up of Different Total Temporomandibular Joint Replacement Prostheses: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg. 2017 Aug 24. pii: S0278-2391(17)31145-X. [Epub ahead of print]
  • National Institute of Dental and Craniofacial Research (NIDCR). Oral health topics. 
  • Choosing Wisely (2016) American Dental Association. 
  • Goiato MC, da Silva EV, de Medeiros RA, et al. Are intra-articular injections of hyaluronic acid effective for the treatment of temporomandibular disorders? A systematic review. Int J Oral Maxillofac Surg. 2016;45(12):1531-1537.
  • American Association of Oral and Maxillofacial Surgeons. Clinical Condition Statements. Temporomandibular Disorders. 2017. Accessed Nov 2017. 
  • Scrivani SJ, Mehta NR. Temporomandibular disorders in adults. UpToDate. 
  • Zou L, He D, Ellis E. A Comparison of Clinical Follow-Up of Different Total Temporomandibular Joint Replacement Prostheses: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg. 2017 Aug 24. pii: S0278-2391(17)31145-X. [Epub ahead of print]
  • Zokaee H, Akbari Zahmati AH, Mojrian N, Boostani A, Vaghari M. Efficacy of low-level laser therapy on orofacial pain: A literature review. Adv Hum Biol [serial online] 2018 [cited 2018 Jul 11];8:70-3.
  • Fernando M. Munguia, DDS, MS/John Jang, DMD, MS/Mahmoud Salem, DDS, MS/Glenn T. Clark, DDS, MS/Reyes Enciso, PhD, Efficacy of Low-Level Laser Therapy in the Treatment of Temporomandibular Myofascial Pain: A Systematic Review and Meta-Analysis. Journal of Oral & Facial Pain and Headache [25 Apr 2018].
  • Talmaceanu D, Lenghel LM, Bolog N, et al. Imaging modalities for temporomandibular joint disorders: an update. Clujul Med. 2018;91(3):280-287.
  • Zatarain LA, Smith DK, Deng J, et al. A Randomized Feasibility Trial to Evaluate Use of the Jaw Dynasplint to Prevent Trismus in Patients With Head and Neck Cancer Receiving Primary or Adjuvant Radiation-Based therapy. Integr Cancer Ther. 2018 Sep;17(3):960-967. 
  • FDA regulation of PMA devices
  • American Association of Oral and Maxillofacial Surgeons. Parameters of Care: AAOMS Clinical Practice Guidelines for Oral and Maxillofacial Surgery. Temporomandibular Joint Surgery. (AAOMS ParCare) Sixth Edition. 2017. 
  • Kanatsios S, Breik O, Dimitroulis G. Biomet stock temporomandibular joint prosthesis: Long-term outcomes of the use of titanium condyles secured with four or five condylar fixation screws. J Craniomaxillofac Surg. 2018 Oct;46(10):1697-1702.
  • Zou L, Zhang L, He D, Yang C, Zhao J, et al. Clinical and Radiologic Follow-Up of Zimmer Biomet Stock Total Temporomandibular Joint Replacement After Surgical Modifications. J Oral Maxillofac Surg. 2018 Dec;76(12):2518-2524.
  • de Melo DP, Bento PM, Peixoto LR, et al. Is infrared thermography effective in the diagnosis of temporomandibular disorders? A systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Sep 26. pii: S2212-4403(18)31190-8.

 

Policy History:

  • January 2020 - Annual Review, Policy Revised
  • January 2019 - Annual Review, Policy Revised
  • January 2018 - Annual Review, Policy Revised
  • January 2017 - Annual Review, Policy Revised
  • January 2016 - Annual Review, Policy Revised
  • January 2015 - Annual Review, Policy Renewed
  • February 2014 - Annual Review, Policy Revised
  • May 2013 - Annual Review, Policy Revised
  • May 2012 - Annual Review, Policy Revised
  • July 2011 - Annual Review, Policy Revised

Wellmark medical policies address the complex issue of technology assessment of new and emerging treatments, devices, drugs, etc.   They are developed to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Wellmark medical policies contain only a partial, general description of plan or program benefits and do not constitute a contract. Wellmark does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Wellmark or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. Our medical policies may be updated and therefore are subject to change without notice.

 

*CPT® is a registered trademark of the American Medical Association.