Cracked Tooth Syndrome and Insurance

If an indirect restoration is being placed on a tooth because of Cracked Tooth Syndrome (CTS), dental insurance might or might not pay for it. To increase the chances of coverage, the submitted dental claim must be detailed and complete.

A diagnostic x-ray is necessary. A photo can be helpful. A narrative is almost always needed to convey clinical information. The goal is to document that patient has pain, a proper diagnosis of CTS was made, and other possible causes for the pain were thoroughly considered and ruled out. There are many causes of tooth biting pain, and it must be shown that these other causes were ruled out before an indirect restoration will be considered for reimbursement by insurance.

The narrative should include information about:

Photographs are very helpful to show clinical information not fully demonstrated in x-rays:

 

See also: