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We would like to clarify Delta
Dental's payment policy for the following procedures and
codes: consultations (D9310) and evaluations
(D0120-0180).
Prior to January 1, 2003, a
consultation by definition was not payable to the same
provider who rendered care. Common Dental Terminology
(CDT-3), which are codes that describe the procedures
dentists submit to carriers for payment, clearly stated
that procedure D9310 (a consultation) was a service
provided by a dentist other than the practitioner
providing treatment. Delta Dental's policy, therefore,
was to deny payment for the D9310 to a provider
rendering care.
Health Insurance Portability and
Accountability Act (HIPAA) regulations now require that
all carriers be compliant with CDT-4 coding. Delta
Dental has implemented the CDT-4 codes, which revised
the definition of code D9310. The revised code states
that the dentist billing a D9310 could be reimbursed for
rendering care. Simply put, a diagnostic procedure that
was not payable prior to CDT-4 is now payable at 100%
and subject to the same contractual frequency limits as
evaluations/examinations.
For example, whether the rendering
dentist billed D9310 or a different evaluation code,
such as D0140 (limited oral evaluation - problem
focused), either procedure would be paid and the patient
would receive the equivalent of two evaluations of any
type in 12 consecutive months.
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