A-29, r. 5 - Regulation respecting the application of the Health Insurance Act

Section 31 Disposition versions

2020-05-07

31. The services referred to hereafter are considered insured services where they are rendered by a dentist to an insured person in an institution which operates a hospital centre:

(a)  examination, consultation or visit;

(b)  radiography, whether intraoral, extraoral or by injection of a contrast substance;

(c)  local or regional anesthesia;

(d)  emergency opening of the pulp chamber;

(e)  the following surgery services:

i.  package for complex surgery (cases of traumatism, reconstruction or oncology) where the duration of the anesthesia is 4 hours or more;

ii.  removal of a foreign body from the oral cavity or maxilla, excluding a dental implant;

iii.  removal by antrostomy of a tooth, dental fragment or foreign body;

iv.  surgical exposure, for orthodontic purposes, of a tooth whose crown is covered with bony tissue;

v.  incision or drainage of abscess;

vi.  osteitis treatment including alveolitis and osteomyelitis;

vii.  excision and curettage of an intraosteal cyst or granuloma;

viii.  marsupialization of an intraosseous cyst;

ix.  evacuation of a cervicofacial hematoma or seroma;

x.  biopsy;

xi.  excision of a tumor;

xii.  mandibulectomy or maxillectomy;

xiii.  complete lowering of the floor of the mouth or extension of mucous folds;

xiv.  excision of genial apophyses, of mylohyoid ridge or torus;

xv.  reinsertion of the mylohyoid muscle;

xvi.  alveolectomy, tuberoplasty or alveoplasty;

xvii.  excision of hyperplastic tissue or excision of excess mucous membrane;

xviii.  treatment of the salivary glands;

xix.  closure of the buccosinusal opening;

xx.  frenectomy;

xxi.  gingivectomy in the case of hyperplastic gingivitis resulting from the absorption of a medicinal substance;

xxii.  operculectomy;

xxiii.  hemorrhage control;

xxiv.  repair of a soft tissue laceration;

xxv.  neural transposition and decompression;

xxvi.  avulsion or alcoholization of a branch of the trigeminal nerve;

xxvii.  infiltration of a branch of the trigeminal nerve for diagnostic purposes;

xxviii.  anastomosis of a peripheral nerve under a microscope;

xxix.  additional exploration under a microscope of a vascular anastomosis of a micro-anastomosed free flap performed in less than 14 days of the initial procedure;

xxx.  complete avulsion of the inferior dental nerve;

xxxi.  implantation of an alloplastic craniomaxillofacial prosthesis to correct congenital, developmental or post-traumatic defects;

xxxii.  placement or removal of craniomaxillofacial distractors;

xxxiii.  stitching of a cut nerve;

xxxiv.  tracheotomy;

xxxv.  submandibular percutaneous intubation;

xxxvi.  the following services related to the correction of a cleft palate:

(A)  closing of the soft palate;

(B)  closing of the hard palate;

(C)  additional lengthening of the palate with intravelar myoplasty;

(D)  pharyngeal flap to cure a velopharyngeal insufficiency;

(E)  cure of a residual palatal fistula;

(F)  reconstruction of the alveolar ridge;

(G)  primary rhinoplasty in the presence of cleft lip or secondary by open or endonasal approach;

xxxvii.  cheiloplasty or reconstruction of the lip;

xxxviii.  glossectomy;

xxxix.  bone graft;

xl.  taking of the graft;

xli.  reduction of fractures:

(A)  frontal bone, zygomatic arch, malar bone, orbit, nose, maxilla, mandible, condyle or alveolar bone;

(B)  opened reduction of a bucket handle mandibular fracture;

(C)  bicornal flap;

(D)  occlusion of the frontal sinus;

xlii.  immobilization of a tooth loosened by traumatism;

xliii.  reimplantation of a completely exfoliated tooth;

xliv.  placement of a mandibular reconstruction plate or removal of bone fixation (pins, plate or screws) by surgical approach;

xlv.  placement or removal of an intermaxillary fixation or a preprosthetic splint;

xlvi.  the following services rendered for the treatment of the temporomandibular articulation:

(A)  luxation reduction;

(B)  meniscectomy;

(C)  condylectomy or high condylectomy, including condyloplasty;

(D)  temporomandibular arthroplasty;

(E)  coronoidectomy;

(F)  intra-articular infiltration including medication;

(G)  arthrocentesis;

(H)  arthroscopy;

(I)  injection of botulinum toxin for functional purposes;

(J)  implantation of a glenoid fossa or condylar prosthesis;

(K)  cure of ankylosis;

xlvii.  mandible, maxilla and interdental osteotomy;

xlviii.  corticotomy;

xlix.  repositioning or lessening of the symphysis menti;

l.  the following oncology and reconstruction services:

(A)  neck dissection;

(B)  lip repair with Abbé flap or cross lip flap;

(C)  correction of post-traumatic or surgical scars;

(D)  transfer of fat to correct scar disorders;

(E)  isolated debridement of skin wounds or mucous membranes, including the excision of necrotic tissue and foreign bodies;

(F)  post-traumatic or cleft lip dermabrasion;

(G)  graft by transfer of a local pedicled myocutaneous flap, by transfer of a regional pedicled flap, free cutaneous graft of head and neck region or by free microanastomosed flap;

(H)  reduction and rearrangement of the soft tissue of a flap done during a subsequent session, including section of the pedicle if necessary by direct closure;

(I)  intralesional injection of pharmaceutical agent for non-cosmetic purposes.

R.R.Q., 1981, c. A-29, r. 1, s. 31; O.C. 1712-82, s. 1; O.C. 1771-83, ss. 1 and 2; O.C. 1980-88, s. 1; O.C. 1134-91, s. 1; O.C. 1179-95, s. 6; O.C. 1100-99, s. 1; O.C. 840-2004, s. 1; O.C. 21-2015, s. 1; O.C. 446-2020, s. 2.

2015-02-12

31. For the purposes of subparagraph b of the first paragraph of section 3 of the Act, the oral surgery services listed below are considered insured services:

(A)  Diagnosis:

Examination

Consultation

(B)  Radiography:

Intraoral radiographs

Extraoral radiographs

Injection of contrast substance

(C)  Anaesthesia:

Local and regional

(D)  Surgery:

Package for complex surgery (cases of trauma, reconstruction or oncology where the duration of the anaesthesia is 6 hours or more)

Removal of foreign body from oral cavity or maxilla

Removal of teeth, dental fragments or foreign body by anthrostomy

Surgical exposure, for orthodontic purposes, of tooth whose crown is covered with bony tissue

Incision and drainage of abscess

Osteitis treatment

— alveolitis

— osteomyelitis

Excision and curettage of intraosteal cyst or granuloma

Marsupialization of intraosseous cyst

Evacuation of cervicofacial hematoma / seroma

Biopsy

Excision of tumor

Mandibulectomy

Maxillectomy

Complete lowering of the floor of the mouth

Extension of mucous folds

Excision of genial apophyses

Excision of mylohyoid ridge

Reinsertion of mylohyoid muscle

Alveolectomy

Tuberoplasty

Alveoplasty

Excision of hyperplastic tissue

Excision of excess mucous membrane

Excision of torus

Treatment of salivary glands

Closure of buccosinusal opening

Frenectomy

Gingivectomy in the case of hyperplastic gingivitis resulting from absorption of medicinal substance

Operculectomy

Haemorrhage control

Repair of laceration of soft tissue

Complete avulsion of inferior dental nerve

Avulsion of a branch of trigeminal nerve

Neural transposition and decompression

Alcoholization of a branch of trigeminal nerve

Infiltration of a branch of trigeminal nerve for diagnostic purposes

Anastomosis of a peripheral nerve under a microscope

Vascular anastomosis under a microscope

Implantation of alloplastic craniomaxillofacial prosthesis to correct congenital, developmental or post-traumatic defects

Craniomaxillofacial distractor

Stitching of a cut nerve (neurorraphy)

Tracheotomy

Submandibular percutaneous intubation

Cleft palate

— closing of soft palate

— closing of hard palate

— additional lengthening of palate with intravelar myoplasty

— pharyngeal flap to cure velopharyngeal insufficiency

— cure of residual palatal fistula

— reconstruction of alveolar ridge

— primary rhinoplasty in the presence of cleft lip

— secondary rhinoplasty by open or endonasal approach

Cheiloplasty (reconstruction of lip)

Glossectomy

Bone graft

Taking of graft

Reduction of fractures

— bicoronal flap

— reduction of frontal bone

— occlusion of frontal sinus

— zygomatic arch

— zygomatic arch or malar bone, or both

— orbit

— nose

— maxilla

— mandible

— condyle

— alveolar bone

— opened reduction of bucket handle mandibular fracture

Immobilization of tooth loosened by trauma

Reimplantation of completely exfoliated tooth

Mandibular reconstruction plate and bone fixation

— placement of reconstruction plate

— removal of bone fixation (pins, plate or screws) by surgical approach

Intermaxillary fixation and preprosthetic splint

Treatment of temporomandibular articulation

— luxation

— meniscectomy

— condylectomy

— high condylectomy (condyloplasty)

— temporomandibular arthroplasty

— coronoidectomy

— arthrocentesis

— arthroscopy

— injection of botulinum toxin for functional purposes

— implantation of glenoid fossa prosthesis

— implantation of condylar prosthesis

— cure of ankylosis

— infiltration of temporomandibular articulation (intra-articular medication including substance)

Osteotomy

— mandible

- vertical or horizontal branch by intra or extraoral approach

- segmental

— maxilla

- le Fort I

- total turbinectomy

- le Fort II

- le Fort III

- segmental

- zygomatic arch

- nasal pyramid

— interdental

Corticotomy

Repositioning or lessening of symphysis menti

Emergency opening of pulp chamber (emergency endodontia)

Oncology and reconstruction

— neck dissection

— lip repair with Abbé flap or cross lip flap

— correction of post-traumatic or surgical scars

— post-traumatic / cleft lip dermabrasion

— graft by transfer of local pedicled myocutaneous flap

— graft by transfer of regional pedicled flap

— free cutaneous graft, head and neck region

— graft by free microanastomosed flap

— intralesional injection of pharmaceutical agent for non-cosmetic purposes.

R.R.Q., 1981, c. A-29, r. 1, s. 31; O.C. 1712-82, s. 1; O.C. 1771-83, ss. 1 and 2; O.C. 1980-88, s. 1; O.C. 1134-91, s. 1; O.C. 1179-95, s. 6; O.C. 1100-99, s. 1; O.C. 840-2004, s. 1; O.C. 21-2015, s. 1.

2012-09-01

31. For the purposes of subparagraph b of the first paragraph of section 3 of the Act, the oral surgery services listed below are considered insured services:

(A)  Diagnosis:

Examination

Consultation

(B)  Radiography:

Intraoral radiographs

Extraoral radiographs

Injection of contrast substance

(C)  Anaesthesia:

Local and regional

(D)  Surgery:

Package for complex surgery (cases of trauma, reconstruction or oncology where the duration of the anaesthesia is 6 hours or more)

Removal of foreign body from oral cavity or maxilla

Removal of teeth, dental fragments or foreign body by anthrostomy

Surgical exposure, for orthodontic purposes, of tooth whose crown is covered with bony tissue

Incision and drainage of abscess

Osteitis treatment

— alveolitis

— osteomyelitis

Excision and curettage of intraosteal cyst or granuloma

Biopsy

Excision of tumor

Mandibulectomy

Maxillectomy

Complete lowering of the floor of the mouth

Extension of mucous folds

Excision of genial apophyses

Excision of mylohyoid ridge

Reinsertion of mylohyoid muscle

Alveolectomy

Tuberoplasty

Alveoplasty

Excision of hyperplastic tissue

Excision of excess mucous membrane

Excision of torus

Treatment of salivary glands

Closure of buccosinusal opening

Frenectomy

Gingivectomy in the case of hyperplastic gingivitis resulting from absorption of medicinal substance

Operculectomy

Haemorrhage control

Repair of laceration of soft tissue

Complete avulsion of inferior dental nerve

Avulsion of a branch of trigeminal nerve

Neural transposition and decompression

Alcoholization of a branch of trigeminal nerve

Infiltration of a branch of trigeminal nerve for diagnostic purposes

Anastomosis of a peripheral nerve under a microscope

Stitching of a cut nerve (neurorraphy)

Tracheotomy

Submandibular percutaneous intubation

Palatine fissure

Cheiloplasty (reconstruction of lip)

Glossectomy

Bone graft

Taking of graft

Reduction of fractures

— bicoronal flap

— reduction of frontal bone

— occlusion of frontal sinus

— zygomatic arch

— zygomatic arch or malar bone, or both

— orbit

— nose

— maxilla

— mandible

— condyle

— alveolar bone

Immobilization of tooth loosened by trauma

Reimplantation of completely exfoliated tooth

Insertion of splints

— intra- or periosteal (stem or wire for pericranial suspension)

— placement of a reconstruction plate

— acrylic prosthesis or cap splint attached to maxilla or teeth

— arch

— pericranial device

Removal of splints

— intra- or periosteal: stem, wire or screw for pericranial suspension or pericranial device, or both

— acrylic prosthesis or cap splint attached to maxilla or teeth

— arch

— pins, plates or screws requiring a surgical approach

Treatment of temporomandibular articulation

— luxation

— meniscectomy

— condylectomy

— high condylectomy (condyloplasty)

— temporomandibular arthroplasty

— coronoidectomy

— arthrocentesis

— arthroscopy

— infiltration of temporomandibular articulation (intra-articular medication including substance)

Osteotomy

— mandible

- vertical or horizontal branch by intra or extraoral approach

- segmental

— maxilla

- le Fort I

- total turbinectomy

- le Fort II

- le Fort III

- segmental

- zygomatic arch

- nasal pyramid

— interdental

Corticotomy

Repositioning or lessening of symphysis menti

Emergency opening of pulp chamber (emergency endodontia).

R.R.Q., 1981, c. A-29, r. 1, s. 31; O.C. 1712-82, s. 1; O.C. 1771-83, ss. 1 and 2; O.C. 1980-88, s. 1; O.C. 1134-91, s. 1; O.C. 1179-95, s. 6; O.C. 1100-99, s. 1; O.C. 840-2004, s. 1.