US · guidance
CMS Pub. 100-02, ch. 15, § 150.1
Treatment of Temporomandibular Joint (TMJ) Syndrome
PASS memo Read.014
There are a wide variety of conditions that can be characterized as TMJ, and an equally
wide variety of methods for treating these conditions. Many of the procedures fall within
the Medicare program’s statutory exclusion that prohibits payment for items and services
that have not been demonstrated to be reasonable and necessary for the diagnosis and
treatment of illness or injury (§1862(a)(1) of the Act). Other services and appliances
used to treat TMJ fall within the Medicare program’s statutory exclusion at 1862(a)(12),
which prohibits payment “for services in connection with the care, treatment, filling,
removal, or replacement of teeth or structures directly supporting teeth....” For these
reasons, a diagnosis of TMJ on a claim is insufficient. The actual condition or symptom
must be determined.
History
(Rev. 1, 10-01-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
de54e3d94b0235a795683e01dc788c1d7d771c814a84fbab437e815f9c8f3109
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