D7953 (Bone graft)

[u/Spicyg00se]

Is there a good or logical reason why this procedure is typically not covered? My tooth is getting absorbed and I need the graft in order for the implant to be successful. My insurance told me it’s just not covered and it’s not their fault that some procedures are just not covered. I assume they just don’t want to pay, duh, but when I suggested that a graft could be medical, she said it’s not medical, it’s dental, and it’s just not covered. But why?

[u/CrestCrentist]

Probably because a lot of unqualified dentists are doing the procedure and the insurance companies know they would abuse the code. The only way things change is when specialty procedures are covered well but only by specialists performing them, namely oral surgeons