Psychiatric/Psychological: TMJ dysfunction is often a psychosomatic condition, usually resulting from tension or stress. Bruxism is a common tension habit which can lead to the TMJ syndrome. Psychiatric/Psychological visits may be considered medically necessary when reported with a diagnosis of TMJ.
TMJ dysfunction may include psychological components such as fear of pain, and depression which may contribute to an exacerbation of symptoms.
Relaxation therapy, electromyographicbiofeedback and cognitive behavioral therapy may be considered medically necessary for treatment of TMJ as part of a comprehensive pain management plan.
Relaxation therapy, electromyographic biofeedback, and cognitive behavioral therapy are considered medically necessary in chronic headaches and insomnia, which are frequently associated with TMD/TMJ conditions.The above therapies may be considered medically necessary in treating these conditions as well.
Treatment in multi-disciplinary pain centers may be considered medically necessary in those few individuals who have been unresponsive to less, comprehensive interventions.
Services that do not meet the criteria of this policy will be considered not medically necessary.