Non-Surgical Endodontics
Defines indications and non-indications for non-surgical endodontic procedures (direct/indirect pulp cap, therapeutic pulpotomy, partial pulpectomy for apexogenesis, apexification/recalcification, pulpal regeneration, pulpal debridement, pulpal therapy for primary teeth, endodontic therapy, treatment of root canal obstruction, incomplete endodontic therapy, internal root repair, and retreatment). Also provides applicable CDT procedure codes and descriptive service inclusions.
Template Update and changed policy type classification from 'Coverage Guideline' to 'Clinical Policy'.
Coverage Summary
Scope: This policy (Policy Number DCP009.12, Status: CURRENT) defines indications and non-indications for non‑surgical endodontic procedures including direct and indirect pulp caps, therapeutic pulpotomy, partial pulpotomy for apexogenesis, apexification/recalcification, pulpal regeneration, pulpal debridement (pulpectomy), pulpal therapy for primary teeth (resorbable filling), endodontic (root canal) therapy, treatment of root canal obstruction (non‑surgical access), incomplete endodontic therapy, internal root repair of perforation defects, and retreatment of previous root canal therapy. It also provides an applicable CDT procedure code list and notes on inclusive intra‑operative services.
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