CurrentBlue Cross Blue Shield - MainePolicy 02-901

Core Buildup - includes post and core procedures

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Policy governing clinical coverage and documentation requirements for core buildup and post-and-core dental procedures used to restore teeth to support crowns; applies to providers treating Blue Cross Blue Shield - Maine members.

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyCore Buildup - includes post and core procedures

Policy CodePolicy 02-901

Change TypeNo material change

Effective DateJan 1, 2026

Last ReviewOct 14, 2025

Next Review DateJan 1, 2026

Key ActionInclude current pretreatment diagnostic radiograph(s) dated within 12 months that show the radiographic apex with submitted requests.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

D2950, D2952-D2957, D2955CDT codes referenced

12 moRadiograph recency

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CurrentBlue Cross Blue Shield - MainePolicy 02-901

Core Buildup - includes post and core procedures

Customize your policy alerts

Sign up for Blue Cross Blue Shield - Maine Policy 02-901 alerts

Get alerted when Policy 02-901 changes without checking for updates manually.

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Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyCore Buildup - includes post and core procedures

Policy CodePolicy 02-901

Change TypeNo material change

Effective DateJan 1, 2026

Last ReviewOct 14, 2025

Next Review DateJan 1, 2026

Key ActionInclude current pretreatment diagnostic radiograph(s) dated within 12 months that show the radiographic apex with submitted requests.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

D2950, D2952-D2957, D2955CDT codes referenced

12 moRadiograph recency

Crown-to-root threshold

apex includedApex required

Coverage criteria for core buildup and post-and-core procedures

inv-01: Posterior teeth — covered circumstances

Covered benefit only when ALL of the following are met

Posterior coverage criteria: A significant portion of missing tooth structure due to caries, fracture, or defective restoration.

From Adjunctive Documentation: posterior teeth criteria [[chunk 3]].

Posterior coverage criteria: Insufficient tooth structure coronal to the intended restorative margin for adequate retention.

From Adjunctive Documentation: posterior teeth criteria [[chunk 3]].

Posterior coverage criteria: A crown or retainer is either existing (to be recemented/rebonded) or is treatment planned.

From Adjunctive Documentation: posterior teeth criteria [[chunk 3]].

inv-02: Anterior teeth — covered circumstances

Covered benefit only when ALL of the following are met

Anterior coverage criteria: A significant portion of missing tooth structure due to caries, fracture, or defective restoration.

From Adjunctive Documentation: anterior teeth criteria; endodontic treatment alone does not automatically constitute necessity [[chunk 3]].

Anterior coverage criteria: Insufficient tooth structure coronal to the intended restorative margin for adequate retention.

From Adjunctive Documentation: anterior teeth criteria [[chunk 3]].

Anterior coverage criteria: A crown or abutment is either existing or is treatment planned.

From Adjunctive Documentation: anterior teeth criteria [[chunk 3]].

inv-03: Primary tooth criteria

Primary teeth considered only when ALL criteria are met

Primary tooth criteria: Must meet the same criteria as a permanent tooth for core buildup and/or post and core.

From Adjunctive Documentation: primary tooth must meet same criteria as permanent tooth [[chunk 4]].

Primary tooth criteria: Radiographic images must demonstrate intact root structure and adequate periodontal support with no evidence of active periodontal disease.

Radiographic requirements for primary teeth [[chunk 4]].

Primary tooth criteria: Occlusal function with an opposing tooth when the primary tooth meets criteria for full coverage indirect restoration coverage.

Occlusal function requirement for primary teeth [[chunk 4]].

Primary tooth criteria: Radiographic imaging must demonstrate no permanent tooth successor present, or the permanent tooth successor is unlikely to erupt.

inv-04: Periodontal and endodontic considerations

Coverage only if AND where the following endodontic and periodontal conditions are acceptable

Endo/Perio conditions: Teeth demonstrating uncontrolled or untreated periodontal disease evidenced by loss of supporting bone will not be considered for core buildup and/or post and core.

Periodontal exclusion from Adjunctive Documentation [[chunk 4]].

Endo/Perio conditions: Untreated or unresolved periapical or periradicular pathology will not be considered for benefit (see Dental Clinical Policy 03-001: Endodontic Therapy).

Endodontic status requirement [[chunk 4]].

Endo/Perio conditions: Unresolved lesion in close proximity to the pulp chamber in the absence of planned endodontic therapy will not be considered.

Endodontic requirement [[chunk 4]].

Endo/Perio conditions:

inv-05: Situations excluded from benefit

Exclusions: Submitted for pulp capping, insulation, or protection of the pulp; undercut block-outs; enhancement of box-form or fillers to reduce final restorative material; repair of complications from attrition, abrasion, erosion, or abfraction; correction of developmental or congenital defects; placement for partial coverage indirect restorations (onlays, inlays, veneers); or when the tooth exhibits caries into the furcation.

Explicitly listed exclusions from Adjunctive Documentation [[chunk 3]][[chunk 5]].

Core buildup and/or post-and-core procedures will not be considered when submitted for purposes unrelated to restoring adequate tooth structure to retain an extracoronal restoration. Examples of excluded purposes include: pulp capping, insulation or protection of the pulp; creating undercut block-outs; enhancing box-form or using fillers to reduce the amount of final restorative material; repair of complications from attrition, abrasion, erosion, or abfraction; correction of developmental or congenital defects; use with partial-coverage indirect restorations such as onlays, inlays, or veneers; and when the tooth exhibits caries into the furcation.

Teeth that demonstrate uncontrolled or untreated periodontal disease with loss of supporting bone are not eligible for core buildup or post-and-core benefits. Prior to consideration, the periodontal condition of the tooth and adjacent structures must be evaluated and documented; inadequate periodontal support is an exclusion to coverage.

Endodontic therapy alone does not automatically justify a core buildup or post-and-core. Teeth with untreated or unresolved periapical or periradicular pathology, teeth with an overfill/underfill root canal obturation or poor condensation, teeth with internal or external resorption, or unresolved lesions near the pulp without planned endodontic therapy will not be considered for benefit. In addition, the diagnosis of Cracked Tooth Syndrome may not meet criteria for these procedures.

Procedure codes and coding considerations

Referenced CDT CodesCDT

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

Radiograph recency

RequirementPretreatment diagnostic radiograph must be current (within 12 months)

Image contentRadiographic image(s) must be dated and include the radiographic apex

Additional documentationClinical chart notes, intra-oral photographs, 6‑point periodontal charting, and periodontal therapy history may also be required

Crown-to-root ratio

ThresholdCrown-to-root ratios poorer than 1:1 are considered less than ideal

AssessmentUnfavorable ratios require evaluation of full‑mouth dental condition, medical and dental history, periodontal history and continuing care, age, and occlusion

Documentation, prior authorization, and common denial triggers

Prior Authorization

Prior Authorization / Codes Referenced

Prior authorization may be required for certain procedures. Check group contract and payer-specific requirements prior to scheduling. Affected CDT codes include core buildup, post and core, and related services listed below — obtain prior authorization when plan or local medical review requires it.

Affected codes: D2950, D2952, D2953, D2954, D2957, D2955
Verify PA per member contract and group-specific benefit provisions

Documentation Required

Required Documentation

Must include current (within 12 months), dated, pretreatment, diagnostic-quality radiographic image(s) that include the radiographic apex. Additional required documentation may include clinical chart notes, intra-oral photographs, current dated 6-point periodontal charting, and history of periodontal therapy when relevant.

Radiographs: dated, within 12 months, must show radiographic apex

Background and purpose

A core buildup is the restoration of coronal tooth structure when there is insufficient remaining tooth to retain a separate extracoronal restoration. The procedure rebuilds the internal anatomy of the tooth to provide adequate retention and support for a crown or retainer; prefabricated and custom (indirect) post-and-core systems integrate the post and core to reestablish coronal form when indicated.

Key definitions

Core buildup — definition

DefinitionBuilding up of coronal tooth structure when there is insufficient retention for a separate extracoronal restorative procedure

PurposeRebuilds internal anatomy of the tooth prepared to support a crown

Relation to postsThe core buildup is integral to prefabricated and indirectly fabricated post systems

Prefabricated post and core — definition

DefinitionPrefabricated post-and-core systems are available in standardized shapes and sizes that include a post and core component

UseProvided as a ready-made post and core to be placed when indicated to retain a crown

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyCore Buildup - includes post and core procedures

Policy CodePolicy 02-901

Change TypeNo material change

Effective DateJan 1, 2026

Last ReviewOct 14, 2025

Next Review DateJan 1, 2026

Key ActionInclude current pretreatment diagnostic radiograph(s) dated within 12 months that show the radiographic apex with submitted requests.

SourceLink

On This Page

Requirement regarding permanent successor for primary teeth [[chunk 4]].

A tooth with an overfill/underfill root canal obturation or poor condensation may not be considered.

Endodontic condensation/obturation consideration [[chunk 5]].

Endo/Perio conditions: Teeth with internal or external resorption may not be considered for benefit.

Resorption exclusion [[chunk 5]].

Clinical implicationPoor crown-to-root ratio may affect consideration for core buildup/post-and-core benefit

Clinical chart notes documenting rationale and treatment plan

Intra-oral photographs when anatomy or restoration prevents radiographic clarity

6-point periodontal charting and periodontal therapy history when periodontal status is relevant

Documentation Required

Adjunctive Documentation When Radiographs Are Insufficient

When radiographs do not clearly demonstrate the need for a core buildup or post and core (initial or replacement crown cases), provide adjunctive documentation to support medical necessity.

Clinical chart notes stating diagnostic rationale and treatment justification
Intra-oral photographs demonstrating tooth structure, fracture, or restoration condition
Image or documentation of initial restoration placement when existing restoration removal does not reveal need on radiograph
For posterior teeth, core buildup/post and core covered only when: significant missing tooth structure from caries/fracture/defective restoration; insufficient coronal tooth structure for retention; and a crown/retainer is existing or treatment planned
For anterior teeth, similar criteria apply — endodontic treatment alone does not automatically necessitate core/post

Documentation Required

Documentation for Primary Teeth

Primary teeth are subject to the same clinical criteria as permanent teeth. Additional radiographic and clinical requirements apply when considering core buildup or post and core for primary teeth.

Radiographs must demonstrate intact root structure and adequate periodontal support with no evidence of active periodontal disease
Occlusal function with an opposing tooth is required when criteria are for full coverage indirect restoration coverage
Imaging must show no permanent tooth successor present, or that the permanent successor is unlikely to erupt

Denial Risk

Common Denial Triggers and Exclusions

Common denial triggers and exclusions are centered on indications, documentation gaps, and certain clinical conditions. Submissions for the purposes below will not be considered or may be denied.

Requests submitted solely for pulp capping, insulation/protection of the pulp, undercut block-outs, enhancement of box-form, or fillers to reduce final restorative material will not be considered
Core/post procedures for cracked tooth syndrome, repair of attrition/abrasion/erosion/abfraction complications, developmental or congenital defects, or for partial coverage indirect restorations (onlays, inlays, veneers) are not covered
Core/post will not be considered when tooth exhibits caries into the furcation
Subgingival/subosseous caries that may compromise supracrestal tissue attachment (STA) without addressing restorative and periodontal considerations will be excluded
Coverage for third molar teeth is contract dependent and requires the completed crown to be in occlusal function with an opposing tooth (must occlude with at least one-third of an opposing tooth unless contract exceptions apply)

Denial Risk

Clinical Condition–Related Denial Risks

Clinical condition-related denial risks should be assessed and documented. Presence of these conditions without appropriate remediation or documentation may lead to denial.

Uncontrolled or untreated periodontal disease (loss of supporting bone) — such teeth will not be considered for core/post
Untreated or unresolved periapical or periradicular pathology — see Endodontic Therapy policy (Dental Clinical Policy 03-001)
Unresolved lesions in close proximity to the pulp chamber without planned endodontic therapy
Overfill/underfill root canal obturation, poor condensation, internal or external resorption — these findings may preclude benefit unless addressed
Unfavorable crown-to-root ratios (poorer than 1:1) require comprehensive assessment including full-mouth dental condition, medical/dental history, periodontal status, age, and occlusion

Note

Alternate Coverage Per Contract

Alternate coverage may apply depending on group contract language. In some instances, core buildup may be alternated to a less extensive benefit.

Group contracts may allow alternation of a core buildup to a one-surface restoration when root canal therapy is performed through a retained existing crown
Always verify specific group contract provisions and benefit limits prior to treatment

Relation to core buildup

Prefabricated systems incorporate the core and are integral to core buildup when used

Indirect post and core — definition

DefinitionIndirect (custom) post-and-core is fabricated to suit the specific needs of the tooth

FabricationCustom-made to the tooth; the core is integral to the post in indirect systems

IndicationUsed when a prefabricated system is not suitable and tooth-specific fabrication is required to support a crown