CDCP and lab fees: what practices and labs need to know in 2026
Under the Canadian Dental Care Plan, lab fees are reimbursed when they are reasonable and customary. Here is what that means for practices and labs.
By the Tusko team
Published
On this page
The Canadian Dental Care Plan reimburses lab fees that are “reasonable and customary”, and only alongside an eligible procedure.
The plan can ask for the lab’s invoice, and it can adjust the amount.
For a practice, that makes the lab invoice part of the claim. For a lab, it makes a clear invoice part of the service.
This guide follows the Dental Benefits Guide in effect from 1 April 2026. Check the current guide before you rely on any detail here.
What the plan says about lab fees
The rule is one short paragraph in the Dental Benefits Guide.
“The CDCP will reimburse reasonable and customary laboratory fees. The CDCP reserves the right to require a copy of the laboratory report/invoice and to adjust the laboratory fee requested by oral health providers.”
Canadian Dental Care Plan, Dental Benefits Guide
The same paragraph says a lab fee is considered “only in conjunction with an eligible procedure code”. Four things follow from that.
- The lab fee rides on a procedure. A lab charge with no covered procedure beside it is not considered.
- The guide gives a test, with no dollar figure. The fee has to be reasonable and customary.
- The invoice may be requested. The practice should be able to produce it for any CDCP case.
- The amount can be adjusted. What the practice asks for and what the plan pays can differ.
What the guide leaves open
Two practical questions have no answer in that paragraph.
The guide gives no figure for a reasonable and customary fee. A practice cannot look up in advance what the plan will pay for a given lab invoice.
It also does not describe how an adjustment is made. The coverage page only says a client may owe more than the co-payment.
When a case is unusual or the lab fee is high, ask the plan before treatment starts. Keep the answer with the claim.
What patients pay, and why the lab should care
The plan covers a share of its own fee for each service. The share depends on adjusted family net income.
What the plan covers, by adjusted family net income
Three shares of the plan’s established fees, by adjusted family net income. Under $70,000, the plan covers 100% and the patient pays 0%. From $70,000 to $79,999, the plan covers 60% and the patient pays 40%. From $80,000 to $89,999, the plan covers 40% and the patient pays 60%.
- Under $70,000
- 100%
- The patient pays 0%
- $70,000 to $79,999
- 60%
- The patient pays 40%
- $80,000 to $89,999
- 40%
- The patient pays 60%
Those percentages apply to the CDCP’s established fees. Canada.ca notes that those fees “may not be the same as what providers charge”.
It also says a client may have to pay more “if the cost of your oral health care services is more than what the CDCP will reimburse”.
So the cost talk happens before the case is sent. A lab may see a pause while a patient decides, and it helps to know why.
Which lab work needs preauthorization
Some of the work a lab makes cannot start on the plan’s account until the plan agrees.
- Crowns need preauthorization.
- Partial dentures need preauthorization.
- Complete dentures appear on canada.ca’s coverage list without that note. The guide sets conditions for some types.
The guide limits crowns to “4 crowns in any 120 months (10 years) per client” and one in any 96 months for each eligible tooth.
Approval lasts a while. The guide says most decisions are valid for up to 12 months, as long as the client is still eligible on the day of service.
Crowns under the CDCP covers the request itself and how to keep the case moving while you wait.
What this changes for the practice
Most of the work is in the order of the steps.
- Confirm coverage before you prepare the tooth. For a crown or a partial, that means an approved preauthorization.
- Know the lab fee before you claim. Ask the lab for its fee for that case, in writing.
- Tell the patient what they may owe. Cover the co-payment and any amount above what the plan pays.
- Tell the lab it is a CDCP case. Say if approval is in hand or still pending.
- Keep the lab’s invoice with the claim. The plan can ask for it later.
Step four is the one that gets skipped. A lab that does not know a case is waiting on approval cannot plan its bench.
Dentures follow the same order, with one difference. A partial needs approval first, and a standard complete denture is listed without that step.
What this changes for the lab
A commercial lab does not submit claims to the plan. Its paperwork still decides how smoothly the practice’s claim goes.
- Invoice each case on its own. Name the patient, the teeth in FDI notation, the work and the date.
- Itemize. A single total is hard to defend if the plan asks what it was for.
- Keep fees consistent. A published lab fee schedule shows a charge is your usual one.
- Send copies quickly. When a practice needs an invoice again, the claim is waiting on it.
- Mark cases that are on hold for approval. Nobody should wonder why one stopped.
Expect requests for old invoices. A practice can be asked for one long after the case was seated.
How Canadian dental labs build a fee schedule goes further on setting and publishing fees.
Settle these with your lab before the first CDCP case
A ten-minute call now saves a stalled case later. Five points cover it.
- How the practice will flag a CDCP case on the Rx
- What the lab does with a case whose approval is still pending
- How soon the lab can confirm its fee for a case
- What each invoice will show, line by line
- Who to ask for a copy of an invoice, and how fast it comes
Write the answers down and share them with the front desk. They are the ones who will be asked.
Keeping a CDCP case moving
A CDCP crown has more steps than a private one, and each is a place for a case to stall.
| Step | Who does it | What the other side needs to know |
|---|---|---|
| Request preauthorization | Practice | That a case is coming, and roughly when |
| Approval arrives | Practice | That the lab can start, and the seat date |
| Rx and scans go to the lab | Practice | Everything on a complete Rx |
| Case is made and invoiced | Lab | The fee, itemized, before the claim goes in |
| Claim is submitted | Practice | Nothing, unless the invoice is requested |
Two dates matter to the lab: the day approval lands and the seat appointment. Share both.
Where a shared case helps
Approval status, the seat date and a request for an invoice are small details. They are also the ones that go missing between two inboxes.
Tusko does not submit claims. It keeps the case, its dates and its messages in one place that the practice and the lab both open.
See how it looks for practices and for labs.
More on Canadian rules
The plan is one of several Canadian rules that touch the case between a practice and a lab.
Does the CDCP pay dental lab fees?
Yes, with conditions. The Dental Benefits Guide says the plan reimburses reasonable and customary laboratory fees, and only together with an eligible procedure code.
Does the lab bill the CDCP directly?
The guide describes laboratory fees as requested by the oral health provider with the claim. The lab’s invoice goes to the practice, as it always has.
Can a patient be charged more than the CDCP pays?
Canada.ca says clients may have to pay fees on top of any co-payment when a service costs more than the plan reimburses. Tell the patient before treatment starts.
Do crowns need preauthorization under the CDCP?
Yes. Crowns need preauthorization, and the guide limits them to four in any 120 months per client and one in any 96 months per eligible tooth.
Sources
Related guides
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.
FDI notation names each tooth with two digits, the quadrant and the position. Here is how to read it, write it on a lab Rx and avoid mix-ups.
Data residency means the country where patient information is stored. Here is what Canadian privacy law says about it, and what to ask a software vendor.