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Crowns under the CDCP: preauthorization and keeping lab cases moving

A crown under the Canadian Dental Care Plan needs approval before treatment starts. Here is what the request needs, and how to keep the lab case moving.

By the Tusko team

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A crown under the Canadian Dental Care Plan needs approval before it is made. The request goes in first, the decision comes back, and only then does the lab case begin.

That adds a wait to the front of every CDCP crown. Handled well, it costs nothing but time. Handled badly, it leaves a case stalled and a lab guessing.

This guide follows the Dental Benefits Guide in effect from 1 April 2026. Check the current guide before you rely on any detail.

What the plan requires for a crown

Three rules shape every case.

Preauthorization. Canada.ca lists crowns as a service that requires preauthorization.

Limits. The Dental Benefits Guide allows “4 crowns in any 120 months (10 years) per client”, and one in any 96 months for each eligible tooth.

Conditions on the tooth. The guide sets clinical criteria for the tooth that is to be crowned.

Read those criteria in the guide itself before you plan a case. They decide whether a request can succeed.

Check the patient’s crown history against both limits before you send anything.

What goes in the request

The guide lists what a preauthorization request for a crown must include.

  • A completed claim form
  • A treatment plan showing all relevant completed and pending treatment
  • Periapical and bitewing radiographs, dated within the last 12 months
  • A complete periodontal chart, dated within the last 12 months
  • Clinical findings and notes that support the request

Since November 2024, requests can be submitted electronically.

An incomplete request is a delay you can avoid. Check the list twice before it goes.

Keep a copy of everything you sent, with the date. If the plan asks a question, you will want to see exactly what it has.

How long approval lasts

The guide says most decisions are valid for up to 12 months from the date of approval.

There is a condition. The client has to be eligible for coverage on the date of service, which is the day the work is done.

So approval gives you room to schedule. You still need to check eligibility again before the preparation visit.

Do not use all of that room. Aim to prepare the tooth within a few weeks of approval, while the records are current.

Where the lab case fits

A CDCP crown has three more steps than a private one, and all three come before the lab is involved.

A CDCP crown, and what the lab should know at each step

A flow of the six steps of a crown under the Canadian Dental Care Plan, with who does each and what the lab should know: records and request, waiting for the decision, approval arrives, preparation and scan, the crown is made, and seat, then claim.

  1. Records and request

    The lab should know: nothing yet, unless you want to warn it of volume.

    Practice

  2. Waiting for the decision

    The lab should know: nothing, or that a case is pending.

    The plan

  3. Approval arrives

    The lab should know: that a case is coming.

    Practice

  4. Preparation and scan

    The lab should know: the Rx, the scans and both dates.

    Practice

  5. The crown is made

    The lab should know: whether an itemized invoice is needed.

    Lab

  6. Seat, then claim

    The lab should know: nothing, unless the invoice is requested.

    Practice

The request goes in first, the decision comes back, and only then does the lab case begin.

The simplest rule is to send nothing to the lab until approval is in hand. The lab then gets a normal case.

Some practices like to tell the lab a case is on its way. If you do, mark it clearly as pending, so that no work starts.

Do not prepare the tooth early

It is tempting to prepare the tooth while the patient is in the chair and send the request afterwards.

The risk falls on the patient. If the request is refused, they have a prepared tooth, a temporary and a bill they did not expect.

Use the first visit for records. Take the radiographs, the charting and the notes the request needs.

Book the preparation once the answer is in. The patient waits a little longer, and nobody is surprised.

What the patient pays

Approval does not mean the plan pays everything.

The plan covers a share of its own established fee, depending on family income. Canada.ca notes that those fees may not match what a provider charges.

The lab fee is treated on its own terms. The plan reimburses lab fees it considers reasonable and customary, and can adjust the amount.

Tell the patient what they may owe before treatment starts. CDCP and lab fees has the co-payment table and the plan’s wording on lab charges.

What to tell the patient at the first visit

Patients who are new to the plan may expect the crown to start that day. Set out the sequence before they leave.

  • The plan has to approve a crown before any work starts
  • The practice sends the request, and calls when the answer arrives
  • The answer can be no, and the practice will explain the options if so
  • Approval does not mean the plan pays the full amount

Put the same points in writing. A patient who was told once, in the chair, may not remember them.

Keep the case moving while you wait

The wait is dead time only if nothing is prepared.

  • Have the records complete on the first visit. A request that goes in the same week saves a week.
  • Note the date you submitted. Review open requests every week, so none is forgotten.
  • Book nothing until the answer arrives. A preparation visit booked on hope will be moved.
  • Call the patient the day approval lands. Offer times for the preparation then.
  • Send the lab a complete Rx with both dates. The crown should not be held up twice.

Keep a short list of open requests: patient, tooth, date sent, date answered. It takes one line each.

If the plan asks for more information, send it the same day and note the date. A request waiting on the practice is a delay you control.

If the request is refused

Read the reason the plan gives, and compare it with what you sent.

Tell the patient the same day. Talk through the options, which may include a different restoration or paying privately.

Close the line on your list of open requests. A refused request left open looks like one still waiting.

When approval arrives

From here the case runs like any other crown, with two additions.

Check eligibility again on the day of the preparation. Approval depends on the patient still being covered.

Write the approval date on the case. It shows whoever books the visits how long the approval has left.

Tell the lab it is a CDCP case. Ask for an invoice that names the patient, the tooth in FDI notation, the work and the date.

Then book the seat appointment against the lab’s date, with a gap. Dental lab turnaround times shows how to count it.

Keep the lab’s invoice with the claim. The guide says the plan can ask for a copy.

A page for the front desk

  • Coverage and crown history checked before the request
  • Every item on the request list included
  • The date submitted recorded, and the open list reviewed weekly
  • No preparation booked until approval is in hand
  • Eligibility checked again on the day of treatment
  • The lab told it is a CDCP case, and asked for an itemized invoice
  • The invoice filed with the claim

One place for the waiting

A pending approval is one more status to track, beside every case already at a lab.

Tusko does not submit claims or requests to the plan. Once a case is sent, it keeps the Rx, the dates and the messages in one place for the practice and the lab.

See how it looks for practices. For the rest of what the plan means for labs, read CDCP and lab fees.

How many crowns does the CDCP cover?

The Dental Benefits Guide limits crowns to four in any 120 months for each client, and one in any 96 months for each eligible tooth. Every crown needs preauthorization.

Can we prepare the tooth before approval arrives?

The guide requires preauthorization for crowns, so plan the preparation for after approval. Starting earlier leaves the patient exposed to the full cost if the request is refused.

How long does a preauthorization last?

The guide says most decisions are valid for up to 12 months from the date of approval, as long as the client is still eligible for coverage on the date of service.

Does the lab need to know a case is under the CDCP?

Yes. The lab’s invoice may be requested with the claim, and a case that is waiting for approval should be marked as waiting, so nobody starts it early or wonders why it stopped.

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