American Cleft Palate - Craniofacial Association

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Retrospective Study Regarding Efficacy of Medically Necessary Orthodontic Care Criteria Gets the Gre

Retrospective Study Regarding Efficacy of Medically Necessary Orthodontic Care Criteria Gets the Greenlight to Move Forward

The American Association of Orthodontists (AAO) and other dental care partners proposed a set of criteria to be used in the United States to determine when orthodontic care could be characterized as medically necessary for insurance purposes. One of the criteria or “proposed auto-qualifiers” includes: “Defects of cleft lip and palate or other craniofacial anomalies or trauma.”

A retrospective study that will apply these criteria to existing orthodontic cases received IRB approval.

Excerpt from the article:

“Payers will supply a sampling of claims that have been determined to qualify as being medically necessary. The study will then apply the AAO proposed auto-qualifiers to these claims to determine how effective the qualifiers will be in determining medical necessity.”

To read the full article, click here.