CurrentBlue Cross Blue Shield - WisconsinPolicy 02-901

Core Buildup - includes post and core procedures

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Defines clinical and documentation requirements, coverage criteria, and coding guidance for core buildup and post-and-core procedures for dental benefit determinations.

Policy Summary

PayerBlue Cross Blue Shield - Wisconsin

PolicyCore Buildup - includes post and core procedures

Policy CodePolicy 02-901

Change TypeEditorial refinements

Effective DateJan 1, 2026

Last ReviewOct 14, 2025

Next Review DateJan 1, 2026

Key ActionSubmit prior authorization with dated radiographs (within 12 months) including the radiographic apex and supporting documentation to demonstrate criteria are met.

SourceLink

POLICY UPDATE CHANGES

Minor editorial refinements to description, clinical indications, criteria, and references; intent unchanged.

>=1Radiographs required (recency)

D2950, D2952-57CDT codes listed (informational)

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CurrentBlue Cross Blue Shield - WisconsinPolicy 02-901

Core Buildup - includes post and core procedures

Customize your policy alerts

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

Get alerted when Policy 02-901 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 and documentation requirements, coverage criteria, and coding guidance for core buildup and post-and-core procedures for dental benefit determinations.

Policy Summary

PayerBlue Cross Blue Shield - Wisconsin

PolicyCore Buildup - includes post and core procedures

Policy CodePolicy 02-901

Change TypeEditorial refinements

Effective DateJan 1, 2026

Last ReviewOct 14, 2025

Next Review DateJan 1, 2026

Key ActionSubmit prior authorization with dated radiographs (within 12 months) including the radiographic apex and supporting documentation to demonstrate criteria are met.

SourceLink

POLICY UPDATE CHANGES

Minor editorial refinements to description, clinical indications, criteria, and references; intent unchanged.

>=1Radiographs required (recency)

D2950, D2952-57CDT codes listed (informational)

Coverage Criteria

Posterior tooth criteria

Covered for posterior teeth when ALL of the following are met:

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

From policy criteria 3.a-c.

Anterior tooth criteria

Covered for anterior teeth when ALL of the following are met:

Anterior coverage: A significant portion of missing tooth structure due to caries, fracture, or defective restoration; insufficient tooth structure coronal to the intended restorative margin for adequate retention; and a crown or abutment is either existing or treatment planned.

From policy criteria 4.a-c.

Primary tooth criteria

Covered for primary teeth when ALL of the following are met:

Primary tooth coverage: Meets the same criteria as a permanent tooth; radiographs must demonstrate intact root structure, adequate periodontal support with no evidence of active periodontal disease, occlusal function with an opposing tooth, and no permanent tooth successor present or the permanent successor is unlikely to erupt.

From policy criteria 10.

Core buildup and post and cores will not be considered when submitted for the purpose of pulp capping, insulation, or protection of the pulp; for undercut block-outs; for enhancement of box-form or fillers to reduce final restorative material; for partial coverage indirect restorations such as onlays, inlays, or veneers; or when subgingival/subosseous caries may potentially compromise supracrestal tissue attachment without addressing restorative and periodontal considerations.

Core buildup and post and cores are not covered when placed to repair complications from attrition, abrasion, erosion, or abfraction; when the tooth exhibits caries into the furcation; or for third molars that are not in occlusal function (contract-dependent exceptions may apply).

A diagnosis of "Cracked Tooth Syndrome" alone may not qualify a tooth for a core buildup and/or post and core; clinical and radiographic criteria described in this policy must be met to establish medical necessity.

Teeth demonstrating uncontrolled or untreated periodontal disease with loss of supporting bone will not be considered for core buildup and/or post and core placement. Requests will also be denied for teeth with unresolved periapical or periradicular pathology, teeth with overfill/underfill root canal obturation or poor condensation, and teeth with internal or external resorption unless addressed per Dental Clinical Policy 03-001.

Coding and Radiography Requirements

CDT codes (informational)CPT

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 and content

Recency requirementRadiographic image(s) must be current within 12 months

Image content requirementRadiograph(s) must include the radiographic apex

Image type and timingDated, pretreatment, diagnostic-quality radiographic image(s) are required

Provider Actions and Documentation

Prior Authorization

Prior authorization and documentation expectations

Prior authorization/clinical documentation should demonstrate the coverage criteria are met. Submit dated pretreatment diagnostic-quality radiographic image(s) that include the radiographic apex and any additional information necessary to substantiate medical necessity.

Radiographs must be current (within 12 months) and pretreatment.
When radiographs do not clearly demonstrate need, include adjunctive documentation (see below).

Documentation Required

Required documentation

Must include current (within 12 months), dated, pretreatment, diagnostic-quality radiographic image(s) that include the radiographic apex. Clinical chart notes, intra-oral photographs, current dated 6‑point periodontal charting, and history of periodontal therapy may also be required. When the indication is not evident on radiograph(s), provide clinical chart notes stating rationale, intra-oral photographs, and images of initial placement if applicable.

Background

A core buildup rebuilds coronal tooth structure when there is insufficient tooth structure coronal to the intended restorative margin to provide adequate retention for an extracoronal restoration. Prefabricated post-and-core systems and custom (indirect) post-and-core restorations both include a core that is integral to retention of a crown or retainer when indicated.

Definitions

Core buildup / Post and core

DefinitionCore buildup: rebuilding internal tooth anatomy prepared for a crown when there is insufficient coronal structure for retention.

PurposeNecessary for crown retention when insufficient tooth structure exists for an extracoronal restoration.

Post-and-core typesPrefabricated post-and-core systems are standardized; indirect (custom) post-and-core are custom fabricated to fit the tooth.