CurrentAnthemPolicy 06-102

Implant Maintenance Procedures

Governs implant maintenance procedures performed when prostheses are removed and reinserted, including cleansing of prostheses and abutments; intended for providers submitting dental services under the plan.

Policy Summary

PayerAnthem

PolicyImplant Maintenance Procedures

Policy CodePolicy 06-102

Change TypeNo material change

Effective Date

Next Review Date

Key ActionDocument removal and reinsertion of the implant prosthesis when submitting implant maintenance services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

5listed implant maintenance procedure elements

01/01/2023publish date

11/04/2022last review date

CDT 2023coding reference edition

Coverage Criteria

Implant Maintenance Procedure Elements

Implant maintenance procedures include the following elements:

Required elements: 1) Documentation of removal and reinsertion of the implant prosthesis; 2) Cleansing and decontamination of implant prosthesis; 3) Active debriding of the implants; 4) Examination of all aspects of the implant system including occlusion and stability of the superstructure; 5) Review of home care instructions.

Elements listed in policy

Inclusion or exclusion of procedure, diagnosis, or device codes in this document is provided for informational purposes only and does not guarantee that a service is a covered benefit or that a provider will be reimbursed. Coverage and benefit determinations are made according to the member's contract benefits in effect at the time of service. Refer to the member's contract to determine whether a specific implant maintenance service is a covered benefit and whether prior authorization or other plan requirements apply.

Coding References

CDT / ICD-10 references (informational)mixed

CDT (various)	CDT codes for implant maintenance procedures when prostheses are removed and reinserted, including cleansing of prostheses and abutments
ICD-10-CM (various)	ICD-10-CM Diagnoses for dental diseases and conditions (see the current CDT code book for details)

Policy Summary

PayerAnthem

PolicyImplant Maintenance Procedures

Policy CodePolicy 06-102

Change TypeNo material change

Effective Date

Next Review Date

Key ActionDocument removal and reinsertion of the implant prosthesis when submitting implant maintenance services.

SourceLink

On This Page

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Provider Actions & Billing Guidance

Prior Authorization

Coverage & Prior Authorization

Refer to the member's contract benefits in effect at the time of service to determine coverage and prior authorization requirements for implant maintenance procedures. Inclusion of CDT or other codes in this policy is informational and does not imply coverage or reimbursement.

CDT codes are informational only; check member contract for coverage.
Prior authorization may be required per the member's plan benefits.

Documentation Required

Provider Documentation Required

Provide clear documentation of the procedure when removing and reinserting implant prostheses. Document the clinical indication for removal, cleansing/decontamination steps performed, condition of abutments and prosthesis, and any adjustments or repairs to the superstructure.

Record reason for removal and date/time of removal and reinsertion.
Describe cleansing/decontamination methods used for prosthesis and abutments.
Note any adjustments to occlusion, repairs, or changes to implant components.

Documentation Required

Required Documentation for Removal/Reinsertion

Documentation of removal and reinsertion of the implant prosthesis is required and should be retained in the patient record to support medical necessity and any billing submitted.

Include clinical notes that show removal and reinstallation, cleaning procedures, and post-procedure assessment.
Maintain records of patient home care instructions provided and follow-up recommendations.

Denial Risk

Denial Triggers

Services that do not meet the member's contract benefits or generally accepted standards of dental care may be denied. Failure to provide required documentation (including removal/reinsertion details) or billing codes that are inconsistent with the documented service may trigger claim denials.

Denial may occur if the service is not a covered benefit under the member's contract.
Denial risk increases when clinical documentation is incomplete or missing.
Inclusion of a CDT code in this policy does not guarantee coverage — verify benefits before rendering services.

Background

Successful dental implant outcomes depend heavily on effective patient home care and routine professional maintenance. Because implants are not anchored by a periodontal ligament and lack its protective mechanisms, they require more intensive maintenance to prevent peri-implant pathology. The therapeutic goal of implant maintenance is to minimize implant loss by preventing peri-implant disease.

Professional implant maintenance commonly includes cleansing and decontamination of the implant prosthesis and abutments, active debridement of the implants, examination of the implant system (including occlusion and stability of the superstructure), documentation of prosthesis removal and reinsertion, and review of home care instructions to support long-term success.

Definitions

Generally accepted standards of dental practice

DefinitionStandards based on credible peer‑reviewed dental literature, views of practicing dentists in the relevant clinical area, specialty society recommendations/criteria, and other relevant factors from credible sources.

PurposeDental services provided by a dentist exercising prudent clinical judgment for evaluating, diagnosing, or treating a dental injury or disease that are in accordance with these standards in type, frequency, and extent.

ScopeApplies to services considered effective for the patient’s dental injury or disease and not performed primarily for the convenience of the patient or provider.

Evidence basisRelies on credible scientific evidence published in peer‑reviewed dental literature generally recognized by the practicing dental community.

Clinical inputIncludes the views of recognized dentists practicing in the relevant clinical area and specialty society recommendations as part of the standard-setting process.