Medicare AdvantageCoverageMedium impact
MA04.002, Extraction of Bony Impacted Teeth and Exposure of Impacted Teeth
Independence Blue Cross·NJ · Dentistry, Oral & Maxillofacial Surgery, General Surgery·Medical Policy
We identified it
Jun 19, 2026
Summary
Independence Blue Cross Medicare Advantage policy MA04.002 continues to classify extraction of bony impacted teeth and exposure of impacted teeth as non-covered services under Medicare Advantage plans, consistent with Medicare coverage determinations. This is a reissue with no substantive coverage changes, but billing teams must ensure these procedures and associated radiographs are consistently denied and not submitted for reimbursement.
Action Required
Billing team must maintain denial protocols for all Independence Blue Cross Medicare Advantage plans in New Jersey and other applicable regions. Verify that billing system rules are configured to automatically deny or block claims for CPT codes 70300, 70310, 70320, 70355 and HCPCS codes D0220, D0230, D0330, D7230, D7240, D7241, D7280, D7283 when linked to ICD-10 diagnosis codes K01.0 or K01.1. Train staff that extraction of bony impacted teeth, exposure of impacted teeth, associated E/M services, facility charges, and diagnostic radiographs for these conditions are not eligible for reimbursement. Do not appeal denials for these non-covered services unless clinical documentation supports a different diagnosis or procedure code.