Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Dental Services)
Coordination Between
Dental and Medical
Carriers
If you perform the types of service listed above for your patients,
bill Blue Cross as usual. If the patient has a dental plan in addition
to a medical-surgical policy, the dental plan is the primary payer.
Note: If you receive payments from both the dental and medical
plans for the same services, refund the medical carrier. We
will coordinate up to our U&C allowances or billed charges,
whichever is less.
TMJ Claims Submission The following guidelines should be used when preparing TMJrelated
disorder claims for submission:
11-4
Codes Guidelines
ICM-9-CM The primary diagnosis code should be 524.60-
524.69, temporomandibular joint disorders. All
other primary diagnosis codes submitted for TMJ
and craniomandibular disorders will be rejected.
HCPCS
codes
CPT codes
nonsurgical
CPT codes
surgical
The HCPCS code for orthotic therapy should be
D7880. All other orthotic codes submitted for TMJ
and craniomandibular disorders will be rejected.
Study casts and/or mounted or unmounted study
models are considered an integral part of the splint
therapy and should not be billed separately.
Orthotic adjustments and office call visits are
considered an integral part of the orthotic therapy
and should not be billed separately. Only the initial
visit may be billed separately.
The following procedure codes are considered
eligible for reimbursement for surgical services of
the temporomandibular joint: 21050, 21060, 21070,
21073, 21240, 21242, 21243, 29804 (TMJ
arthroscopy—surgical only).
Note: All postoperative office visits are considered
an integral part of the surgical fee and will be
denied if billed separately during the global
surgical period.
Blue Cross Blue Shield of Minnesota Provider Policy and Procedure Manual (03/06/12)