West Virginia Code of State Rules
Agency 114 - Insurance Commission
Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER
Series 114-29 - Health Insurance Benefits For Temporomandibular And Craniomandibular Disorders
Section 114-29-5 - Procedures Covered

Universal Citation: 114 WV Code of State Rules 114-29-5

Current through Register Vol. XLI, No. 38, September 20, 2024

5.1. The insurance coverage required by this rule shall at a minimum include benefits for the following procedures:

5.1.1. Health history (medical and/or dental) pertinent to symptoms;

5.1.2. Clinical examination related to the presenting symptoms;

5.1.3. Imaging procedures; provided, that radiographs must be diagnostic for temporomandibular disorders (TMD) and/or craniomandibular disorders (CMD);

5.1.4. Conventional diagnostic and therapeutic injections;

5.1.5. Temporary orthotics; provided that splints or appliances may be limited to one every three (3) years, and that all adjustments to the appliance performed during the first six (6) months of its installation are considered part of the total appliance fee. Those appliances designed for orthodontic purposes such as bionators, functional regulators, Frankel devices, and similar devices are not covered;

5.1.6. Physical medicine and physiotherapy which shall include:
5.1.6.1. Ultrasound

5.1.6.2. Diathermy

5.1.6.3. High Voltage Galvanic Stimulation

5.1.6.4. Transcutaneous Nerve Stimulation.

5.1.7. Surgery on the Temporomandibular Joint which includes, but is not limited to, arthotomy and diagnostic arthroscopy.

5.2. Insurance coverage for the diagnosis and treatment of temporomandibular disorders (TMD) and craniomandibular disorders (CMD) as required by this rule shall be provided without regard to whether such diagnosis and treatment is provided by a doctor, dentist, or other health care professional so long as such provider is permitted by their professional license to perform such procedures. No distinction may be made as to whether such diagnosis and treatment are for a medical or a dental condition.

Disclaimer: These regulations may not be the most recent version. West Virginia may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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