CommercialCoverageMedium impact
Periodontal Scaling and Root Planing 13.01.04
Excellus BlueCross BlueShield·Dentistry·Dental
Effective date
May 22, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their periodontal scaling and root planing policy, effective May 22, 2025. The policy clarifies coverage criteria requiring pocket depths of at least 4mm and specifies that prior authorization is recommended (but not required) for full-mouth procedures.
Action Required
Before May 22, 2025: Billing team must update procedures to ensure periodontal charting documentation shows pocket depths of at least 4mm and evidence of root surface calculus or bone loss for claims submission. Consider obtaining prior authorization for full-mouth, four-quadrant procedures and include written time estimates for each quadrant. Update encounter forms to remind providers that gingivitis alone does not qualify for coverage.