Medical Policy

Policy Num:      13.005.001
Policy Name:     Dental Implants
Policy ID:          [13.005.001]  [Ac / L / M+ / P+]  [0.00.00]

Last Review:      October 24, 2024
Next Review:      October 20, 2025
 

Related Policies: None

Dental Implants

Summary

Dental implants are attachments that replace the root function of a tooth that are placed in the edentulous spaces to replace missing teeth. They are made of materials (titanium) capable of osseointegration in order to coexist in a healthy and natural way with the rest of the tissues of the mouth. After the bone integration of the implant occurs, a crown or prosthesis will be constructed on top of them.

Objective

Dental implants replace missing teeth using different treatments plan; (Implants/ Abutment Supported Removable denture, Implant/Abutment Supported Fixed Dentures, Single Crowns implants/ Abutment Supported).

Policy Statements

1.   There must be bone integration of the implant, to be able move to the prosthesis phase of crowns, bridges or dentures.

2.   To the insured person that does not have implant coverage; the participant can charge him as a private patient, the implant and all the other steps  included before inserting the crown. (Example: "healing caps", surgeries, analogous and abutments).

3.    In those coverages that do not include the benefit of implants, all necessary procedures as a result of a complication for the implant are excluded.

Policy Guidelines

   1.   Radiographic images that shows osseointegrated implant

   2.   Corrects implant services codes to be evaluate

   3.   Narrative report if necessary

Benefit Application

BlueCard/National Account Issues - N/A

Benefits are determined by the group contract, member benefit booklet, and/or individual subscriber certificate in effect at the time services were rendered.  Benefit products or negotiated coverages may have all or some of the services discussed in this medical policy excluded from their coverage.

Background

Definition of interest;

Abutment crown

      A crown that retains or support a fixed bridge.

Crown

      A prosthesis that is used to restore a tooth to proper occlusion, contact and contour.

Dental Implants

      Are attachments that replace the root function of a tooth placed in the edentulous spaces to replace the   missing teeth.

Denture

      A prosthesis replacing missing teeth.

              a- Complete denture- prosthesis replacing all the teeth in the arch.

              b- Partial denture- prosthesis replacing some tooth in the arch or quadrant.

Eposteal implants

      A dental implant that receives its primary support by resting on the bone. Used where advanced bone resorption may prevent the use of endosteal implant.

Implant abutment

      Is the implant that support and retain a fixed prosthesis.

Implant abutment fixed bridge

      A prosthesis that replaces one or more teeth and is cemented to the implant abutment. It consists of one or more pontics held in place by one or more     implant  abutments.

Implant abutment removable complete denture

      A complete denture that rest on implants abutments instead of resting in the alveolar bone. The denture is fixed but removable, giving more stability and comfort.

Pontic

      The part of a fixed bridge that is suspended between abutment replacing missing teeths

Subperiosteal implant

       Implant on top of the bone. Is a metal framework that sits on the jaw bone, but is underneath the gums.

Regulatory Status

N/A

Rationale

Is a medical device made of Titanium that are inserted in the jawbone as artificial roots to replace missing teeth and help to bring back oral masticatory function with different treatments plans; (Implants/ Abutment Supported Removable denture, Implant/Abutment Supported Fixed Dentures, Single Crowns implants/ Abutment Supported). This rehabilitation of the mouth improves the patient ability to eat and speak as enjoy a better quality of life regaining loss of oral function, treat disease and improve the appearance of one’s teeth.

Promotion of greater diversity and inclusion in clinical research of historically marginalized groups (e.g., People of Color [African-American, Asian, Black, Latino and Native American];LGBTQIA (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual); Women; and People with Disabilities [Physical and Invisible]) allows policy populations to be more reflectiveof and findings more applicable to our diverse members. While we also strive to use inclusive language related to these groups in our policies, use of gender-specific nouns (e.g.,women, men, sisters, etc.) will continue when reflective of language used in publications describing study populations.

Population Reference No. 1 

Individuals: With missing teeth. Interventions of interest is: Dental Implants. Comparators of interest are: Fixed Bridges, Dento alveolar supported complete denture, Removable Partial denture. Relevant outcomes include: Functional outcomes (restore mastication), Quality of life Implants/ Abutment Supported Removable denture. More stable and less traumatic in comparison to dento alveolar supported dentures. Implant/Abutment Supported Fixed Dentures. Fixed restoration in comparison to a removable prosthesis. Single Crowns implants/ Abutment Supported. Eliminate the need to prepare the structure of natural teeth that are used to support pontics.

Supplemental Information

N/A

Practice Guidelines and Position Statements

N/A

Medicare National Coverage

N/A

References

1. Participating Odontologist Manual 2024. Rules and Limitations for Implant Services.

2. Participating Prosthodontist Manual 2024. Rules and Limitations for Implant Services.

3. Participating Oral and Maxillofacial Surgeon Manual 2024. Rules and Limitations for Implant Services.

4. Participating Periodontic Manual 2024. Rules and Limitations for Implant Services.

5. Richard L. Gorwood, Dentistry and Dental Insurance Claim, 1993, Prosthodontics Removable and Fixed, Implant services, pages 129-131.

6. Infam Ahmad, Manual de Consulta Rápida en Prostodoncia, 2013, Sección 17; Implantes Dentales. (Prosthodontics Quick Consultation Manual, 2013, Section 17; Dental Implants.)

7. Steven J. Sadousky, Evidence Based Implant Treatment Planning and Clinical Protocols, 2016.

8. Academy of osseointegration. 2010 guidelines of the academy of osseointegration for the provision of dental implants and Associated Patient Care. Int J Oral Maxillofacial Implants. 2010 May-jun;25(3);620-627 Steven J. Sadousky, Evidence Based Implant Treatment Planning and Clinical Protocols, 2016.

Codes

Appplicable Modifiers

N/A

Policy History