Does TRICARE cover TMJ treatment?

TRICARE covers treatment for temporomandibular joint (TMJ) disorders when medically necessary, as TMJ conditions are classified as a medical rather than dental benefit. Covered services include diagnostic evaluation including imaging (X-rays, MRI, CT scans), conservative treatments such as physical therapy and pain management, oral splints and occlusal guards prescribed by a treating provider, medications for pain and inflammation, and surgical intervention when conservative treatments have failed. Pre-authorization is required for surgical TMJ procedures, and documentation of failed conservative therapy is typically necessary. Under TRICARE Prime, a referral from the primary care manager is needed to see a TMJ specialist, while TRICARE Select allows direct access. TMJ treatments provided solely for dental purposes, such as orthodontic correction of bite alignment for aesthetic reasons, are not covered under the medical benefit. Standard copays and cost-shares apply based on the beneficiary's plan and provider network status.