Medicare and TMJ

[beachbum2012]

Has anyone had any luck getting TMJ diagnosis and/or treatment covered by original Medicare? I have a client on a medsupp who called Medicare. They gave him the names and numbers of several oral surgeons and clinics. He called 5 of them and they all said they didn't take Medicare. He's got dental insurance too but that has TMJ in there as an exclusion.

Should he just keep calling dentists or oral surgeons until he finds someone who accepts Medicare? I've done a bit of searching and it seems TMJ is covered under Part B, but maybe not every form of treatment, only ones that are "medically necessary" obviously. Any help is appreciated.

 

[TwoCents]

Has anyone had any luck getting TMJ diagnosis and/or treatment covered by original Medicare? I have a client on a medsupp who called Medicare. They gave him the names and numbers of several oral surgeons and clinics. He called 5 of them and they all said they didn't take Medicare. He's got dental insurance too but that has TMJ in there as an exclusion.

Should he just keep calling dentists or oral surgeons until he finds someone who accepts Medicare? I've done a bit of searching and it seems TMJ is covered under Part B, but maybe not every form of treatment, only ones that are "medically necessary" obviously. Any help is appreciated.

You might have better luck finding an ENT who treats TMJ. I would also recommend trying Medicare.gov's physician search.

 

[beachbum2012]

The names Medicare gave him were from their physician search. I verified with him today when I searched there for him too.

I called a couple places. One office referred me to University of Michigan. I called their office and they said they have oral surgeons on staff who accept Medicare, but it all depends on whether his exact diagnosis is medical-related or dental-related.

I like the idea about the ENT though too.

 

[LostDollar]

Years back, the possibility of getting TMJ covered by any kind of insurance (U65) was pretty much non-existent. Given the level of control that Medicare seems to place on "medically necessary", I wouldn't offer someone much hope of getting Medicare coverage for treatment either.