Summary
The dental implants policy (13.01.01) has a current effective date of July 16, 2026, and that annual review left the policy intent unchanged. A single implant is medically appropriate when a functional deficit exists, meaning fewer than four points of contact for posterior teeth in occlusion per side, and implant bodies anchoring a denture are covered only when traditional dentures dislodge or are painful, up to four upper or two lower implant bodies. Implants to replace a second molar that extends an arch with functional first molar occlusion, or to replace third molars, are not medically necessary, and codes D6196 and D6280 were added effective 01/01/26.
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