Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerPolicy UpdatesDental/Oral & MaxillofacialBlue Cross Blue Shield - Maine Crown Lengthening C…
    Ask Trek AI about this page
    CurrentBlue Cross Blue Shield - MainePolicy 04-206

    Clinical Crown Lengthening

    Customize your policy alerts

    Sign up for Blue Cross Blue Shield - Maine Policy 04-206 alerts

    Get alerted when Policy 04-206 changes without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Defines clinical criteria and coding guidance for when clinical crown lengthening (hard tissue) is considered appropriate for restorative dental treatment; applies to providers and claims reviewers under the payer's dental benefit policies.

    Policy Summary
    PayerBlue Cross Blue Shield - Maine
    PolicyClinical Crown Lengthening
    Policy CodePolicy 04-206
    Change TypeNo material changes
    Effective Date
    Last ReviewOct 26, 2022
    Next Review Date
    Key ActionSubmit a dated diagnostic pretreatment radiograph (≤12 months) documenting <3 mm of sound tooth structure to the alveolar crest for prior authorization.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    D4249Primary CDT code
    6 weeksHealing interval
    12 months

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Radiograph max age
    < 3 mmRadiographic threshold
    natural onlyTeeth covered

    Coverage Criteria for Clinical Crown Lengthening

    inv-01: General Criteria (Covered when ALL are met)

    Clinical crown lengthening is considered appropriate when ALL of the following are met:

    Radiographic documentation: A current (within 12 months), dated, diagnostic, pretreatment radiograph documents less than three millimeters of sound natural tooth structure between the restorative margin and the alveolar crest.< 3 mm; radiograph ≤12 months

    A radiograph older than 12 months may lead to denial.

    Periodontal health: Procedure is performed in a periodontally healthy environment.

    Clinical crown lengthening may only be performed in a periodontally healthy environment; will not be considered when performed with treatment for unhealthy periodontal tissues in same quadrant/date of service.

    Purpose: Necessary to allow a restorative procedure on a tooth when the proposed restoration margin would violate the periodontal attachment (e.g., subgingival caries or fracture requiring removal of soft and hard tissue to enable restoration).

    Will be considered only when subgingival caries or fracture requires removal of tissue to enable restoration.

    Surgical technique: Requires reflection of a full thickness flap with removal of hard (osseous) and soft (gingival) tissue and alters crown-root ratio.

    If resulting crown-root ratio is inadequate, the procedure provides no long-term benefit.

    Healing interval: A minimum of 6 weeks must be allowed for bone and soft tissue healing prior to final restoration.>= 6 weeks

    inv-02: Situations considered not appropriate / inclusive rules

    Crown lengthening is NOT considered appropriate in the following situations or is considered inclusive with other procedures:

    Concurrent unhealthy periodontal treatment: Will not be considered when performed in conjunction with any periodontal procedure that addresses treatment for unhealthy periodontal tissues within the same quadrant on the same date of service (e.g., gingivectomy, frenectomy, distal wedge reduction, grafting, scaling and root planing).

    When performed with osseous surgery for periodontal disease, crown lengthening is inclusive with the osseous surgery.

    Elective or cosmetic: Procedures performed to correct congenital or developmental defects or for cosmetic reasons are elective/cosmetic and will not be allowed.
    Structural loss due to non-restorable causes: Will not be considered for treatment of teeth with structural loss due to wear, erosion, attrition, abrasion, and abfraction.
    Natural teeth only:

    Clinical crown lengthening will not be considered when performed in conjunction with any periodontal procedure that addresses treatment for unhealthy periodontal tissues within the same quadrant on the same date of service. Examples include, but are not limited to, gingivectomy, frenectomy, distal wedge reduction, grafting, and scaling and root planing — these procedures are considered an integral component of the periodontal treatment and not separately payable when addressing unhealthy periodontal tissues. Additionally, crown lengthening is not considered for teeth with structural loss due to wear, erosion, attrition, abrasion, or abfraction, and procedures performed to correct congenital or developmental defects or for cosmetic reasons are elective and will not be allowed.

    Troughing of soft tissue performed solely as part of crown preparation or to visualize margins for impressions does not meet the CDT descriptor for D4249 and is not considered clinical crown lengthening. Similarly, when clinical crown lengthening is performed on the same date as placement of a crown, D4249 is considered inclusive with the crown and is not separately payable.

    Coding and Procedure Codes

    Included CDT codeCDT
    D4249Clinical crown lengthening - hard tissue
    Inclusive/adjunct proceduresCDT
    D4274Mesial/distal wedge procedure (performed in conjunction with D4249 on same date of service; considered inclusive)
    D4249Clinical crown lengthening - hard tissue (noted as inclusive with crown when performed same date)
    inv-07: Radiographic tooth-to-alveolar crest distance — numeric threshold
    Radiographic distance thresholdLess than 3 millimeters of sound natural tooth structure between the restorative margin and the alveolar crest
    Measurement sourceDated, diagnostic, pretreatment radiograph documenting the measurement
    ApplicabilityRequirement applies to natural teeth proposed for restorative procedures where the restoration margin would violate the periodontal attachment apparatus
    inv-08: Radiograph recency requirement
    Maximum age of radiographWithin 12 months (current, dated pretreatment radiograph)
    Documentation requirement

    Provider Requirements and Documentation

    Documentation Required

    Pretreatment documentation required

    A current (within 12 months), dated, diagnostic, pretreatment radiograph and supporting documentation must be submitted prior to clinical crown lengthening to document indication for the procedure.

    • Pretreatment radiograph must document < 3 mm of sound natural tooth structure between the restorative margin and the alveolar crest.
    • Radiograph must be dated and current within 12 months.
    Denial Risk

    Claims may be denied if pretreatment radiograph older than 12 months or insufficient

    Claims may be denied if the required pretreatment radiograph is older than 12 months or does not document less than 3 mm of sound natural tooth structure between the restorative margin and the alveolar crest.

    • Denial risk when radiograph > 12 months old.

    Background

    Clinical crown lengthening is a surgical procedure performed in a periodontally healthy environment to expose adequate tooth structure when there is insufficient coronal tooth structure for restoration. The procedure requires reflection of a full-thickness flap with removal of both hard (osseous) and soft (gingival) tissue and results in an alteration of the crown‑to‑root ratio. If osseous resection produces an inadequate crown‑to‑root ratio, the procedure provides no long‑term benefit. A minimum healing interval of 6 weeks is required prior to final restoration.

    Definitions and Standards

    inv-14: Generally accepted standards of dental practice
    Definition sourceStandards based on credible peer-reviewed dental literature, specialty society recommendations, and views of recognized practicing dentists
    PurposeServices must be provided in accordance with generally accepted standards of dental practice — appropriate in type, frequency and extent
    ExclusionsServices that are primarily for convenience, cosmetic, or more costly than alternatives are not considered in accordance with standards
    Evidence basisIncludes credible scientific evidence published in peer‑reviewed dental literature generally recognized by the practicing dental community
    Policy Summary
    PayerBlue Cross Blue Shield - Maine
    PolicyClinical Crown Lengthening
    Policy CodePolicy 04-206
    Change TypeNo material changes
    Effective Date
    Last ReviewOct 26, 2022
    Next Review Date
    Key ActionSubmit a dated diagnostic pretreatment radiograph (≤12 months) documenting <3 mm of sound tooth structure to the alveolar crest for prior authorization.
    SourceLink
    On This Page
    Coverage Criteria for Clinical Crown LengtheningCoding and Procedure CodesProvider Requirements and DocumentationBackgroundDefinitions and Standards
    Clinical crown lengthening will be considered for natural teeth only.
    Same-day crown procedure / troughing: If crown lengthening is performed on the same date of service as the crown, D4249 is considered inclusive with the crown and not separately payable; troughing of soft tissue as part of crown preparation or to visualize margins for impressions does not meet the CDT descriptor for D4249.
    Adjunct inclusive procedure: Mesial/distal wedge procedure (D4274) performed in conjunction with D4249 on the same date of service is considered inclusive.
    Radiograph must be submitted as part of pretreatment/prior authorization to document tooth-to-alveolar crest measurements
    Additional recordsWhen indications are not evident radiographically, additional patient records may be requested
  1. Denial risk when radiograph does not clearly document < 3 mm of sound natural tooth structure.
    2. Documentation Required

    If performed with osseous surgery for periodontal disease — inclusion rule

    When crown lengthening is performed in conjunction with osseous surgery for periodontal disease, the crown lengthening procedure is considered inclusive with the osseous surgery; submit documentation showing the relationship of procedures.

    • If performed with osseous surgery for periodontal disease on the same date of service in the same quadrant, crown lengthening is inclusive and should not be billed separately.
    • Provide operative notes and radiographs that demonstrate the procedures and rationale.