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CDT 2018 Changes Are Here!!

The American Dental Association (ADA) has published the new procedure code set for 2018. These codes are in effect as of January 1, 2018. Be sure to submit claims using only the current code set or they will be returned to your office for resubmission with the correct codes. There are 37 changes associated with Current Dental Terminology (CDT) 2018. There are 18 new codes, 3 deletions and 16 revisions to existing codes. The three deleted codes are related to denture repairs and are replaced by six new codes that define the repairs by arch and material. Many of the revisions made to specific existing codes are editorial in nature and do not change the meaning of the procedures or impact our coverage status and current processing policies. The following lists the changes and their related standard National Processing Policies, as well any updated standard National Processing Policies for existing procedure codes.

Deleted Codes:

Claims for these codes with dates of service on or after January 1, 2018 will be returned to office to be resubmitted with valid 2018 CDT codes.

  • D5510 Repair broken complete denture base
  • D5610 Repair resin denture base
  • D5620 Repair cast framework

Standardly Non-Covered New Codes That Are Denied:

Fees for these standardly non-covered codes are denied, which means Delta Dental doesn’t pay, but the patient can be charged. (NOTE: Disallowed means Delta Dental doesn’t pay and the participating dentist agrees not to charge the patient.)

  • D0411 HbA1c in-office point of service testing
  • D6118 Implant/abutment supported interim fixed denture- mandibular
  • D6119 Implant/abutment supported interim fixed denture- maxillary
  • D7296 Corticotomy- one to three teeth, per quadrant
  • D7297 Corticotomy- four or more teeth, per quadrant
  • D7979 Non-surgical sialolithotomy
  • D8695 Removal of fixed orthodontic appliance – other than at conclusion of treatment

Standardly Non-Covered New Codes That Are Disallowed:

Fees for these standardly non-covered codes are disallowed, which means Delta Dental doesn’t pay and the participating dentist agrees not to charge the patient. Fees for transmitting the data are considered part of the overall dental procedures performed.

  • D9995 Teledentistry – synchronous; real-time encounter
  • D9996 Teledentistry – asynchronous; information stored and forwarded to dentist for subsequent review

Standardly Covered New Codes:

  • D5511 Repair broken complete denture base, mandibular (Replaces D5510)
  • D5512 Repair broken complete denture base, maxillary (Replaces D5510)
  • D5611 Repair resin partial denture base, mandibular (Replaces D5610)
  • D5612 Repair resin partial denture base, maxillary (Replaces D5610)
  • D5621 Repair cast partial framework, mandibular (Replaces D5620)
  • D5622 Repair cast partial framework, maxillary (Replaces D5620)
  • D6096 Remove broken implant retaining screw (Once every 7 years)

Standardly Covered New Codes:

  • D9222 Deep sedation/general anesthesia – first 15 minute increment (Fees are disallowed for more than one hour total of general anesthesia with covered oral surgery. Use D9223 for each subsequent 15 minute increment.)
  • D9239 Intravenous moderate (conscious) sedation/ analgesia – first 15 minutes (Fees are disallowed for more than one hour total of IV Sedation with covered oral surgery procedures. Use D9243 for each subsequent 15 minute increment.)

Existing Codes with New Standard National Processing Policies:

  • D0270 Bitewing, single radiographic image: Benefits for bitewing radiographs are limited to no more than two images for children under the age of 10. An alternate benefit is given of D0272, bitewings, two radiographic images. The difference in fees is disallowed.
  • D0273 Bitewings, three radiographic images: Benefits for bitewing radiographs are limited to no more than two images for children under the age of 10. An alternate benefit is given of D0272, bitewings, two radiographic images. The difference in fees is disallowed.
  • D0274 Bitewings, four radiographic images: Benefits for bitewing radiographs are limited to no more than two images for children under the age of 10. An alternate benefit is given of D0272, bitewings, two radiographic images. The difference in fees is disallowed.
  • D0277 Vertical bitewings, 7 – 8 radiographic images: Benefits for bitewing radiographs are limited to no more than two images for children under the age of 10. An alternate benefit is given of D0272, bitewings, two radiographic images is given. The difference in fees is disallowed.
  • D1575 Distal shoe space maintainer- fixed – unilateral: Benefits are limited to children, up to age 9. (Previous age limit was up to age 8.) Benefits are denied for more than one space maintainer of any type provided in the same quadrant in a lifetime. Previous limit was one space maintainer per tooth space in a lifetime.
  • D4355 Full mouth debridement: Benefits are disallowed when performed on the same date of service by the same dentist as a D0150, comprehensive evaluation or a D0160, detailed and extensive evaluation or a D0180, comprehensive periodontal evaluation.
  • D7960 Frenulectomy: Benefits are limited to treatment of medically documented cases of feeding or speech impediments
  • D7963 Frenuloplasty: Benefits are limited to treatment of medically documented cases of feeding or speech impediments

If you have any questions, please feel free to contact Eleanor Vien, Director of Professional Relations at 603-223-1305 or by email to evien@nedelta.com