CurrentBlue Cross Blue Shield - MainePolicy 02-901

Core Buildup (including post and core procedures)

Defines clinical and documentation criteria for when coronal core buildups and post-and-core procedures meet generally accepted standards of dental care and may be considered a covered benefit under Blue Cross Blue Shield - Maine dental plans.

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyCore Buildup (including post and core procedures)

Policy CodePolicy 02-901

Change TypeNo material change

Effective DateJan 1, 2023

Next Review Date

Key ActionInclude most recent, dated pretreatment radiographic image(s) that show the radiographic apex when submitting for review.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

D2950-D2957CDT codes listed

17Clinical criteria items

Radiograph requiredDocumentation requirement

Applies to posterior/anterior/primaryTooth-specific guidance

Coverage Criteria — Core Buildups and Post-and-Core

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inv-01: Posterior teeth

Covered when ALL of the following are met for posterior teeth

Posterior tooth core buildup coverage: a) A significant portion of missing tooth structure due to caries, fracture, or defective restoration; b) Insufficient tooth structure coronal to the intended restorative margin for adequate retention; c) A crown or retainer is either existing (to be recemented/rebonded) or is treatment planned.

From criteria items 3.a-c

inv-02: Anterior teeth

Covered when ALL of the following are met for anterior teeth

Anterior tooth core buildup coverage: a) A significant portion of missing tooth structure due to caries, fracture, or defective restoration; b) Insufficient tooth structure coronal to the intended restorative margin for adequate retention; c) A crown or abutment is either existing (to be recemented/rebonded) or is treatment planned.

From criteria items 4.a-c

inv-03: Primary teeth

Primary tooth (including primary within adult dentition) considered when ALL of the following are met

Primary tooth core buildup coverage: Tooth must meet the same criteria as a permanent tooth; radiographic images must demonstrate intact root structure, adequate periodontal support with no evidence of active periodontal disease, occlusal function with an opposing tooth when criteria for full coverage indirect restoration are met, and radiographic evidence that no permanent successor is present or the permanent successor is unlikely to erupt.

From criteria item 10

inv-04: Periodontal and endodontic

Coverage only if periodontal and endodontic conditions are acceptable

Periodontal considerations: Teeth demonstrating uncontrolled or untreated periodontal disease, evidenced by loss of supporting bone, will not be considered for core buildup placement. Unfavorable crown-to-root ratios (worse than 1:1) require a full assessment of the patient's overall dental and periodontal status before consideration.

From criteria items 11 and 15

Endodontic considerations: Teeth with untreated or unresolved periapical or periradicular pathology, unresolved lesions near the pulp without planned endodontic therapy, overfill/underfill or poor root canal obturation, or internal/external resorption may not be considered for benefit.

From criteria items 17.a-d

inv-05: Not covered / exclusions

Not covered when ANY of the following apply

Non-covered indications: Placement for the purpose of pulp capping, insulation, or protection of the pulp; use as a filler to eliminate undercuts or enhance box form; correction of concave irregularity; repair of complications from attrition, abrasion, erosion, or abfraction; for partial coverage indirect restorations (onlays, inlays, veneers, 3/4 crowns); or performed for correction of developmental or congenital defects.

From criteria items 5,8,9,18

Exclusions and scope: Core buildups are intended to restore coronal tooth structure to retain a full‑coverage indirect restoration and are not covered when performed to correct developmental or congenital defects, for partial‑coverage indirect restorations (for example, onlays, inlays, veneers, or ¾ crowns), or to repair complications from attrition, abrasion, erosion, or abfraction. Additionally, claims submitted for purposes of pulp capping, pulpal insulation/protection, elimination of undercuts or enhancement of box forms, or as fillers to reduce final restorative material will not be considered a covered benefit.

Third molar and group contract considerations: Determination of benefit for third molars requires that the completed crown be in occlusal function with an opposing tooth; the crown must occlude with at least 1/3 of an opposing tooth, subject to group contract exceptions (for example, crowns supporting removable or fixed partial dentures).

Core buildup is considered not medically necessary when used solely for pulpal insulation, pulp capping, or protection of the pulp, or when used merely as a filler to eliminate undercuts, box forms, or to correct preparation irregularities. Core buildups will not be considered when the procedure is intended for partial‑coverage indirect restorations (onlays, inlays, veneers, ¾ crowns) or for repair of complications from non‑restorative wear processes (attrition, abrasion, erosion, abfraction).

Core buildup is also not medically necessary for teeth with uncontrolled or untreated periodontal disease (evidenced by loss of supporting bone), for teeth with unfavorable crown‑to‑root ratios without a full assessment of the patient’s overall dental and medical context, or when endodontic conditions (untreated or unresolved periapical/periradicular pathology, unresolved lesions near the pulp without planned endodontic therapy, poor root canal obturation, or internal/external resorption) make the tooth unsuitable for restorative benefit.

Coding

CDT codes (applicable)CDT

D2950	core buildup, including any pins when required
D2952	post and core in addition to crown, indirectly fabricated
D2953	each additional indirectly fabricated post - same tooth
D2954	prefabricated post and core in addition to crown
D2957	each additional prefabricated post - same tooth
D2955	post removal

Third molar occlusal function

RequirementMust occlude with at least 1/3 of an opposing tooth (group contract dependent).

ScopeApplies to third molar (completed crown) when determining eligibility for a core buildup or post-and-core procedure.

ExceptionsExceptions may be considered for crowns supporting removable or fixed partial dentures; subject to group contract provisions.

Provider Actions and Documentation

Prior Authorization

Prior Authorization / Document Submission

Prior authorization/review may be required per plan contract. When submitting a request for review, include the member information, tooth number, proposed procedures and CDT codes, and all required supporting documentation listed below.

Include applicable CDT procedure codes on the submission
Indicate whether the procedure is initial or replacement crown-related
Attach clinical treatment plan and expected restorative margin location

Note

Provider Action — Additional Evidence

Providers should supply clear rationale and supporting clinical information when the need for a core buildup is not evident on the radiograph.

Clinical chart notes stating rationale for core buildup
Intra-oral photographs demonstrating tooth condition
Image of initial restoration placement when radiographs do not demonstrate need after restoration removal

Documentation Required

Required Documentation

Must include most recent, dated, properly identified pretreatment diagnostic radiographic image(s) that include the radiographic apex. When radiographic evidence is insufficient to demonstrate need, include clinical chart notes, intra-oral photographs, current dated 6‑point periodontal charting, and documentation of periodontal therapy as applicable.

Pretreatment radiograph(s) showing the radiographic apex and tooth in question
Dated clinical chart notes describing tooth structure loss, fracture, or defective restoration
Intra-oral photographs when radiographs are inconclusive
Current 6‑point periodontal charting and history of periodontal therapy when periodontal status is relevant

Denial Risk

Triggers for Denial

Claims may be denied when documentation does not support medical necessity or when exclusions apply. Examples of denial triggers include submissions for purposes that are not covered, inadequate radiographic or clinical documentation, and contraindicating clinical findings.

Documentation does not demonstrate insufficient remaining tooth structure or significant missing tooth structure due to caries, fracture, or defective restoration
Submitted for pulp capping, insulation/protection of pulp, undercut block-outs, or solely to enhance box-form/fillers
Core buildup for teeth with uncontrolled or untreated periodontal disease or loss of supporting bone
Core buildup for repairs related to attrition, abrasion, erosion, or abfraction
Core buildup when subgingival/subosseous caries may compromise supracrestal tissue attachment without addressing periodontal/restorative considerations
Endodontic or periapical pathology that is untreated or unresolved (see Dental Policy 03-001)
Primary teeth lacking intact root structure, adequate periodontal support, or evidence regarding permanent successor eruption

Definitions

Core buildup

DefinitionRestorative procedure to rebuild coronal tooth structure to provide retention for a full coverage indirect restoration when insufficient tooth structure remains.

Not indicated forPulpal insulation, filler to eliminate undercuts or box forms, or correction of concave irregularity in a tooth preparation.

Coverage conditions (posterior/anterior)Covered only when significant missing tooth structure exists, insufficient coronal structure for retention, and a crown/retainer is existing or treatment planned.

Post and core

DefinitionPlacement of a post (prefabricated or indirectly fabricated) within a root canal with a core buildup to retain an indirect crown.

Related CDT codesD2952, D2953, D2954, D2957 (post and core procedures and additional posts).

Additional procedureD2955 for post removal.

Background

A core buildup restores coronal tooth structure to provide retention for a full‑coverage indirect restoration when insufficient tooth structure remains. It is not intended for pulpal insulation or protection, as a filler to remove undercuts or correct preparation irregularities, nor as a solution for partial‑coverage indirect restorations. Endodontic treatment alone does not automatically indicate that a core buildup or post and core is necessary; coverage for posterior or anterior teeth requires documentation of a significant portion of missing tooth structure, insufficient coronal tooth structure for retention, and an existing or treatment‑planned crown/retainer or abutment.