Dental Policy Bulletins

Number: 014
(Updated)

Subject: Tooth positioners for orthodontic treatment

Date: April 30, 2013

Important Note

This Clinical Policy Bulletin expresses our determination of whether certain services or supplies are medically necessary. We have reached these conclusions based on a review of currently available clinical information including:
  • Clinical outcome studies in the peer-reviewed published medical and dental literature
  • Regulatory status of the technology
  • Evidence-based guidelines of public health and health research agencies
  • Evidence-based guidelines and positions of leading national health professional organizations
  • Views of physicians and dentists practicing in relevant clinical areas
  • Other relevant factors
We expressly reserve the right to revise these conclusions as clinical information changes, and welcome further relevant information.

Each benefits plan defines which services are covered, excluded and subject to dollar caps or other limits. Members and their dentists will need to consult the member's benefits plan to determine if any exclusions or other benefits limitations apply to this service or supply. The conclusion that a particular service or supply is medically necessary does not guarantee that this service or supply is covered (that is, will be paid for by Aetna) for a particular member. The member's benefits plan determines coverage. Some plans exclude coverage for services or supplies that we consider medically necessary. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. In addition, coverage may be mandated by applicable legal requirements of a state, the federal government or CMS for Medicare and Medicaid members.

Policy

A system utilizing aligners may be considered by Aetna as comprehensive orthodontic treatment.

Background

Orthodontic aligners are a treatment modality used for the correction of malpositioned teeth. The total treatment time may vary based on factors such as the difficulty of each individual case and/or system used.

Codes1

D8070 -- Comprehensive orthodontic treatment of the transitional dentition
D8080 -- Comprehensive orthodontic treatment of the adolescent dentition
D8090 -- Comprehensive orthodontic treatment of the adult dentition

Revision Dates

Original: November 22, 2005
Updated: March 29, 2010; April 9, 2012; April 30, 2013
Revision: November 20, 2006; April 29, 2008; March 30, 2009; March 14, 2011 

The above policy is based on the following references:

1American Dental Association. Current dental terminology, CDT 2013: 79.*

2Invisalign website. Align Technology, Inc. March 11, 2011. http://www.invisalign.com

3Joffe L. Invisalign: early experiences. J.Orthod. 2003 Dec; 30:348-52.

4Hajeer MY, Millett DT, Ayoub AF, Siebert JP. Applications of 3D imaging in orthodontics: part II. J. Orthod. 2004 Jun; 31:154-62.

*Copyright 2012 American Dental Association. All rights reserved.



Property of Aetna. All rights reserved. Dental Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical/dental advice. This Dental Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating health care professionals are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating health care professionals are solely responsible for medical/dental advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.

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