Temporomandibular Joint Syndrome definition

Temporomandibular Joint Syndrome or “TMJS” means muscle tension and spasms related to the temporomandibular joint, facial, and cervical muscles, causing pain, loss of function, and neurological dysfunction.
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Temporomandibular Joint Syndrome or “TMJS” means muscle tension and spasms related to the temporomandibular joint, facial, and cervical muscles, causing pain, loss of function and neurological dysfunction. Covered Services: • Medical care or services to treat dysfunction or TMJS resulting from a medical cause or Injury. • Office visits for medical evaluation and treatment. • X-rays of the temporomandibular joint including contrast studies, but not dental x-rays. • Myofunctional therapy. • Surgery to the temporomandibular joint, such as condylectomy, meniscectomy, arthrotomy, and arthrocentesis. Coverage Limitations: • See the Temporomandibular Joint Dysfunction or Syndrome category of your Schedule of Out-of-Pocket Expense for specific limitations to this benefit. Non-Covered Services: • Bite splints, orthodontic treatment, or other dental services to treat TMJS are not covered. Covered Services: • One vision screening, performed as part of a physical exam, during each Plan Year to determine vision loss. • Eyeglasses, eyeglass frames, (all types of contact lenses if Medically Necessary) or corrective lenses every two (2) years for adults and yearly for children up to the age of 18 years. • Refractions. Coverage Limitations: • Refractions are limited to one time per Plan Year. • Eyeglass frames are limited to a specific selection. • Contact lenses are covered for Medically Necessary reasons only. Non-Covered Services: • Eye exercises, visual training, orthoptics, sensory integration therapy. • Radial keratotomy, laser surgeries and other refractive keratoplasty. • All other vision care services and supplies. Covered Services: • One hearing screening, performed as part of a physical exam, during each Plan Year to determine hearing loss. • Services and supplies related to hearing care, including ear plugs, external BAHA devices, hearing aids and adjustments • Examinations for hearing aids Coverage Limitations: • Hearing aids will be limited to one hearing aid per ear every three years, up to $600.
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Temporomandibular Joint Syndrome or "TMJ" means muscle tension and spasm related to the temporomandibular joint, facial, and cervical muscles, causing pain, loss of function and neurological dysfunction. The following services are covered when approved in advance by UnitedHealthcare Community Plan:
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Examples of Temporomandibular Joint Syndrome in a sentence

  • Diagnosis, therapeutic, or surgical procedures related to Temporomandibular Joint Syndrome (TMJ) and associated musculature and neurological conditions.

  • Treatment of fractures or dislocations; congenital malformations; malignancies, cysts, or neoplasms; or Temporomandibular Joint Syndrome (TMJ).

  • Eyeglasses or contact lenses (except when used as a prosthetic lens replacement for aphakic patients as in this Evidence of Coverage), dental prostheses or appliances (except for Medically Necessary treatment of Temporomandibular Joint Syndrome (TMJ)).

  • Medically Necessary surgical treatment, as determined by CareFirst BlueChoice, for Temporomandibular Joint Syndrome (TMJ).

  • Benefits are available to You for the diagnosis, therapeutic, or surgical procedures related to Temporomandibular Joint Syndrome (TMJ) and associated musculature and neurological conditions.

  • All other procedures involving the teeth or areas surrounding the teeth, including shortening of the mandible or maxillae for cosmetic purposes or for correction of malocclusion, Temporomandibular Joint Syndrome (TMJ) treatment or treatment for craniomandibular pain syndrome (CPS), will not be covered.

  • Medically Necessary surgical treatment, as determined by CareFirst, for Temporomandibular Joint Syndrome (TMJ).

  • The following services for the diagnosis and treatment of Temporomandibular Joint Syndrome (TMJ): surface electromyography; Doppler analysis; vibration analysis; computerized mandibular scan or jaw tracking; craniosacral therapy; orthodontics; occlusal adjustment; and dental restorations.

  • The following is a complete list of all limitations and exclusions under this Plan: Discounts for treatments of fractures or dislocations, congenital malformations, malignancies, cysts or neoplasms, or Temporomandibular Joint Syndrome (TMJ) are not provided.

  • Benefits are available to Plan Participants for the diagnosis, therapeutic, or surgical procedures related to Temporomandibular Joint Syndrome (TMJ) and associated musculature and neurological conditions.

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