Number: 034
(Updated)
Subject: Temporary anchorage devices in orthodontics
Date: February 17, 2016
Important note
This Clinical Policy Bulletin explains how we determine whether certain services or supplies are medically necessary. We made these decisions 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
- 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, 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.
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 (osseointegrated).
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 (D60101) or mini-implants (D60131), placed for the ultimate purpose of supporting a prosthesis are not considered temporary anchorage devices. They are not removed and discarded after orthodontic treatment. This is true even though they may be used for orthodontic anchorage.
Codes1
D7292 -- Surgical placement: temporary anchorage device [screw retained plate] requiring surgical flap. Insertion of a temporary skeletal anchorage device that is attached to the bone by screws and requires a surgical flap. Includes device removal.
D7293 -- Surgical placement: temporary anchorage device requiring surgical flap. Insertion of a device for temporary skeletal anchorage when a surgical flap is required. Includes device removal.
D7294 -- Surgical placement: temporary anchorage device without surgical flap. Insertion of a device for temporary skeletal anchorage when a surgical flap is not required. Includes device removal.
Revision 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
Revised:
The above policy is based on the following references:
1American Dental Association. CDT 2016 Dental Procedure Codes: 55, 69*
2Current products and practice, bond anchorage devices in orthodontics. Jagadish Prabhu and Richard Cousley, Journal of Orthodontics, Vol. 33, No. 4, 288-307, December 2006 doi:10.1179/146531205225021807© 2006 British Orthodontic Society.
3Lecture summary: temporary anchorage devices in orthodontics: clinical experimentation or evidence-based? Dr. Jason Cope, Summary by Dr. Rodney D. Hyduk, July 19, 2006.
4Temporary anchorage devices for tooth movement: a review and case reports. McGuire, MK, Scheyer ET, Gallerano RL, J Periodontal, 2006 Oct;77(10):1613-24.
*Copyright 2015 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.
