# TN Insurance Bulletin (1988-09-01): TN Insurance Bulletin (1988-09-01): Temporomandibular Joint Syndrome (TMJ)

> Tennessee · Agency guidance · In force

URL: https://www.frixlaw.com/law-library/statutes/TN_INS_B_19880901_9_1_88

## Section

- **Citation:** TN Insurance Bulletin (1988-09-01)
- **Heading:** TN Insurance Bulletin (1988-09-01): Temporomandibular Joint Syndrome (TMJ)
- **Jurisdiction:** Tennessee
- **Kind:** Agency guidance
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** Tennessee Department of Commerce and Insurance Bulletins / TN Insurance Bulletin (1988-09-01): Temporomandibular Joint Syndrome (TMJ)

## Text

c
STATE OF TENNESSEE
DEPARTMENT OF COMMERCE AND INSURANCE
500 JAMES ROBERTSON PARKWAY
NASHVILLE, TENNESSEE 37219
NED McWHERTER
GOVERNOR
ELAINE A. McREYNOLDS
COMMISSIONER
B U L L E T I N
TO:
All Health Insurers Doing Business
in Tennessee
FR:
Elaine A. McReynolds, Commissioner
~~J11
Department of Commerce and Insurance ~
RE:
Temporomandibular Joint Syndrome (TMJ)
DA:
September 1, 1988
The
purpose
of
this
bulletin
is
to
announce
the
Department's position regarding coverage of temporomandibular
joint disorders
under major
medical policies.
As
you are
aware,
TMJ
is
a
condition
involving
the
temporomandibular
joint causing headaches, muscle tenderness, facial pain, and
other head and neck pains.
Diagnosis and treatment are often
multidisciplinary in scope.
The question then arises as to
the scope of coverage of
TMJ
under
a
major medical policy
issued
in
Tennessee.
T.C.A.
Section
56-7-1002
requires
policies issued in Tennessee to cover surgical procedures or
other medical or health care services specified in the policy
which are within the
scope
of
practice
of
dentistry
when
performed by a duly licensed dentist.
Therefore, an accident
and
health policy
must
cover
treatment
of
TMJ
by
a
duly
licensed dentist when such treatment could also be performed
by a physician.
The
Department
has
adopted
the
American
Dental
Association (ADA) categorization of TMJ treatment into Phase I
and Phase II treatment.
Phase
I
treatment includes diagnosis and management of
systems.
Treatment
may
include
soft
diet,
medications,
thermal
agents,
temporary
splints,
and
voluntary
self-
disengagement of the teeth.
Phase II treatment occurs once symptoms have subsided and
the patient has been maintained through appliances in a stable
pain-free condition for from 3-6 months
I
and Phase II treatment.
Phase
I
treatment includes diagnosis and management of
systems.
Treatment
may
include
soft
diet,
medications,
thermal
agents,
temporary
splints,
and
voluntary
self-
disengagement of the teeth.
Phase II treatment occurs once symptoms have subsided and
the patient has been maintained through appliances in a stable
pain-free condition for from 3-6 months.
Such treatment may
include alteration of the occlusion, which may be accomplished
through
occlusal
adjustment
of
the
teeth,
restorative
treatment, prosthodontic treatment, orthodontic treatment, or
surgery.
"/
11 B

It is the Department's position that Phase I treatment of
TMJ shall be covered
by accident
and health policies.
In
addition, surgery, although part of Phase II treatment, should
also be covered by accident and health policies when surgical
procedures could also be performed by a physician.
Policy
filings
will
be
reviewed
in
light
of
this
announced position.
Accordingly, any exclusion of TMJ
in a
major medical policy will not be allowed.
Any exclusion of
treatment by a dentist will not be allowed.
Coverage cannot
be limited to surgical means only.
The Department will allow
an exclusion for orthodontics or treatment to the teeth or
gums,
however,
the
Department
does
not
consider
Phase
I
treatment to
be
treatment to the teeth or
gums.
Phase
I
treatment of the temporomandibular joint may,
under Phase
I
treatment,
be
accomplished
in
some
instances
through
the
application of devices to the teeth or gums and would not be
excluded under
an exclusion for treatment
to
the teeth or
gums.
EAM/cmf

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/TN_INS_B_19880901_9_1_88. Check the current official text before relying on it. Not legal advice.