CDT 2024 code and policy changes

As of January 1, 2024, the American Dental Association’s (ADA’s) procedure code changes will be in effect. Associated changes to Northeast Delta Dental policies will also be effective January 1, 2024. There are 14 new codes and no deleted codes.

Please be sure not to submit claims for the new codes with dates of service prior to January 1, 2024. Your claims will be returned to your office for resubmission with the correct codes for the dates of service involved, which will result in unnecessarily delaying the 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, and 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.

D2976 Band stabilization - per tooth. Covered benefit once per tooth per lifetime. Benefits are limited to posterior permanent teeth only.

D6089 Accessing and retorquing loose implant screw - per screw. Covered benefit once every 24 months. 

Non-covered codes which are denied and billable to the patient:

D1301 Immunization counseling. Benefits for immunization counseling are denied unless covered by group/individual contract.

D2991 Application of hydroxyapatite regeneration medicament – per tooth. Benefits are denied unless covered by group/individual contract.

D7284 Excisional biopsy of minor salivary glands. Benefits for excision are denied. See Not Billable to the Patient for more information.

D7939 Indexing for osteotomy using dynamic robotic assisted or dynamic navigation. Benefits are denied as a specialized procedure.

D9938 Fabrication of a custom removable clear plastic temporary aesthetic appliance. Benefits are denied unless covered by group/individual contract.

D9939 Placement of a custom removable clear plastic temporary aesthetic appliance. Benefits are denied unless covered by group/individual contract.

D9954 Fabrication and delivery of oral appliance therapy (OAT) morning repositioning device. Benefits are denied unless covered by group/individual contract.

D9955 Oral appliance therapy (OAT) titration visit. Benefits are denied unless covered by group/individual contract.

D9956 Administration of a home sleep apnea test. Benefits are denied unless covered by group/individual contract.

D9957 Screening for sleep-related breathing disorder. Benefits are denied unless covered by group/individual contract.

D0396 3D printing of a 3D dental surface scan. Not billable to the patient, as 3D printing of a surface scan is inclusive of other procedures.

D2989 Excavation of a tooth resulting in the determination of non-restorability. Not billable to the patient, as D2989 is considered an incomplete service.

D7284 Excisional biopsy of minor salivary glands. The fee for biopsy of oral tissue is included in the fee for a surgical procedure (e.g., apicoectomy, extractions, etc.) and is not billable to the patient when performed by the same dentist/dental office in the same surgical area and on the same date of service.

D0210 Intraoral comprehensive series of radiographic images. The policy “When benefits are requested for D0330 in conjunction with full mouth series (D210) by the same dentist/dental office, fees for the D0330 are not billable to the patient as a component of the D0210 on the same date of service” is being discontinued. Claims for either a D0210 or D0330 will continue to fall to the contractual frequency limitation. Benefits are limited to either an intraoral complete series radiographic images (D0210) or panoramic radiographic image (D0330) within the five-year period. Any additional benefits are denied.

D0230 Intraoral periapical each additional radiographic image. Individually listed intraoral radiographic images by the same dentist/dental office are considered a complete series if the fee for individual radiographic images (excluding D0330) equals or exceeds the fee for a complete series done on the same date of service. Any fee in excess of the fee for an intraoral comprehensive series (D0210) is not billable to the patient.

D0330 Panoramic radiographic image. The policy, “A panoramic radiographic image with or without supplemental radiographic images (such as periapicals, bitewings and/or occlusal), is considered a complete series for the purpose of frequency limitations and any fee in excess of the fee allowed for D0210 is not billable to the patient,” is being discontinued. Claims for either D0210 or D0330 will continue to fall to the contractual frequency limitation. Benefits are limited to either a panoramic radiographic image (D0330) or an intraoral complete series radiographic images (D0210) within the five-year period. Any additional benefits are denied.

D0364 Cone beam CT capture and interpretation with limited field of view – less than whole jaw. Covered benefit under Diagnostic & Preventive, once per 12 months. Fees are denied when procedure codes D0364, D0365, D0366 or D0367 are performed within 12 months. D0365 Cone beam CT capture and interpretation with full field of view of one full dental arch – mandible. Covered benefit under Diagnostic & Preventive, once per 12 months. Fees are denied when procedure codes D0364, D0365, D0366 or D0367 are performed within 12 months.

D0365 Cone beam CT capture and interpretation with full field of view of one full dental arch – mandible. Covered benefit under Diagnostic & Preventive, once per 12 months. Fees are denied when procedure codes D0364, D0365, D0366 or D0367 are performed within 12 months.

D0366 Cone beam CT capture and interpretation with full field of view of one full dental arch - maxilla, with or without cranium. Covered benefit under Diagnostic & Preventive, once per 12 months. Fees are denied when procedure codes D0364, D0365, D0366 or D0367 are performed within 12 months.

D0367 Cone beam CT capture and interpretation with limited field of view both jaws, with or without cranium. Covered benefit under Diagnostic & Preventive, once per 12 months. Fees are denied when procedure codes D0364, D0365, D0366 or D0367 are performed within 12 months.

D0368 Cone beam CT capture and interpretation for TMJ series including two or more exposures. Benefits are denied unless covered by group/individual contract. When TMJ services are covered, benefit once per lifetime.

D0372 Intraoral tomosynthesis - comprehensive series of radiographic images. Benefits intraoral tomosynthesis are denied.

D0373 Intraoral tomosynthesis - bitewing - radiographic image. Benefits intraoral tomosynthesis are denied.

D0374 Intraoral tomosynthesis – periapical radiographic image. Benefits intraoral tomosynthesis are denied.

D8000 Orthodontics

Direct-to-consumer orthodontic:

• Covered benefit under orthodontics. 
• One direct-to-consumer retainer, per lifetime. 
• Treatment requires an attestation signed by the treating dentist. 
• Provider must be licensed in patient's resident state.
• Ineligible on those with transitional dentition (D8070).

Resources available: You may wish to order the new CDT 2024 book from the ADA and the CDT 2024 App and/or Coding Companion Guide.