ModifiedBlue Cross Blue Shield - WisconsinPolicy 02-901

Core Buildup - includes post and core procedures

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Defines coverage, documentation, and clinical criteria for core buildup and post-and-core procedures for dental restoration with guidance for providers and required supporting documentation.

Policy Summary

PayerBlue Cross Blue Shield - Wisconsin

PolicyCore Buildup - includes post and core procedures

Policy CodePolicy 02-901

Change TypeEditorial refinements (no material changes)

Effective DateJan 1, 2025

Last ReviewOct 25, 2024

Next Review DateJan 1, 2025

Key ActionInclude current (within 12 months) dated pretreatment diagnostic radiograph(s) showing the radiographic apex with authorization submission.

SourceLink

POLICY UPDATE CHANGES

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

5CDT codes listed explicitly

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ModifiedBlue 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

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Defines coverage, documentation, and clinical criteria for core buildup and post-and-core procedures for dental restoration with guidance for providers and required supporting documentation.

Policy Summary

PayerBlue Cross Blue Shield - Wisconsin

PolicyCore Buildup - includes post and core procedures

Policy CodePolicy 02-901

Change TypeEditorial refinements (no material changes)

Effective DateJan 1, 2025

Last ReviewOct 25, 2024

Next Review DateJan 1, 2025

Key ActionInclude current (within 12 months) dated pretreatment diagnostic radiograph(s) showing the radiographic apex with authorization submission.

SourceLink

POLICY UPDATE CHANGES

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

5CDT codes listed explicitly

Coverage Criteria

Medically necessary coverage criteria

Covered when ALL of the following are met for posterior or anterior teeth (as specified):

General covered conditions (posterior and anterior teeth): A core buildup and/or post-and-core is covered only when: (a) there is 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 exists; and (c) a crown or abutment is either existing (to be recemented/rebonded) or is treatment planned.

Posterior-specific condition: For posterior teeth, coverage applies only under the general covered conditions above.

Anterior-specific condition: For anterior teeth, coverage applies only under the general covered conditions above; endodontic treatment alone does not automatically justify a core buildup or post-and-core.

Primary tooth criteria: Primary teeth considered for core buildup/post-and-core must meet the same criteria as permanent teeth and must show intact root structure, adequate periodontal support with no active periodontal disease, occlusal function with an opposing tooth, and radiographic evidence that no permanent successor is present or unlikely to erupt.

Contract-dependent exceptions: Exceptions may exist for crowns supporting removable or fixed partial dentures and group contract variations may allow alternation of a core buildup to a one-surface restoration in certain circumstances.

Core buildup and post-and-core procedures are not covered when performed for pulp capping, insulation or protection of the pulp, undercut block-outs, enhancement of box-form, or as fillers to reduce final restorative material. Core buildup and/or post-and-core procedures performed to correct developmental or congenital defects, for repair of complications from attrition, abrasion, erosion, or abfraction, or when submitted for partial-coverage indirect restorations (e.g., onlays, inlays, veneers, or ¾ crowns) are also excluded. Additionally, the diagnosis of Cracked Tooth Syndrome may not qualify for coverage.

Core buildup may be alternated to a one-surface restoration depending on group contract provisions in specific situations, for example when root canal therapy is performed through a retained existing crown; such contract-dependent alternation does not imply general coverage for the excluded indications listed above.

A core buildup and/or post-and-core will not be considered when there is evidence of untreated or unresolved endodontic disease. Specifically, teeth with untreated or unresolved periapical or periradicular pathology, an unresolved lesion in close proximity to the pulp without planned endodontic therapy, overfill/underfill or poorly condensed root canal obturation, or internal or external root resorption are contraindications to coverage. In such cases, see the Endodontic Therapy policy (03-001) for appropriate management prior to consideration of core buildup or post-and-core placement.

Coding / Procedure Codes

CDT codesCPT

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

Provider Actions, Documentation & Authorization

Prior Authorization

Prior Authorization / Documentation Expectations

Prior authorization may be required and adequate documentation must be submitted to establish medical necessity for core buildup and/or post and core procedures. Provide current, dated, pretreatment, diagnostic-quality radiographic image(s) that include the radiographic apex (must be within 12 months). When radiographs do not clearly demonstrate need, submit adjunctive documentation such as clinical chart notes stating rationale, intra-oral photographs, and images of initial restoration placement or removal. Additional supporting records that may be requested include current dated 6-point periodontal charting, history of periodontal therapy, and clinical notes addressing periodontal and endodontic status.

Current dated pretreatment radiograph(s) within 12 months showing the radiographic apex
Clinical chart notes documenting rationale for core buildup/post & core
Intra-oral photographs and images of initial placement or restoration removal when applicable
Current dated 6-point periodontal charting and history of periodontal therapy when relevant

Background

A core buildup restores coronal tooth structure when there is insufficient tooth structure coronal to the intended restorative margin for adequate retention of an extracoronal restoration. Coverage is intended to rebuild the internal tooth anatomy required to prepare for a crown or to support an existing crown/abutment that will be recemented or rebonded. For posterior and anterior teeth alike, coverage requires a significant portion of missing tooth structure due to caries, fracture, or defective restoration, insufficient remaining coronal tooth structure for retention, and an existing or planned crown/abutment. Prefabricated post-and-core systems are standardized and integral with the core, while indirect (custom) post-and-core restorations are fabricated to the specific tooth; in both cases the core functions to reestablish form and retention for the final extracoronal restoration.

Definitions

Core buildup — definition

DefinitionBuilding up coronal tooth structure when there is insufficient retention for a separate extracoronal restorative procedure; used to rebuild internal tooth anatomy prepared for a crown and to provide retention for an extracoronal restoration.

IndicationNecessary when insufficient coronal tooth structure exists to retain a crown or abutment and when a crown or abutment is existing or treatment planned.

Relation to postsThe core is integral to both prefabricated and indirectly fabricated post systems; core buildup may be performed with a post-and-core when indicated.

Prefabricated post-and-core — definition

DefinitionPrefabricated post-and-core systems that are manufactured in standardized shapes and sizes and include a core integral to the post.

Fabrication

Revision History

2019-03-04revision

Published as an external-facing policy (version recorded in revision history).

2019-04-22revision

Updated criteria numbering.

2019-07-23revision

Revised policy verbiage.

Denial Risk

Triggers for Denial

Claims for core buildup and/or post and core are subject to denial when required documentation or clinical indications are missing or when clinical contraindications exist. Ensure documentation addresses periodontal health, endodontic status, and amount of remaining tooth structure. Review common denial triggers below and supply complete records to avoid claim denial.

Untreated or unresolved periapical or periradicular pathology
Unresolved lesion near the pulp chamber without planned endodontic therapy
Overfill/underfill root canal obturation or poor condensation
Teeth with internal or external resorption
Insufficient remaining tooth structure coronal to the intended restorative margin for retention
Core/post procedures submitted for protection of pulp, pulp capping, undercut block-outs, or for enhancement of box-form only
Diagnosis of cracked tooth syndrome without documentation meeting coverage criteria
Procedures for repair of attrition, abrasion, erosion, or abfraction
Subgingival/subosseous caries that may compromise supracrestal tissue attachment without addressing restorative/periodontal considerations
Teeth with uncontrolled or untreated periodontal disease (loss of supporting bone)
Crown-to-root ratio poorer than 1:1
Primary teeth lacking intact root structure, adequate periodontal support, or without demonstrated occlusal function and no permanent successor considerations
Third molar crowns not in occlusal function with an opposing tooth (must occlude with at least 1/3 of an opposing tooth) — contract dependent
Teeth exhibiting caries into the furcation

Documentation Required

Required/Adjunctive Documentation Details

When clinical and radiographic evidence is insufficient to demonstrate necessity for a core buildup and/or post and core, submit adjunctive documentation addressing the specific coverage criteria: extent of missing tooth structure due to caries/fracture/defective restoration; insufficient coronal tooth structure for retention; and whether a crown or retainer is existing or treatment planned. For primary teeth and posterior/anterior distinctions, include radiographic proof of intact root structure and periodontal support as specified. Note that benefits are not considered for developmental/congenital defects, partial coverage indirect restorations (onlays, inlays, veneers, ¾ crowns), or when core/post placement would be for noncovered purposes described above. Some group contracts may permit alternation of a core buildup to a one-surface restoration under specified conditions (e.g., root canal therapy done through a retained existing crown).

Documentation should explicitly address criteria: missing tooth structure, retention needs, and existing or planned crown/retainer
Primary tooth documentation must show intact root structure, adequate periodontal support, occlusal function, and absence or unlikely eruption of permanent successor
Benefits not considered for partial coverage indirect restorations or developmental/congenital defect correction
Contract-dependent: core buildup may be alternated to a one-surface restoration in some group contracts