BlueCross BlueShield of Tennessee Administrative Services

Non-Cosmetic Pediatric Orthodontia

This policy document only applies to Individual and Small Group EHB Products

DESCRIPTION

Orthodontia, also known as orthodontics and dentofacial orthopedics, is a specialized branch of dentistry that focuses on the diagnosis and treatment of dental and facial irregularities.  Pediatric orthodontic problems are commonly referred to as malocclusion.  Malocclusion may be caused by missing teeth, extra teeth, crowded teeth and/or abnormal alignment of the jaw.  Most of these pediatric problems are inherited; however, significant deviation of the teeth and/or jaw may also be caused by accidents, burns, osteomyelitis or other severe trauma. Orthodontic treatment, which involves the application of wires and orthodontic brackets (i.e., braces), is performed to correct the alignment of teeth and jaws.

POLICY

MEDICAL APPROPRIATENESS 

SOURCE

DDS consultants

ORIGINAL EFFECTIVE DATE:  1/1/2017

MOST RECENT REVIEW DATE:  1/1/2017

ID_Product Development

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

This document has been classified as public information.