The cost of TMJ treatment or a custom sleep apnea appliance depends on the diagnosis and the treatment chosen, so Sleep Apnea and TMJ Dental Group gives every patient a written fee for their own plan after the evaluation, before any treatment starts. This article explains what drives the cost and how insurance treats each.
What determines the cost of a sleep apnea appliance?
The fee for oral appliance therapy covers more than the device. It includes the evaluation, records and scans, a custom adjustable appliance, the adjustment visits needed to reach the right jaw position, and follow-up visits to check your teeth and bite. The AASM/AADSM guideline suggests a custom, adjustable appliance made by a qualified dentist rather than a non-custom device, and periodic follow-up with both a dentist and a sleep physician (Ramar 2015). A store-bought mouthpiece costs less but is not what the guideline recommends for diagnosed obstructive sleep apnea. See how a mandibular advancement appliance works.
Does insurance pay for a sleep apnea mouthpiece?
Usually through medical insurance, not dental insurance, because obstructive sleep apnea is a medical diagnosis. Plans typically require a sleep test showing obstructive sleep apnea and a physician’s order. The practice is out-of-network with all plans, including Medicare: you pay the office, and we provide itemized paperwork with the diagnosis and procedure codes for you to submit. Whether your plan reimburses an out-of-network provider depends on your plan.
What determines the cost of TMJ treatment?
TMJ care ranges from education and home exercises to a series of visits with splints, medication or injections. A 2023 BMJ guideline for chronic TMJ pain puts the strongest recommendations on lower-cost conservative care: cognitive behavioral therapy, therapist-assisted mobilization, supervised jaw exercise and education (Busse 2023). Starting with the best-supported options can avoid paying for treatments with weaker evidence. See TMJ treatment without surgery.
Does insurance cover TMJ treatment?
It varies more than for sleep apnea. Some medical plans cover TMJ evaluation and treatment, some dental plans cover part of it, and many plans exclude TMJ treatment entirely. Check your plan documents for a TMJ or TMD exclusion before your visit.
How is the fee given to me?
After the evaluation, you receive your diagnosis, your treatment options and the fee for each in writing. Nothing is started until you agree. Call (818) 877-0118 to ask about the evaluation fee. The office is at 23101 Sherman Pl, Suite 415, West Hills, and is expected to open in mid-January 2027.
References
- Ramar K, Dort LC, Katz SG, et al. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med. 2015;11(7):773-827. PMID 26094920. doi:10.5664/jcsm.4858
- Busse JW, Casassus R, Carrasco-Labra A, et al. Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline. BMJ. 2023;383:e076227. PMID 38101929. doi:10.1136/bmj-2023-076227
