Myofunctional therapy
Myofunctional therapy is a behavioral treatment that retrains orofacial muscles to improve breathing, chewing, and swallowing patterns. Insurance companies such as Aetna and Cigna rarely cover myofunctional therapy, classifying it as experimental or investigational according to their 2023 policy bulletins.
CPT code 92526 often applies to myofunctional therapy claims, but insurers like UnitedHealthcare typically deny reimbursement unless linked directly to speech pathology needs. Out-of-pocket costs for myofunctional therapy average $150 per session in the U.S, as per YourInsurance.info.
Based on data from the American Speech-Language-Hearing Association (ASHA). Pediatric patients with sleep-disordered breathing represent a primary group referred for this therapy by orthodontists and ENTs.
Most dental insurance plans exclude coverage for myofunctional therapy because they categorize it outside of standard dental procedures. Flexible Spending Accounts (FSAs) sometimes reimburse these services if prescribed by a physician, but documentation requirements are strict.
Appeals for denied claims succeed less than 10% of the time according to 2022 National Association of Dental Plans statistics.
Is myofunctional therapy covered by insurance?
Myofunctional therapy is not usually covered by insurance. It is considered a ‘wellness service’ and there are currently no medical codes that provide coverage for this type of therapy. However, some insurance providers may offer reimbursement if the myofunctional therapist has a direct contract with them. It is best to check with your individual provider…
See also Myopia coverage, and Myomectomy cost.