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Health Coverage
Clinical Policy Bulletins
Dental - Clinical Policy Bulletins Number: 014 Subject: Tooth Positioners For Orthodontic Treatment (Invisalign®) Date: April 29, 2008 Important Note This Clinical Policy Bulletin expresses Aetna's determination of whether certain services or supplies are medically necessary. We have reached these conclusions based on a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical and dental literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians and dentists practicing in relevant clinical areas, and other relevant factors). We expressly reserve the right to revise these conclusions as clinical information changes, and welcome further relevant information.Each benefits plan defines which services are covered, which are excluded and which are subject to dollar caps or other limits. Members and their dentists will need to consult the member's benefits plan to determine if there are any exclusions or other benefits limitations applicable to this service or supply. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (that is, will be paid for by Aetna) for a particular member. The member's benefits plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. In addition, coverage may be mandated by applicable legal requirements of a state, the federal government or CMS for Medicare and Medicaid members. Policy
Aetna considers Invisalign® and any other system using aligners as comprehensive orthodontic treatment. Background Orthodontic aligners are an orthodontic treatment modality used for the correction of malpositioned teeth. A series of clear, custom made, removable aligners are created to effectively move teeth into their desired position. The treatment combines orthodontic science with three-dimensional computer graphics to project tooth movement. The system moves teeth into alignment without the use of metal wires and brackets. The aligners are made from a thin, transparent plastic that fits over the buccal, lingual/palatal and occlusal surfaces of the teeth and correspond to a series of computer-created models. They are usually worn for a minimum of twenty hours per day and are changed as desired clinical results are achieved, typically every two weeks. The total treatment time for case completion varies, as does the number of aligners for each case. Codes1
D8070 -- Comprehensive orthodontic treatment of the transitional dentition Revision Dates The above policy is based on the following references: 1American Dental Association. Current dental terminology, CDT 2007-2008: 65.* 2Invisalign website. Align Technology, Inc. August 13, 2004. http://www.invisalign.com 3Joffe L. Invisalign: early experiences. J.Orthod. 2003 Dec; 30:348-52. 5Hajeer MY, Millett DT, Ayoub AF, Siebert JP. Applications of 3D imaging in orthodontics: part II. J. Orthod. 2004 Jun; 31:154-62. *Copyright 2006 American Dental Association. All rights reserved.
Property of Aetna. All rights reserved. Dental Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical/dental advice. This Dental Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating health care professionals are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating health care professionals are solely responsible for medical/dental advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change. |
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