Will Medicare pay for TMJ surgery?

2 answers | Last updated: Nov 19, 2016
A fellow caregiver asked...

Will Medicare pay for TMJ surgery, which I am told has to be done by an oral surgeon?

Expert Answers

The answer is probably yes, but you should make sure with the surgeon's office before the surgery. Whether Medicare Part B covers it depends on the exact kind of oral surgery, and on who performs it. Medicare considers most oral surgery to be "dental" rather than "medical," and so does not cover it. But Medicare Part B can cover oral surgery in a few instances. If the treatment involves not teeth or gums but the bones of the mouth and jaw, as in TMJ surgery, Medicare will probably cover it.

The other key to whether Medicare will provide coverage is whether physicians (M.D.s) as well as dentists and non-physician oral surgeons also perform the same kind of treatment. If so, Medicare is more likely to consider the surgery to be covered "medical" care even if it is performed by a non-M.D. oral surgeon. One other condition -- the oral surgeon who performs the operation must participate in Medicare.

If you are in the process of scheduling oral surgery, ask the surgeon's office whether they participate in Medicare and if so, to request in advance that Medicare determine whether it will cover the procedure. It may take some written documentation by the oral surgeon's office, which could take some time. Once the surgeon's office receives Medicare approval, you'll know that the surgery will be covered. If the oral surgeon does not participate in Medicare but the surgery is of the type Medicare might cover, consider asking your primary care physician or dentist for a referral to a different oral surgeon who does Medicare-covered work.

Community Answers

A fellow caregiver answered...

Good luck with this one.  My mom fell and broke her jaw in three places.  She was taken to the emergency room first, and then was later treated by an oral surgeon.  Medicare wouldn't cover anything, including the emergency room.  Good luck finding an oral surgeon that takes medicare too.  We couldn't find a single one.