MMC Benefits Handbook
Temporomandibular Joint (TMJ) Coverage
NOTE: Out-of-network services are not covered under the Anthem BCBS Narrow Network (National Blue High Performance Network (Blue HPN Non-Tiered)) except for urgent and emergency care.
The Plan covers services for diagnostic and surgical treatment of conditions affecting the temporomandibular joint when provided by and under the direction of a physician. Coverage includes the diagnostic or surgical treatment required as a result of an accident, trauma, congenital defect, developmental defect or pathology.
  • Diagnostic coverage includes examination, radiographs and applicable imaging studies, and consultation.
  • Non-surgical treatment includes clinical examinations, oral appliances (orthotic splints), arthrocentesis and trigger-point injections. Surgical treatment* includes arthrocentesis, arthroscopy, arthroplasty, arthrotomy, open or closed reduction of dislocations and TMJ implants.
*Surgical treatment is provided if the following criteria are met:
    • There is clearly demonstrated radiographic evidence of significant joint abnormality.
    • Non-surgical treatment has failed to adequately resolve the symptoms.
    • Pain or dysfunction is moderate or severe.