All PlansCoverageMedium impact
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
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
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.