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Dentovio public answer
Post and core is governed by bundling rules and imaging, and two payers publish an explicit downgrade.
Post and core is governed by bundling rules and imaging, and two payers publish an explicit downgrade. Guardian allows the benefit only in conjunction with a covered crown or bridge unit, only where less than 3 mm of sound dentin remains circumferentially after preparation, and may limit an indirectly fabricated post and core to the prefabricated allowance as the least expensive alternate treatment. Cigna publishes no post-and-core policy but bars a core buildup on the same date of service and the same tooth as a post and core. Delta Dental Insurance requires a periapical radiograph and a written report. United Concordia's DE/PA/WV Medical Assistance guide requires a post-endodontic x-ray in addition to the pre-treatment film, approvable only where tooth structure is insufficient for retention. Aetna carries no post-and-core row at all; its core-buildup bulletin is imaging-primary, and carious destruction of the clinical crown at or below the osseous crest is grounds for denial rather than support for a post.
Dentovio is an independent publisher — not a dental payer, the ADA, or any state dental board. These summaries describe the payers' published clinical-review and documentation criteria as addressed to dentists — what a reviewer looks for on a claim, never what a patient's plan pays. Individual plan contracts govern: every payer document here states that the member's plan documents control coverage, frequencies and exclusions where they conflict with the policy, and payers revise policy documents on their own schedules. Where a record's reach is narrower than the payer — one plan line, one federal program, one state Medicaid program — or where a figure comes from a plan-sponsor or federal-program document rather than the payer's own policy manual, the record says so. Educational billing reference only, not billing, legal, or clinical advice. CDT codes are referenced by number only; CDT is the American Dental Association's copyrighted code set and this page does not reproduce ADA descriptors.
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