Common use of Medically Necessary Orthodontics Clause in Contracts

Medically Necessary Orthodontics. Covered Benefits include services for limited, interceptive and comprehensive Orthodontic treatment of the primary, transitional and adolescent dentition in addition to removable and fixed appliance therapy. Treatment visits are provided for pre-orthodontic, periodic orthodontic and orthodontic retention. Orthodontic services will only be covered under this Section if the Member fits the following criteria: Members must have a fully erupted set of permanent teeth to be eligible for comprehensive orthodontic services. All orthodontic services require Authorization, a written plan of care, and must be rendered by a Provider. Orthodontic treatment must be considered medically necessary and be the only method considered capable of: Preventing irreversible damage to the member’s teeth or their supporting structures. Restoring the member’s oral structure to health and function.