11 commercial payer policies list 21050. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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11 policies from 10 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 21050 |
|---|---|---|
| Cigna Commercial Other Services Code List | Mar 7, 2026 | Prior auth required |
| Cigna Comprehensive Code List | Mar 7, 2026 | Prior auth required |
| Policy | Effective | Status of 21050 |
|---|---|---|
| Temporomandibular Disorders | Oct 1, 2026 | Covered |
| Policy | Effective |
|---|
| Status of 21050 |
|---|
| Temporomandibular Joint Disorders | Jan 1, 2026 | Covered |
|---|
| Policy | Effective | Status of 21050 |
|---|---|---|
| Temporomandibular Joint Disorders | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 21050 |
|---|---|---|
| Temporomandibular Joint Disorders | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 21050 |
|---|---|---|
| Temporomandibular Joint Disorders | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 21050 |
|---|---|---|
| Temporomandibular Disorders | Feb 2, 2026 | Covered with conditions |
| Policy | Effective | Status of 21050 |
|---|---|---|
| Treatment of Temporomandibular Joint Disorders – Surest Medical Policy | Oct 1, 2026 | Covered |
| Policy | Effective | Status of 21050 |
|---|---|---|
| Treatment of Temporomandibular Joint Disorders | Oct 1, 2026 | Covered |
| Policy | Effective | Status of 21050 |
|---|---|---|
| Treatment of Temporomandibular Joint Disorders | Oct 1, 2026 | Covered |