Occlusal adjustment (029)

Number: 029
Update

Subject: Occlusal adjustment

Date: August 1, 2024

Important note

This Clinical Policy Bulletin determines whether certain services or supplies are medically necessary, experimental, investigational, or cosmetic. Aetna® has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical 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 practicing in relevant clinical areas, and other relevant factors).

Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Bulletin.  The discussion, analysis, conclusions, and positions reflected in this Bulletin, including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute an opinion by Aetna and are made without any intent to defame.

Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. New and revised codes are added to the CPBs as they are updated. When billing, you must use the most appropriate code as of the effective date of the submission. Unlisted, unspecified and nonspecific codes should be avoided. 

Each benefits plan defines which services are covered, excluded and subject to dollar caps or other limits. Members and their dentists will need to refer to the member's benefits plan to determine if any exclusions or other benefits limitations apply to this service or supply.

The conclusion that a particular service or supply is medically necessary does not guarantee 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 we consider 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.

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Policy

We consider occlusal adjustment to be part of and inclusive to restorative, prosthodontic, implant, and endodontic services. Occlusal adjustment is appropriate during any phase of periodontal therapy, except in the case of acute conditions. Occlusal adjustment (limited and/or complete) is considered to be therapeutic for the treatment of etiologic factors of occlusal trauma to enable patients to maintain a comfortable and functional dentition. Aetna does not consider occlusal adjustment the sole treatment modality for the management or prevention of a temporomandibular disorder (TMD).  

Background

Occlusal adjustment (odontoplasty) is the reshaping of occlusal surfaces of teeth to create a harmonious contact relationship between maxillary and mandibular teeth. A primary objective of occlusal adjustment is improvement of the functional relations of the dentition in such a way that the teeth and the periodontium will receive uniform stimulation and the occlusal surfaces of the teeth will be exposed to an even physiologic wear.

The rationale for doing an occlusal adjustment can be grouped into the following categories:
 

1. Elimination of traumatic occlusion
2. Stabilization of orthodontic results
3. Establishment of an optimal occlusal pattern prior to extensive restorative procedures

Complete (full-mouth) occlusal adjustments are performed to achieve functional relationships and improve masticatory efficiency. It may be necessary to perform odontoplasty to occlusal surfaces of numerous teeth to establish or maintain occlusal harmony. Treatment is directed toward the elimination or minimization of excessive force or stress placed on the teeth and/or tooth.

Occlusal adjustments are necessary when they are essential to reduce or eliminate traumatic occlusion or when teeth are compromised from loss of periodontal support. Occlusal adjustments may be integral to a comprehensive restorative treatment or part of treatment to correct skeletal and occlusal disharmonies. A complete occlusal adjustment may require multiple visits, is considered part of comprehensive orthodontic treatment and is integral to orthognathic surgery.

Occlusal adjustments are of limited value as the sole treatment modality for the management or prevention of TMD. Scientific evidence does not support the performance of occlusal adjustment as a general method for treating a non-acute TMD, bruxism or headaches. Literature suggests that temporary reversible measures be attempted prior to permanent irreversible disengagement procedures.

Mounting of diagnostic casts, analysis and diagnosis are considered integral to the complete occlusal adjustment.

Codes

D9951 – occlusal adjustment - limited
D9952 – occlusal adjustment - complete

Revision dates

Original policy: January 17, 2006
Updated: September 21, 2007; August 24, 2009; October 4, 2010; January 23, 2012; December 4, 2012; January 13, 2014; January 26, 2015; February 17, 2016; March 15, 2017; April 26, 2018; April 29, 2019; May 6, 2020; October 28, 2021; October 12, 2022; August 16, 2023; August 1, 2024
Revised: October 13, 2008

The above policy is based on the following references:

Iven Klineberg, Steven E. Eckert. Functional Occlusion in Restorative Dentistry and Prosthodontics. Elsevier Ltd 2016. 

American Dental Association. CDT 2024 Dental Procedure Codes.

Copyright 2024 American Dental Association. All rights reserved.

Property of Aetna. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This 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 advice and treatment of members.