CommercialCoverageMedium impact
04.00.05d, Extraction of Bony Impacted Teeth and Exposure of Impacted Teeth
Independence Blue Cross·Oral & Maxillofacial Surgery, Dentistry, ENT (Ear, Nose & Throat)·Medical Policy
Effective date
Apr 2, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross has reissued their policy 04.00.05d covering extraction of bony impacted teeth and exposure of impacted teeth. This is a commercial policy reissue that will be effective April 2, 2025, indicating potential changes to coverage or billing requirements for dental surgical procedures.
Action Required
By April 2, 2025: Billing team must review the updated policy 04.00.05d for extraction of bony impacted teeth and exposure of impacted teeth on the Independence Blue Cross website. Verify current billing procedures align with any new requirements and update encounter forms if coverage criteria or documentation requirements have changed.