CurrentAnthemPolicy 06-101

Surgical Placement of Implant

Defines clinical indications, documentation requirements, and coding references for surgical placement of dental implants (implant fixture placement and related procedures). It guides appropriateness/medical necessity determinations and notes contract-dependent exclusions and prosthetic benefit considerations.

Policy Summary

PayerAnthem

PolicySurgical Placement of Implant

Policy CodePolicy 06-101

Change TypeRevised (No change noted)

Effective DateJan 1, 2026

Next Review Date

Key ActionObtain and retain current (within 12 months), dated diagnostic pretreatment radiographic images and be prepared to provide a comprehensive treatment plan including periodontal status and treatment history when requested.

SourceLink

POLICY UPDATE CHANGES

Policy status marked Revised with last review date 10/28/2025 and publish date 01/01/2026.

1Acceptable immediate placement statement

MultipleCDT codes listed (informational)

ConditionalMultiple-teeth replacement appropriateness

Coverage Summary

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Medical Necessity / Documentation Requirements

General Criteria / Documentation Requirements

Covered when ALL of the following are met:

Clinical indication: dental implants to replace missing natural teeth may be considered appropriate as a result of accidental traumatic injuries, extensive structural damage, pathological disorders, congenital/developmental anomalies.

Replacement of multiple teeth by dental implants in the same arch is not appropriate when other less costly dental services are capable of adequately restoring the occlusion to function (unless specified by group contract).

Prosthetic restoration may be subject to alternate benefit plan provisions.

Archived

Policy contains archived criteria items (items 1,4-6,8,10). Archived items are not active.

Current (within 12 months), dated, diagnostic, pretreatment radiographic images to include full mouth series, panoramic, and/or other appropriate radiographic images.

A comprehensive treatment plan may be requested including periodontal status; may include documentation of a history of definitive periodontal treatment, including maintenance, for the remaining teeth.

ALL of the following OR documented allergy exception

A patient's sensitivity (allergy) to denture restorative materials may be considered a qualification for dental implant placement.
This condition must be documented by a physician and dental provider's letters of medical/dental necessity as well as a copy of the laboratory analysis of the allergy.
Benefits for implant placement is not considered for the correction of developmental or congenital defects (contract dependent).
Coverage for developmental/congenital defects is contract dependent.

Immediate placement of an implant body in a tooth extraction site is an acceptable procedure.

Coding (CDT)

CDT codes (informational list)mixed

D6010	surgical placement of implant body (fixture): endosteal implant
D6011	second stage implant surgery
D6012	surgical placement of interim implant body (fixture) for transitional prosthesis: endosteal implant
D6013	surgical placement of mini implant
D6040	surgical placement: eposteal implant
D6050	surgical placement: transosteal implant
D6100	Surgical removal of implant body
D6104	Bone Graft at the Time of Implant Placement
D6106	Guided Tissue Regeneration (Implant Site, Resorbable Barrier)
D6107	Guided Tissue Regeneration (Implant Site, Non-Resorbable Barrier)

1–10 of 13

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Provider Actions & Documentation Requirements

Documentation Required

Radiographic and treatment plan documentation

Obtain and retain current (within 12 months), dated diagnostic pretreatment radiographic images (full mouth series, panoramic, and/or other appropriate images) and be prepared to provide a comprehensive treatment plan including periodontal status and history of definitive periodontal treatment/maintenance when requested.

Documentation Required

Allergy documentation for denture material sensitivity

If implant placement is based on sensitivity/allergy to denture restorative materials, provide physician and dental provider letters of medical/dental necessity and laboratory analysis of the allergy.

Denial Risk

Multiple teeth replacement with implants may be denied

Replacement of multiple teeth by implants in the same arch may be considered not appropriate (and potentially denied) when less costly dental services can adequately restore occlusion, subject to group contract terms.

Background & Definitions

Dental implants are surgical components (typically titanium fixtures) placed into the jawbone to replace missing teeth; they are durable, long‑lasting solutions that mimic the natural tooth's structure and function. The prosthetic restoration of dental implants and full benefit applicability may be subject to the member's contract or alternate benefit plan provisions.

Implant Fixture: A small, screw-shaped post usually made of biocompatible titanium surgically placed into the jawbone acting as the root of the artificial tooth.