No, Delta Dental does not cover botox for TMJ because no dental insurance covers it and there's no dental billing code for it either.
Delta dental has no TMJ botox coverage
Unfortunately, delta dental does not provide insurance coverage for botox injections to treat temporomandibular joint disorders. While delta does cover TMJ procedures, botox is NOT included.
Below is a typical breakdown for TMJ treatments that it covers.
None of those dental codes are for botox treatments. In order to save you time looking up each code, the table below describes what each of them are.
Dental Billing Code | Procedure Description |
|---|---|
D7840 | Condylectomy |
D7850 | Surgical discectomy |
D7852 | Disc repair |
D7854 | Synovectomy |
D7856 | Myotomy |
D7858 | Joint reconstruction |
D7860 | Arthrotomy |
D7865 | Arthroplasty |
D7870 | Arthrocentesis |
D7871 | Non-arthroscopic lysis & lavage |
D7872 | Arthroscopy - with or without biopsy |
D7873 | Arthroscopy: lavage/lysis of adhesions |
D7874 | Arthroscopy: disc repositioning |
D7875 | Arthroscopy: Synovectomy |
D7876 | Arthroscopy: Discectomy |
D7877 | Arthroscopy: Debridement |
D7880 | Occlusal orthotic device |
D7881 | Occlusal orthotic device adjustment |
Important note: Please take notice of the "limitations" in the benefit breakdown above which literally says every procedure except one, can only be done ONCE every 60 months. This means each of these TMJ procedures will be covered once every 5 years.
As you know, botox is temporary and only lasts about 3-6 months max.
That means you will need to have it reinjected on a routine basis.
What I'm trying to say is that even if delta dental covers it, you'll still be paying out of pocket for every subsequent visit! Over the course of 5 years, you may need up to 20 botox visits and if it covers it once every 5 years, that is not much help at all.
No dental billing code for TMJ botox injections
Ultimately the reason why delta dental does not cover botox for TMJ is because there is no dental billing code for it. This isn't unique to delta dental insurance because there isn't a single dental insurance that has it either.
Unfortunately, it is currently not a recognized insurance billing procedure.
Every dental treatment/procedure has an associated billing code that is used to communicate with dental insurance as to what as done. This code usually starts with the letter "D" followed by a 4 digit numerical code.
Botox injections for temporomandibular joint treatment does not have such a code.
What this all means: What I'm trying to say is that TMJ botox treatment is not covered by dental insurance. If you elect to have this procedure done, you will have to pay out of pocket for it. The cost will depend on how many units you need to treat your condition.
Verdict
If you have delta dental, you shouldn't hold your breath hoping for TMJ botox coverage... but it really isn't their fault because no dental insurance has coverage for it. Nonetheless, our dentists in Long Island City do provide botox for TMJ so if you're in the area, make an appointment with us!
