Anterior Multiple Surface Fillings
Defines SelectHealth reimbursement criteria for resin-based composite anterior fillings involving four or more surfaces or the incisal angle; applies to SelectHealth Commercial and SelectHealth Advantage (Medicare/CMS) members and their providers.
No material clinical or coverage changes in this revision.
Reimbursement Criteria
Reimbursement criteria (Commercial and Advantage)
SelectHealth will reimburse anterior multiple surface resin-based composite restorations when documentation and clinical indication criteria are met.
ALL of the following
Documentation
- Pre‑operative X‑rays present; OR if an X‑ray cannot be provided, chart notes must indicate the purpose for performing the restoration
Required for review to support medical necessity
Clinical indications (one or more must be documented)
- Current caries
- Fractures
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