Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.30
    OpenPayerPolicy UpdatesClinical/Medical PolicyWellpoint Implant Prosthetics Coverage | OpenPayer
    Ask Trek AI about this page
    ModifiedWellpointPolicy 06-104

    Implant/Abutment Supported Removable Prosthetics

    Customize your policy alerts

    Sign up for wellpoint Policy 06-104 alerts

    Get alerted when Policy 06-104 changes without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Coverage consideration, clinical criteria, documentation, coding, and benefit limitations for implant/abutment supported removable prosthetics used to replace missing teeth.

    Policy Summary
    PayerWellpoint
    PolicyImplant/Abutment Supported Removable Prosthetics
    Policy CodePolicy 06-104
    Change TypeModified
    Effective Date01/01/2026
    Last ReviewOct 30, 2025
    Next Review DateN/A
    Key ActionObtain current, dated, diagnostic pretreatment full-mouth radiographic imaging performed within 12 months.
    SourceLink
    POLICY UPDATE CHANGES

    Added CDT codes D6114 through D6119 for implant/abutment supported fixed and interim fixed dentures.

    4Clinical indication categories
    12 monthsMaximum radiograph age
    D6055, D6110-D6119, D6090Applicable CDT codes
    No benefitAesthetic replacement
    06-101

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Related implant stability policy

    Coverage Criteria

    Clinical indications

    Implant/abutment supported removable prosthetics to replace missing teeth may be considered appropriate when any one of the following indications is present.

    • Accidental traumatic injury: Accidental traumatic injuries to sound, natural teeth resulting in extraction or avulsion.
    • Pathologic disorder: A pathologic disorder resulting in extraction.
    • Congenitally missing teeth.
    • Congenital dental disorder: A congenital disorder of the teeth resulting in extraction.

    Clinical, documentation, and billing criteria

    The following policy criteria and contract-dependent requirements apply.

    General clinical and administrative criteria

    • Radiographic documentation: Current, dated, diagnostic pretreatment full-mouth radiographic imaging is required.within 12 months
    • Implant stability: The implant body must be stable; see dental clinical policy 06-101.
    • Delivery date: Dependent on provider contract, the delivery date is considered the date of delivery.
    • Temporary or provisional restoration: A temporary or provisional implant/abutment supported removable prosthetic is inclusive with the final restoration.

    Plans without a missing tooth clause

    For plans without a missing tooth clause, coverage determination is contract dependent.

    Contract-dependent benefit determination

    • Necessity determination: Determine the necessity of the implant-supported removable prosthetic.
    • Alternate benefit: Apply an alternate benefit when permitted by the plan contract.

      An alternate benefit may replace all missing teeth.

    Replacement of implant/abutment supported removable prosthetics for aesthetic reasons is not a covered benefit.

    For plans containing a missing tooth clause, there is no benefit for replacement of missing teeth when implant/abutment supported removable prosthetics is treatment planned.

    Coding Requirements

    CDT including but not limited toCPT
    D6055Connecting bar - implant supported or abutment supported
    D6110Implant/abutment supported removable denture for edentulous arch - maxillary
    D6111Implant/abutment supported removable denture for edentulous arch - mandibular
    D6112Implant/abutment supported removable denture for partially edentulous arch - maxillary
    D6113Implant/abutment supported removable denture for partially edentulous arch - mandibular
    D6114Implant/abutment supported fixed denture for edentulous arch - maxillary
    D6115Implant/abutment supported fixed denture for edentulous arch - mandibular
    D6116Implant/abutment supported fixed denture for partially edentulous arch - maxillary
    D6117Implant/abutment supported fixed denture for partially edentulous arch - mandibular
    D6118Implant/abutment supported interim fixed denture for edentulous arch - mandibular = D6113 Implant/abutment supported removable denture for partially edentulous arch - mandibular
    1–10 of 12
    1/2
    ICD-10 CM Diagnoses for Dental Diseases and ConditionsICD-10
    ICD-10-CMDiagnoses for Dental Diseases and Conditions: See the current CDT code book for details
    Pretreatment full-mouth radiographic imaging
    TimingImaging must be current and performed within 12 months.
    DatingThe pretreatment full-mouth radiographic imaging must be dated.
    Image qualityThe imaging must be diagnostic.

    Provider Documentation and Action Items

    Documentation Required

    Pretreatment Radiographic Imaging Required

    Obtain current, dated, diagnostic pretreatment full-mouth radiographic imaging before treatment. The imaging must be obtained within 12 months.

    Documentation Required

    Repair or Replacement Documentation

    For repair or replacement of implant/abutment supported removable prosthetics, submit a detailed narrative and/or chart notes as required by the provider contract.

    Documentation Required

    Stable Implant Body

    Document that the implant body is stable. Evaluate implant stability under dental clinical policy 06-101.

    Background

    Implant/abutment supported removable prosthetics are dental prostheses that the patient can remove. They differ from implant/abutment supported fixed dentures or hybrid prostheses, which can be removed only by a dentist.

    Definitions

    Removable implant/abutment supported prosthetic
    Restoration typeRemovable implant/abutment supported prosthetic.
    Patient removalA prosthetic restoration that can be taken out by the patient.
    Clinical useUsed to replace missing teeth.
    Implant/abutment supported fixed denture/hybrid prosthesis
    Prosthesis typeImplant/abutment supported fixed denture or hybrid prosthesis.
    Removal methodMay only be taken out by a dentist.
    Distinction from removable prosthetic
    Policy Summary
    PayerWellpoint
    PolicyImplant/Abutment Supported Removable Prosthetics
    Policy CodePolicy 06-104
    Change TypeModified
    Effective Date01/01/2026
    Last ReviewOct 30, 2025
    Next Review DateN/A
    Key ActionObtain current, dated, diagnostic pretreatment full-mouth radiographic imaging performed within 12 months.
    SourceLink
    On This Page
    Coverage CriteriaCoding RequirementsProvider Documentation and Action ItemsBackgroundDefinitions
    Denial Risk

    No Benefit for Incomplete Service

    If the subscriber does not return for delivery, there is no benefit because the service is considered incomplete.

    Denial Risk

    Aesthetic Replacement Excluded

    Replacement of implant/abutment supported removable prosthetics for aesthetic reasons is not a covered benefit.

    Denial Risk

    Missing Tooth Clause Limitation

    For plans containing a missing tooth clause, there is no benefit for replacement of missing teeth when implant/abutment supported removable prosthetics is treatment planned.

    Billing Rule

    Refer Accidental Trauma Claims to the Medical Plan

    Because medical plans commonly cover dental services related to accidental injury, first refer claims for replacement of teeth lost from an external blow or blunt trauma to the subscriber's or employee's medical plan. The medical plan may cover replacement of missing teeth due to accidental injury.

    Unlike a removable implant/abutment supported prosthetic, it cannot be taken out by the patient.