Temporary anchorage devices in orthodontics (034)

Number: 034
Update

Subject: Temporary Anchorage Devices in Orthodontics

Date: January 27, 2023

Important note

This Clinical Policy Bulletin expresses Aetna's determination of whether certain services or supplies are medically necessary, experimental and 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 this 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 Aetna’s opinion 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

Aetna considers a temporary anchorage device (TAD) to be a device that is temporarily attached to bone to enhance orthodontic anchorage. The procedure includes the device removal.

Background

A temporary anchorage device (TAD) is a biocompatible device that is fixed to bone to enhance orthodontic anchorage and/or overcome anchorage limitations. It is used during procedures to move teeth by either supporting the teeth of the reactive unit or by preventing the need for the reactive unit altogether. The TAD is removed after treatment and the removal is considered part of the overall TAD procedure. TADs may be located transosteally, subperiosteally or endosteally and may be fixed to bone either mechanically (cortically stabilized) or biochemically. 

TADs are generally manufactured with a smooth endosseous surface and/or additional surface treatments to actively discourage osseointegration and simplify their removal.

Osseointegrated dental implants, either conventional (D6010) or mini-implants (D6013), placed for the ultimate purpose of supporting a prosthesis, regardless of the fact that they may be used for orthodontic anchorage, are not considered temporary anchorage devices since they are not removed and discarded after orthodontic treatment. 

Codes

D7292 — placement of temporary anchorage device [screw retained plate], requiring flap
D7293 — placement of temporary anchorage device requiring flap
D7294 — placement of temporary anchorage device without flap

D7298 — removal of temporary anchorage device [screw retained plate], requiring flap

D7299 — removal of temporary anchorage device, requiring flap

D7300 — removal of temporary anchorage device without flap

Review dates

Original policy: August 24, 2009
Updated: October 4, 2010; September 26, 2011; October 29, 2012; January 13, 2014; January 26, 2015; February 17, 2016; March 15, 2017; April 26, 2018; April 29, 2019; May 13, 2020; February 14, 2022; January 27, 2023

Revised:

The above policy is based on the following references:

American Dental Association. CDT 2023 Dental Procedure Codes.

Copyright 2023 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.