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CDT 2021 Changes Are Here!

As of January 1, 2021 the American Dental Association’s (ADA’s) procedure code changes will be in effect.  There are associated changes to Northeast Delta Dental policies that also will be effective January 1, 2021.  There 28 new codes, and four (4) deleted codes that have been replaced by several of the new codes.  Many of the new codes further define existing procedures. 
 
Please be sure not to submit claims for the new codes with dates of service prior to January 1, 2021, and please don’t submit claims for the deleted codes for dates of service on or after January 1, 2021.   Your claims will be returned to your office for resubmission with the correct codes for the dates of service involved.  This will unnecessarily delay processing of your claims.

The following are definitions of terms used in this article:
Denied/Deny: The procedure or service is not covered and the approved amount is collectable from the patient. 
Not Billable to the Patient (NBTP): The procedure is not benefited by Delta Dental nor is it billable to the patient by a participating dentist. 

General Policy – This policy is already in place, but bears repeating because there still seems to be some confusion in its relationship to PPE.  ANY charges related to office overhead, including infection control/PPE, are included in the fee for the dental services provided. Separate fees are not billable to the patient.

New 2021 Standardly Covered Codes and Standard Delta Dental Processing Policies:
Covered once in a two (2) year period
•    D2928 - prefabricated porcelain/ceramic crown – permanent tooth 
Replacement by the same dentist/dental office within 24 months is included in the initial crown placement and is not billable to the patient.   

Covered once in a three year period and all replace D3427 – periradicular surgery:
•    D3471 surgical repair of root resorption – anterior
Not billable to the patient when performed on same tooth/date by the same dentist/dental office as D3333, D3410-D3426, D3430, D3450, D4210-D4212, D4231, D4240/41, D4245,D4249, D4260/61, D4268, D4270, D4273-D4278, D4283, and D4285
•    D3472 surgical repair of root resorption – premolar
Not billable to the patient when performed on same tooth/date by the same dentist/dental office as D3333, D3410-D3426, D3430, D3450, D4210-D4212, D4231, D4240/41, D4245,D4249, D4260/61, D4268, D4270, D4273-D4278, D4283, and D4285
•    D3473 surgical repair of root resorption – molar
Not billable to the patient when performed on same tooth/date by the same dentist/dental office as D3333, D3410-D3426, D3430, D3450, D4210-D4212, D4231, D4240/41, D4245,D4249, D4260/61, D4268, D4270, D4273-D4278, D4283, and D4285
•    D3501 surgical exposure of root surface without apicoectomy or repair of root
            resorption – anterior
Not billable to the patient when performed on same tooth/date by the same dentist/dental office as D3333, D3410-D3426, D3430, D3450, D4210-D4212, D4231, D4240/41, D4245,D4249, D4260/61, D4268, D4270, D4273-D4278, D4283, and D4285
•    D3502 surgical exposure of root surface without apicoectomy or repair of root
            resorption – premolar
Not billable to the patient when performed on same tooth/date by the same dentist/dental office as D3333, D3410-D3426, D3430, D3450, D4210-D4212, D4231, D4240/41, D4245,D4249, D4260/61, D4268, D4270, D4273-D4278, D4283, and D4285
•    D3503 surgical exposure of root surface without apicoectomy or repair of root
            resorption – molar
Not billable to the patient when performed on same tooth/date by the same dentist/dental office as D3333, D3410-D3426, D3430, D3450, D4210-D4212, D4231, D4240/41, D4245,D4249, D4260/61, D4268, D4270, D4273-D4278, D4283, and D4285

Covered once in a lifetime, per site and both replace D7960 – frenulectomy (frenectomy):
•    D7961  buccal/labial frenectomy (frenulectomy)
•    D7962 lingual frenectomy (frenulectomy)

New 2021 Standardly Non-covered Codes and Standard Delta Dental Processing Policies:
Non-covered codes which are denied and billable to the patient:
•    D0604 antigen testing for a public health related pathogen includes coronavirus
•    D0605 antibodies testing for a public health related pathogen includes coronavirus 
•    D1321   counseling for the control and prevention of adverse oral, behavioral, and systemic health effects associated with high-risk substance abuse
•    D1355  caries preventive medicament application – per tooth
•    D5995 periodontal medicament carrier with peripheral seal – laboratory processed – maxillary (Replaces D5994)
•    D5996 periodontal medicament carrier with peripheral seal – laboratory processed – mandibular (Replaces D5994)
•    D6191  semi-precision abutment – placement  (Replaces D6052)
•    D6192  semi-precision attachment – placement (Replaces D6052)
•    D7993 surgical placement of craniofacial implant – extra oral 
•    D7994 surgical placement: zygomatic implant

New 2021 Non-covered Codes which are not billable to the patient and considered part of the existing radiographic or photographic image codes:
•    D0701  panoramic radiographic image – image capture only 
•    D0702 2-D cephalometric radiographic image –image capture only 
•    D0703 2-D oral/facial photographic image obtained intra-orally or extra-orally –image capture only
•    D0704 3-D oral/facial photographic image – image capture only. 
•    D0705 extra-oral posterior dental radiographic image – image capture only 
•    D0706 intraoral – occlusal radiographic image – image capture only
•    D0707 intraoral – periapical radiographic image – image capture only 
•    D0708 intraoral – bitewing radiographic image – image capture only - Image axis may be horizontal or vertical. 
•    D0709 intraoral – complete series of radiographic images – image capture only

Revised Standard Delta Dental Processing Policies for Existing Codes
As of January 1, 2021, risk assessments are covered once in a 12 month period (currently covered once in a three year period).  NOTE: Only Caries or Comprehensive PreViser® risk assessments may billed under these codes.  There is no ADA code for Periodontal risk assessments.
•    D0601 caries risk assessment and documentation, with a finding of low risk 
•    D0602 caries risk assessment and documentation, with a finding of moderate risk
•    D0603 caries risk assessment and documentation, with a finding of high risk 

As of January 1, 2021, the fee for an immediate denture (D5130/D5140) includes any adjustments, relines, or tissue conditioning within 3 months of delivery. Fees are not billable to the patient.
•    D5410  adjust complete denture – maxillary
•    D5411   adjust complete denture – mandibular
•    D5730 reline complete maxillary denture (direct)
•    D5731  reline complete mandibular denture (direct)
•    D5750 reline complete maxillary denture (indirect)
•    D5751  reline complete mandibular denture (indirect)
•    D5850 tissue conditioning – maxillary
•    D5851  tissue conditioning – mandibular

As of January 1, 2021, fees for implant removal are not billable to the patient if performed within three (3) months of the implant placement. 
•    D6100 implant removal, by report

Deleted Codes as of January 1, 2021:
•    D3427 periradicular surgery without apicoectomy (Replaced by D3471; D3472; D3473; D3501; D3502; D3503)
•    D5994 periodontal medicament carrier with peripheral seal – laboratory (Replaced by D5995; D5996
•    D6052  semi-precision attachment (Replaced by D6191; D6192)
•    D7960  frenectomy – also known as frenulectomy (Replaced by D7961; D7962)

Be sure to order your new CDT 2021 book from the ADA!  You may also order the CDT 2021 App and/or the Coding Companion Guide. These are all great resources!