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Dentovio public answer
For osseous surgery the published payer criteria are documentary and temporal rather than numeric.
For osseous surgery the published payer criteria are documentary and temporal rather than numeric. Delta Dental Insurance requires that the procedure include removal of supporting bone (ostectomy) and/or non-supporting bone (osteoplasty) with elevation of a full-thickness flap and closure, plus periodontal charting within 12 months. Guardian applies a generic periodontal-surgical-services standard — radiographs showing pathologic loss of alveolar crest height, periodontal charting, and exclusion of any tooth with 50% or more bone loss for poor prognosis. Aetna's DCPB012 states no pocket-depth, bone-loss, or prior-scaling requirement at all, and limits the benefit typically to one pocket-reduction surgery per quadrant or tooth in any 36 consecutive months. Cigna's office reference guide bars payment and any patient charge for same-office retreatment of a quadrant within 36 months, and United Concordia denies the claim as misreported where the quadrant does not show periodontal disease with moderate-to-deep pockets. Medicaid programs add age bands, prior authorization, and their own frequency caps.
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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