ModifiedWellpointPolicy 03-001

Core Buildup - Includes Post and Core Procedures

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This policy guides coverage and medical-necessity review for core buildups, prefabricated and indirectly fabricated post-and-core procedures, and related post removal. It applies to providers submitting these services, subject to the member’s contract benefits and applicable law.

Policy Summary

PayerWellpoint

PolicyCore Buildup - Includes Post and Core Procedures

Policy CodePolicy 03-001

Change TypeModified — minor editorial refinementspolicy intent unchanged

Effective DateJan 1, 2026

Last ReviewOct 14, 2025

Next Review DateN/A

Key ActionSubmit current, dated, diagnostic-quality pretreatment radiographs obtained within 12 months that include the radiographic apex.

SourceLink

POLICY UPDATE CHANGES

The 2025-10-14 revision states that the policy intent is unchanged and includes minor editorial refinements to the description, clinical indications, criteria, and references.

3Posterior coverage conditions

3Anterior coverage conditions

12 monthsPretreatment radiograph age

1:1Crown-to-root ratio threshold

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ModifiedWellpointPolicy 03-001

Core Buildup - Includes Post and Core Procedures

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Policy Summary

PayerWellpoint

PolicyCore Buildup - Includes Post and Core Procedures

Policy CodePolicy 03-001

Change TypeModified — minor editorial refinementspolicy intent unchanged

Effective DateJan 1, 2026

Last ReviewOct 14, 2025

Next Review DateN/A

Key ActionSubmit current, dated, diagnostic-quality pretreatment radiographs obtained within 12 months that include the radiographic apex.

SourceLink

POLICY UPDATE CHANGES

The 2025-10-14 revision states that the policy intent is unchanged and includes minor editorial refinements to the description, clinical indications, criteria, and references.

3Posterior coverage conditions

3Anterior coverage conditions

12 monthsPretreatment radiograph age

1:1Crown-to-root ratio threshold

1/3Third-molar opposing occlusion

6Listed CDT procedure codes

Medical Necessity and Coverage Requirements

Posterior teeth

For posterior teeth, covered only when all of the following are met:

Posterior-tooth coverage

A significant portion of tooth structure is missing due to caries, fracture, or defective restoration.
Insufficient tooth structure remains coronal to the intended restorative margin for adequate retention.
A crown or retainer is existing for recementation or rebonding, or is treatment planned.

Anterior teeth

For anterior teeth, covered only when all of the following are met:

Anterior-tooth coverage

A significant portion of tooth structure is missing due to caries, fracture, or defective restoration.
Insufficient tooth structure remains coronal to the intended restorative margin for adequate retention.
A crown or abutment is existing for recementation, or is treatment planned.

Primary teeth

For a primary tooth in adult dentition, all of the following must also be demonstrated:

Adult-dentition primary-tooth criteria

The tooth meets the same treatment criteria as a permanent tooth.
The tooth has intact root structure.
The tooth has adequate periodontal support with no active periodontal disease.
The tooth has occlusal function with an opposing tooth.
No permanent successor is present, or the permanent successor is unlikely to erupt.

Clinical suitability

Additional clinical considerations must be evaluated before coverage:

Consider the periodontal health of the tooth and adjacent structures.
Consider the crown-to-root ratio.
Consider the restorative and periodontal implications of subgingival or subosseous caries.
Consider the endodontic status and root-canal quality.
Consider the presence of resorption and furcation caries.
When the crown-to-root ratio is poorer than 1:1

Third molars

For third molars, the completed crown must meet the following functional requirement:

Third-molar function

The completed crown is in occlusal function with an opposing tooth.at least 1/3 of an opposing tooth

Core buildup and/or post-and-core services are not considered when used for pulp capping, insulation or protection of the pulp, undercut block-outs, enhancement of box form, or as fillers to reduce the amount of final restorative material.

Core buildup and/or post-and-core services are not covered when performed to repair complications resulting from attrition, abrasion, erosion, or abfraction.

Core buildup and/or post-and-core services are not considered for partial-coverage indirect restorations, including onlays, inlays, and veneers.

Teeth with uncontrolled or untreated periodontal disease, evidenced by loss of supporting bone, are not considered for core buildup and/or post-and-core placement.

The service is not considered for benefit when the tooth has untreated or unresolved periapical or periradicular pathology, an unresolved lesion close to the pulp without treatment-planned endodontic therapy, poor root-canal obturation or condensation, or internal or external resorption. Teeth with caries extending into the furcation are also not considered.

Services performed to correct developmental or congenital defects are not covered.

Benefits are not considered when subgingival or subosseous caries may compromise supracrestal tissue attachment unless the related restorative and periodontal considerations are addressed.

Endodontic treatment of an anterior tooth alone does not automatically establish medical necessity for a core buildup or post-and-core procedure. The tooth must also meet the applicable coverage criteria, including substantial loss of tooth structure, insufficient coronal structure for retention, and an existing or planned crown or abutment.

A diagnosis of cracked tooth syndrome alone may not qualify a tooth for core buildup or post-and-core coverage.

Coding and Clinical Thresholds

CDT including but not limited tomixed

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

ICD-10-CM Diagnoses for Dental Diseases and ConditionsICD-10

No codes listed

Coding Thresholds

Maximum age of pretreatment radiographsWithin 12 months

Coding Thresholds

Unfavorable crown-to-root ratioPoorer than 1:1

Coding Thresholds

Minimum opposing-tooth occlusion for third molarsAt least 1/3 of an opposing tooth

Documentation and Submission Requirements

Documentation Required

Required Pretreatment Radiographs

Submit current, dated, pretreatment, diagnostic-quality radiographic image(s) obtained within the prior 12 months. The image(s) must include the radiographic apex.

Radiographs must be current, dated, pretreatment, and diagnostic quality.
The radiographic apex must be visible.

Documentation Required

Additional Diagnostic Documentation

When the indication for a core buildup and/or post and core is not obvious on the radiograph, submit additional diagnostic documentation with the initial or replacement crown request.

Clinical chart notes stating the rationale.
Intraoral photographs.
An image of the initial placement when radiographs do not demonstrate the need after removal of an existing restoration.

Policy Background

A core buildup reconstructs missing coronal tooth structure when insufficient retention remains for a separate extracoronal restoration, typically a crown. It restores the internal anatomy of the prepared tooth and provides retention for the planned restoration. Prefabricated post-and-core systems use standardized components, while indirect post-and-core systems are custom fabricated to the tooth; in either approach, the buildup is integral to the restorative treatment.

Procedure Definitions

Definitions

Core buildupBuilding up coronal structure when there is insufficient retention for a separate extracoronal restorative procedure; the buildup restores the internal anatomy of the prepared tooth for a crown.

Definitions

Prefabricated post and coreA post-and-core system using standardized prefabricated components in various shapes and sizes.

Definitions

Indirect post and coreA custom-fabricated post-and-core system made to suit the specific needs of the tooth.

Policy Summary

PayerWellpoint

PolicyCore Buildup - Includes Post and Core Procedures

Policy CodePolicy 03-001

Change TypeModified — minor editorial refinementspolicy intent unchanged

Effective DateJan 1, 2026

Last ReviewOct 14, 2025

Next Review DateN/A

Key ActionSubmit current, dated, diagnostic-quality pretreatment radiographs obtained within 12 months that include the radiographic apex.

SourceLink

On This Page

Assess the patient’s full-mouth dental condition, medical history, dental history, periodontal history, periodontal continuing care, age, and occlusion.

Documentation Required

Unfavorable Crown-to-Root Ratio Assessment

For a crown-to-root ratio poorer than 1:1, document an assessment of the unfavorable ratio and the factors affecting prognosis before submitting the service.

Full-mouth dental condition.
Medical, dental, and periodontal history.
Periodontal continuing care.
Patient age and occlusion.

Documentation Required

Periodontal and Endodontic Assessment

Assess and document periodontal and endodontic status before treatment. Submit supporting records when periodontal support, periapical or periradicular findings, or root-canal quality may affect eligibility.

Consider periodontal health of the tooth and adjacent structures, including supporting bone and current dated 6-point periodontal charting when required.
Document any untreated or unresolved periapical or periradicular pathology and any unresolved lesion near the pulp chamber when endodontic therapy is not planned.
Document root-canal obturation quality; overfill, underfill, or poor condensation may affect eligibility.
History of periodontal therapy may be required.

Documentation Required

Adult-Dentition Primary-Tooth Documentation

For a primary tooth in the adult dentition, submit radiographic and clinical evidence that the tooth can support full-coverage indirect restoration treatment.

Intact root structure.
Adequate periodontal support with no evidence of active periodontal disease.
Occlusal function with an opposing tooth.
No permanent successor is present, or the successor is unlikely to erupt.

Denial Risk

Non-Covered Uses

Core buildups and/or post and cores will not be considered when submitted solely for pulp capping, insulation or protection of the pulp, undercut block-outs, enhancement of box form, or use as fillers for reduction of final restorative material.

Do not submit these services solely for pulp capping.
Do not submit solely for pulp insulation or protection, undercut block-outs, box-form enhancement, or fillers for reduction of final restorative material.

Denial Risk

Restoration Type and Wear-Related Exclusions

Core buildups and/or post and cores are not covered for partial-coverage indirect restorations or when performed to repair complications from tooth wear.

Excludes partial-coverage indirect restorations, including onlays, inlays, and veneers.
Excludes repair of complications from attrition, abrasion, erosion, and/or abfraction.

Denial Risk

Periodontal, Endodontic, and Furcation Risks

Benefits will not be considered when periodontal or endodontic disease, poor prognosis, or furcation involvement makes the tooth unsuitable for treatment.

Uncontrolled or untreated periodontal disease evidenced by loss of supporting bone is exclusionary.
Untreated or unresolved periapical or periradicular pathology is exclusionary.
An unresolved lesion near the pulp chamber without treatment-planned endodontic therapy may be exclusionary.
Overfilled, underfilled, or poorly condensed root-canal obturation may be exclusionary.
Internal or external resorption may be exclusionary.
Subgingival or subosseous caries that may compromise supracrestal tissue attachment requires restorative and periodontal considerations before benefits can be considered.
Caries extending into the furcation is exclusionary.

Denial Risk

Additional Exclusion Conditions

Benefits will not be considered for core buildups and/or post and cores performed for developmental or congenital defects. A diagnosis of cracked tooth syndrome may not qualify the tooth, and other structural conditions may also affect eligibility.

Developmental or congenital defects are excluded.
Cracked tooth syndrome may not qualify a tooth.
Internal or external resorption may not be considered for benefit.

Documentation Required

Primary-Tooth Eligibility

A primary tooth must meet the same treatment criteria as a permanent tooth to be considered for a core buildup and/or post and core. When the primary tooth is in an adult dentition, verify the additional radiographic, periodontal, successor, and occlusal requirements before submission.

The primary tooth must otherwise meet the criteria for treatment as a permanent tooth.
For adult dentition, document intact roots, adequate periodontal support, no active periodontal disease, and an opposing tooth in occlusal function.
Document that no permanent successor is present or that the successor is unlikely to erupt.

Billing Rule

Third-Molar Function

For third-molar determination, the completed crown must be in occlusal function with an opposing tooth. The tooth must occlude with at least one-third of the opposing tooth unless a contract-dependent exception applies for a crown supporting a removable or fixed partial denture.

Document occlusal function with an opposing tooth.
At least one-third occlusion with the opposing tooth is required.
Exceptions may apply for crowns supporting removable or fixed partial dentures, depending on the contract.