CommercialCoverageMedium impact
Dental Implants 13.01.01
Excellus BlueCross BlueShield·Dentistry, Oral & Maxillofacial Surgery·Dental
Effective date
May 22, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their dental implant policy effective May 22, 2025, establishing specific medical necessity criteria including requiring less than 4 points of posterior tooth contact per side for single implants and limiting implant bodies to 4 upper or 2 lower for denture anchoring. The policy also excludes coverage for second molars with functional first molar occlusion and all third molar replacements.
Action Required
Before May 22, 2025: Billing team must implement predetermination requirements for all Excellus BCBS dental implant cases, ensuring submissions include number/location of missing teeth, interarch distance, implant specifications, occlusal scheme, restoration design, and current radiographic imaging. Update system to verify medical necessity criteria: less than 4 posterior contact points per side for single implants, traditional denture issues for implant-anchored dentures (max 4 upper/2 lower bodies), and exclude second molar replacements with functional first molars and all third molar replacements.