CommercialCoverageMedium impact
Periodontal Maintenance 13.01.05
Excellus BlueCross BlueShield·Dentistry·Dental
Effective date
May 22, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has established a new medical policy for periodontal maintenance (D4910) effective May 22, 2025. The policy covers periodontal maintenance following periodontal therapy for preventing disease recurrence, reducing tooth loss, and early detection of oral conditions, with benefits typically allowing services twice per year and contract-dependent coverage.
Action Required
Before May 22, 2025: Billing team must update systems to recognize new Excellus BCBS periodontal maintenance policy 13.01.05. Verify member contracts for specific benefits as coverage is contract-dependent. Ensure D4910 claims include documentation of prior periodontal therapy (scaling/root planing or surgery). Note that once periodontal maintenance begins, it becomes the only eligible prophylactic procedure for coverage.