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NC Medicaid »   Home »   blog

New American Dental Association Procedure Codes

January 4, 2018

Author: Dental Program, DMA, 919-855-4280

Effective with date of service Jan. 1, 2018, the following dental procedure codes were added for the N.C. Medicaid and Health Choice Dental Programs. These additions are a result of updates to the Current Dental Terminology (CDT) 2018 American Dental Association (ADA) Code. Clinical Coverage Policy 4A, Dental Services, will be updated to reflect these changes.

CDT 2018
Code

Description and Limitations

PA Indicator

D5511

Repair broken complete denture base, mandibular

  • Reimbursement rate – same as D5510

N

D5512

Repair broken complete denture base, maxillary

  • Reimbursement rate – same as D5510

N

D5611

Repair resin partial denture base, mandibular

  • Reimbursement rate – same as D5610

N

D5612

Repair resin partial denture base, maxillary

  • Reimbursement rate – same as D5610

N

D5621

Repair cast partial framework, mandibular

  • Reimbursement rate – same as D5620

N

D5622

Repair cast partial framework, maxillary

  • Reimbursement rate – same as D5620

N

D7979

Non-surgical sialolithotomy

  • Not allowed on the same date of service as D7980 (surgical sialolithotomy)
  • Reimbursement rate (to be determined)

Y

D9222

Deep sedation/general anesthesia – first 15 minutes

  • Allowed once per date of service
  • Allowed only in an office setting
  • Deep sedation/general anesthesia performed in the dental office must include documentation in the record of pharmacologic agents, monitoring of vital signs, and complete anesthesia time
  • Reimbursement includes all drugs and/or medicaments necessary for adequate anesthesia
  • Reimbursement includes monitoring and management
  • Reimbursement rate – same as D9223

N

CDT 2018
Code

Description and Limitations

PA Indicator

D9239

Intravenous moderate (conscious) sedation/analgesia – first 15 minutes

  • Allowed once per date of service
  • Allowed only in an office setting
  • Intravenous conscious sedation performed in the dental office must include documentation in the record of pharmacologic agents, IV site, monitoring of vital signs, and complete anesthesia time
  • Reimbursement includes all drugs or medicaments necessary for adequate anesthesia
  • Reimbursement includes monitoring and management
  • Reimbursement rate – same as D9243

N

D9995

  • Teledentistry – synchronous; real-time encounter
  • Reported in addition to other procedures delivered on the same date of service
  • The originating site is the facility in which the beneficiary is located
  • The distant site is the facility from which the provider furnishes the teledentistry service
  • All service sites/providers must be Medicaid or Health Choice enrolled
  • Consultation must take place by an encrypted two-way real-time interactive audio and video telecommunications system
  • Reimbursement rate (to be determined)

Y

The following procedure codes were end-dated effective with date of service Dec. 31, 2017.

Procedure Code

Description

D5510

Repair broken complete denture base

D5610

Repair resin denture base

D5620

Repair cast framework

The following procedure codes descriptions were revised effective with date of service Jan. 1, 2018.

Procedure Code

Description

D1354

Interim caries arresting medicament application – per tooth

D3320

Endodontic therapy, premolar tooth (excluding final restoration)

D3330

Endodontic therapy, molar tooth (excluding final restoration)

D4355

Full mouth debridement to enable a comprehensive oral evaluation and diagnosis on a subsequent visit

D7111

Extraction, coronal remnants – primary tooth

D7980

Surgical sialolithotomy

D9223

Deep sedation/general anesthesia – each subsequent 15-minute increment

D9243

Intravenous moderate (conscious) sedation/analgesia - each subsequent 15-minute increment

The following procedure code criteria was updated due to the description revision effective Jan. 1, 2018.

Procedure Code

Description

D1354

Interim caries arresting medicament application – per tooth

  • Interim caries arresting medicament application
  • Conservative treatment of an active, non-symptomatic carious lesion by topical application of a caries arresting or inhibiting medicament and without mechanical removal of sound tooth structure
  • Limited to beneficiaries ages 1 to 5
  • Allowed once every six calendar months per tooth
  • Limited to a total of four applications per tooth prior to age 6
  • Valid tooth numbers (A-T, AS-TS, 03, 14, 19, 30)
  • Recommended for beneficiaries who are deemed to be at risk for progression of disease to pulpal infection
  • Since the potential for staining of carious enamel and dentin exists, providers must obtain informed consent from the beneficiary’s parent or caregiver prior to rendering the service
  • Reapplication of the caries arresting medicament at recall visits is only indicated if the carious lesions do not appear arrested
  • Treated carious lesions can be restored after treatment with a caries arresting medicament
  • Reimbursement rate of $10 for the first tooth and cutback to 50 percent or $5 for three additional teeth for a total of four teeth reimbursed per date of service (maximum reimbursement of $25 per date of service)

Providers are reminded to bill their usual and customary charges rather than the Medicaid rate. For coverage criteria and additional billing guidelines, refer to Clinical Coverage Policy 4A, Dental Services, on the N.C. Medicaid website.

 

This blog is related to:

  • Bulletins
  • Dental Providers

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https://medicaid.ncdhhs.gov/blog/2018/01/04/new-american-dental-association-procedure-codes