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2023 Processing Updates: New and Old Codes

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lntraoral tomosynthesis: D0372, D0373, D0374, D0387, D0388, D0389

  • Most carriers will not be reimbursing for any of these new codes.

3D Dental Surface and Facial Surface Scanning: D0801, D0802, D0803, D0804

  • Most carriers will not be reimbursing for any of these new codes.  

  • Also note, these codes are designed to be billed only as stand-alone procedures. If done as a part of another treatment, they are considered inclusive of that treatment. For example: if prepping a crown and using a 3D scanner for digital impressions, this process would be considered inclusive of the crown and not a separate code to bill.

Covid and HPV Vaccinations: D1708-D1714, D1781, D1082, D1783

  • Most carriers will not be reimbursing for any of these new codes.  

D4286: Removal of non-resorbable barrier

  • Most carriers will not be reimbursing for this code.  

  • Also note, the placement of non-resorbable membrane codes are considered to include removal as well. This code is designed for dentists who are removing these membranes who did not place them.

D6105: Removal of implant body not requiring bone removal or flap elevation

  • This will be a potentially reimbursed code, however, removal of a failed implant is considered part of the service if the same dentist placed it within a short time period.  

Membrane Codes: D6106, D6107, D7956, D7957

  • For a long time, carriers have often covered membranes for periodontal surgeries, but not extractions or implants. This created a common problem when offices were advised this was a covered code/service, and then were denied because the membrane was not utilized for periodontal surgery. The new membrane codes should help clear up this confusion between offices and carriers.

  • Due to the history of membranes not commonly being covered for extractions and implants, one can expect most carriers will not be reimbursing for these new codes.

D6197: Replacement of restorative material used to close an access opening of a screw-retained implant supported prosthesis, per implant

  • Many carriers will be reimbursing for this code. Since this is an implant code, only expect reimbursement if the policy has implant coverage. Expect a minimum frequency between placement of the original prosthetic and this replacement code. (Ex: If the prosthetic was placed 3 months ago, D6197 would likely be denied).
  • Expect a frequency and reimbursement fee similar to a one-surface composite.
  • Note: this code says replacement, not placement. It is not designed to be coded or billed with the original placement of implant restorations, as that is considered part of the service of placement.

D7509: Marsupialization of odontogenic cyst 

  • Many carriers will request medical insurance billing first for this code. Also expect a trend to see this as an inclusive part of all other surgical D7000 codes and not to be reimbursed in addition to other codes.

D9953: Reline custom sleep apnea appliance (indirect)

  • Most carriers will not be reimbursing for this code.  

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