Oral and Maxillofacial Surgery Section -
Vestibuloplasty
| Topic: Vestibuloplasty |
Last Reviewed Date:
01/2003 |
| Section: Oral and Maxillofacial
Surgery |
Policy No: 49 |
| Revised/Effective Date: 01/2003
|
Next Review Date: 01/2005 |
IMPORTANT INFORMATION
This Dental Policy has been developed through consideration of
generally accepted standards of dental practice, review of dental literature,
dental necessity, and as appropriate, government approval.
Benefit determinations should be based
in all cases on the applicable contract language.
To the extent there are any conflicts between these guidelines and the
contract language, the contract language will control.
The purpose of dental policy is to provide a guide to coverage. Dental
policy is not intended to dictate to providers how to practice dentistry.
Providers are expected to exercise their clinical judgment in providing
the most appropriate care.
|
Description
Vestibuloplasty:
Includes any surgical procedures designed to develop
alveolar ridge height by repositioning the muscles
attached to the buccal, labial, and lingual aspects
of the jaws. It may involve skin grafting techniques.
Vestibuloplasty – ridge extension (secondary
epithelialization) (D7340)
Vestibuloplasty – ridge extension (including
soft tissue grafts, muscle reattachment, revision
of soft tissue attachment and management of hypertrophied
and hyperplastic tissue) (D7350)
Policy/Criteria
Procedure is in accordance with generally accepted
standards of dental practice.
Administrative Guidelines
Subject to review with supporting documentation,
as a dental procedure.
| Codes |
Number |
Description |
| CDT |
D7000-D7999 |
|
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|
