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Dental Inlays and Onlays 13.01.03

Excellus BlueCross BlueShield·Dentistry, Oral & Maxillofacial Surgery·Dental
Effective date
May 22, 2025
We identified it
Jun 20, 2026
Days to comply

Summary

New policy effective May 22, 2025 establishes coverage criteria for dental inlays and onlays on bicuspid/molar teeth for specific indications including fractured cusps, moderate to severe decay into tooth root, and following root canal procedures. Coverage is limited to cementing date and restricted to filling-level reimbursement when replacing existing fillings without decay.

Action Required

Action needed
By May 22, 2025: Billing team must update system to verify coverage criteria for dental inlay/onlay codes D2510-D2664, ensuring claims document one of three qualifying indications: fractured cusp not repairable with filling, moderate to severe mesial/distal decay into root, or post-root canal restoration. Update billing rules to reimburse at amalgam/composite filling rates when replacing existing fillings without decay. Verify coverage only applies on cementing date.

Affected Billing Codes

D2510
D2520
D2530
D2542
D2543
D2544
D2610
D2620
D2630
D2642
D2643
D2644
D2650
D2651
D2652
D2662
D2663
D2664