Number: 043

Subject: Core buildup

Reviewed: November 16, 2017

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 benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit 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 (for example, will be paid for by Aetna) for a particular member. The member's benefit 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.

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Policy

During crown preparation, when there is insufficient remaining coronal structure to retain a crown, a crown buildup may be necessary.  If the tooth has been endodontically treated, it may also require a post.

Background

Per the CDT descriptor, a core buildup includes any required pins and is not a filler to eliminate an undercut, box form, or concave irregularity in a preparation. To qualify as a buildup, its placement is required for the retention of a separate extracoronal restorative procedure.¹

A restoration that is built to occlusion with functioning anatomy and interproximal contacts is not considered a core build up. Core buildups are not benefitted when submitted with inlays or onlays.

Sealing the access cavity made through a crown for endodontic treatment should be reported with the appropriate direct restoration code, such as a single- surface filling.

Coverage Guidelines

Benefits may be extended when core buildup necessity is objectively demonstrated through accompanying pre-operative and post-operative images depicting appropriateness and substantiating that the core buildup has been performed. Narratives may support the images, but not serve as the sole determinate.

Codes¹

D2950 – Core Build up, including any pins when required
D2952 - Post and Core in addition to crown, indirectly fabricated
D2954 – Prefabricated post and core in addition to crown
D2957 – Each additional prefabricated post - same tooth
D2999 – Unspecifiec Restorative Procedure, by report

Effective Date

Original policy: November 16, 2017

The above policy is based on the following references:

¹American Dental Association. CDT 2017: Dental Procedure Codes*

²America Dental Association. CDT 2017 Conding Companion Help Guide for the Dental Team. 2016; 95.

*Copyright 2016 American Dental Association. All rights reserved. Effective January 1, 2017.

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.