Oral and Maxillofacial Surgery Section -
Ridge Augmentation
| Topic: Ridge Augmentation |
Last Reviewed Date:
01/2003 |
| Section: Oral and Maxillofacial
Surgery |
Policy No: 52B |
| 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
Osseous, osteoperiosteal, or cartilage graft
of the mandible or facial bones - autogenous or nonautogenous,
by report (D7950):
Includes obtaining autograft and/or allograft material.
This code may be used for ridge augmentation and/or
sinus lift procedure.
Repair of maillofacial soft and hard tissue
defect (D7955):
Various soft tissue grafting procedures may be used
alone or in combination with autograft, allograft,
or alloplastic materials to augment or repair the
defect and restore anatomic structure to required
form and function. These procedures may require multiple
surgical approaches.
Policy/Criteria
Procedure is in accordance with generally accepted
standards of dental practice.
Procedure is subject to review by the dental consultant
with documentation including x-rays and narratives.
Procedure may be cosmetic.
Covered for the purpose of an appliance only.
Coverage for the purpose of implants only if implants
are a benefit and subject to review with supporting
documentation including x-rays and narratives.
Administrative Guidelines
Process to contract benefits.
Note: purpose of sinus lift procedure is for
implant placement.
| Codes |
Number |
Description |
| CDT |
D7000-D7999 |
|
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