Alerts

Dental Program Policy Changes and Reimbursement Rates Effective December 1, 2017

11/13/2017

PDF Version

TO:  All Dental Providers, Oral Surgeons, Federally Qualified Health Centers (FQHC), Rural Health Centers (RHC) and State Agencies

Procedure codes

Description

Change

D0230, D0240, D0272, D0274

X-ray/radiographs

D0230 is limited to two per year when used in combination with D0272 and D0274. D0240 is limited to two per calendar year. D0272 and D0274 are limited to one per calendar year.

D3230, D3240

Pulpal therapy

Reduction of reimbursement to $131 for D3230 and $157 for D3240

D2140, D2150, D2160, D2161, D2330, D2331, D2332, D2335, D2391, D2392, D2393, D2394, D7140, D2930, D2931, D2932

Restoration of same surface

No reimbursement for a restoration that involves a surface previously restored on the same tooth within the preceding 12 months. (example: If an occlusal restoration is placed on a tooth, no other restoration involving the occlusal surface would be reimbursable if placed within the following 12 months).


D2140, D2150, D2160, D2161, D2330, D2331, D2332, D2335, D2391, D2392, D2393, D2394, D7140, D2740, D2750, D2751, D2752, D2791, D2792, D2930, D2931, D2932, D2940, D2950, D2951, D2952, D2953, D2954, D2957

Restoration of same tooth

No reimbursement for any restoration on the same tooth if treated within the previous 6 months. (example: If an occlusal restoration is placed on a tooth, then a buccal restoration is placed at a later date. This would be reimbursed if they are at least 6 months apart, but not if less than six months.)

D9230

Use of nitrous oxide

Reduction of reimbursement for use of nitrous oxide to $20 per unit


As a reminder, the Provider Billing Manual is updated each quarter (January, April, July, and October) and these changes will be reflected in Chapter 13 of the January 2018 Provider Billing Manual.

Please also refer to Chapter 1-6 of the Provider Billing regarding general information for providers.

You may contact the Dental program for questions by emailing
elizabeth.huckabee@medicaid.alabama.gov.


The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2017 American Medical Association and © 2017 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.