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Claims Processing Policy Changes (Effective 2019)

December 1, 2018
PARSIPPANY, N.J. — December 1, 2018 — The following claims processing policy changes will take effect in 2019:

  • Soft tissue surgical procedures (D4270-D4278): two sites per quadrant will continue to be eligible for payment, but any additional sites beyond two in the same quadrant will be denied rather than disallowed and will be a patient expense as indicated on the pre-treatment authorization or the explanation of benefits.
  • Apicoectomies following a failed endodontic procedure performed within 24 months may be benefited and should be submitted by report. Previously they had been disallowed.
  • Disallowing of fees for repair/replacement of orthodontic retainers will be limited to 24 months from delivery. After 24 months the patient is responsible for approved charges.
  • Frenectomy (7960/7963) will no longer be denied when submitted as a stand-alone procedure.
  • CDT procedure D1354, which includes the use and reporting of silver diamine fluoride and silver nitrate, will be a covered benefit in 2019.
Details of the processing policy related to this code will be published in the 2019 edition of the Participating Dentist Handbook.

In the summer of 2018, the following changes applied to many new, and some existing groups, and they will also remain unchanged for some members and groups. Please be sure to check the benefits for these procedures when verifying a member’s eligibility. All references to a 12-month benefit period may also refer to a calendar year benefit based on a member’s specific coverage:

  • Benefits for bitewing radiographs will remain unchanged through age 18. The benefit for members over age 18 will change to one set of bitewings in 12 months.
  • The benefit for D0210 will change from one set in 36 months to one set in 60 months.
  • The benefit for D0330 will change from one in 36 months to one in 60 months.
  • The benefit for topical fluoride application will change from one in 12 months to two in 12 months.
  • Posterior composites will be covered and no longer alternate benefited to amalgams.

About Delta Dental

Delta Dental of New Jersey, Inc. is New Jersey’s leading dental benefits company, providing or administering coverage to more than 1.6 million people through contracts with groups in New Jersey and Connecticut. In Connecticut, Delta Dental of Connecticut, Inc. is a newly licensed insurer that writes dental coverage on an insured basis, and Delta Dental of New Jersey administers self-funded dental benefit programs. For more information, visit www.deltadentalnj.com.