FYI

Dentist blog from Delta Dental

Category: Policies (Page 1 of 4)

Stay on top of the latest Delta Dental policies on claims processing, contracts, fees, CDT codes, ICD-10, re-credentialing and more.

Reminder: CDT 2021 updates have arrived

The American Dental Association’s CDT procedure codes and nomenclature* have been updated for 2021. The CDT updates for 2021 include 28 new codes, four code deletions and 11 nomenclature and description revisions.

Please review our summary of changes and claims processing policies (PDF) and begin using CDT 2021 codes on claims for procedures provided on and after Jan. 1, 2021.

*CDT coding and nomenclature are the copyright and a trademark of the American Dental Association, all rights reserved.

Amalgam fillings: A closer look at the recent FDA recommendations

The U.S. Food and Drug Administration recently advised against the use of dental amalgam in high-risk groups. What do these new recommendations mean for you and your practice? Here’s a closer look.

What is the case against dental amalgam?

Amalgam fillings contain a mixture of silver, tin, copper and mercury.

In its recommendations released Sept. 24, 2020, the FDA suggested that certain groups of people, including pregnant and nursing women, children under 6 and people with certain health conditions, may experience harmful effects of mercury exposure.

The FDA cited “uncertainties about the acceptable reference exposure levels for mercury vapor” and the potential for negative health outcomes. The FDA did not cite any new scientific evidence for this position.

What is Delta Dental’s position on dental amalgam?

Amalgam is a long-lasting, clinically effective tooth restorative material and has a proven track record of over 150 years. Based on the scientific evidence available, amalgam fillings do not pose a health risk to children or adults, except the small group of people who are allergic to the metal components of amalgam.

The mercury in fillings is safe in its bound form. When it breaks down, however, mercury can be released as vapor. Exposure to high levels of mercury vapor — higher than those in fillings — can cause damage to the kidneys and brain, according to industrial studies.

We recommend you discuss treatment options with your patients who fall into these risk groups or otherwise have concerns.

There are no changes to Delta Dental’s coverage of restorative treatments such as amalgam and composite fillings.

When should amalgam fillings be removed?

The FDA advises against removing or replacing existing amalgam fillings that are in good condition unless medically necessary. This aligns with Delta Dental’s recommendation.

Amalgam fillings that are in good condition, with no nearby decay present in the tooth, should not be removed. Removing them may result in loss of tooth structure and unnecessarily releases mercury vapor.

When removing amalgam fillings, please follow best management practices for amalgam waste handling and disposal. By law, you must use amalgam separators of at least a 95% removal efficiency, as required by the Environmental Protection Agency. This rule went into effect July 14, 2017, with compliance for dental offices since July 14, 2020.

For more information about Delta Dental policies around restorative treatments, please refer to your Dentist Handbook under Provider Tools.

Return to Care supplemental reimbursement program extended through 2020

To help you continue to provide care to your Delta Dental patients during the ongoing COVID-19 pandemic, we’re extending the Return to Care supplemental reimbursement program through December 31, 2020.

As a network dentist, you’ll receive a $10 supplemental reimbursement for performing qualifying evaluation or consultation codes. The program launched June 22 and was later extended to October 20.

The latest extension to December 31 is meant to offer you additional support and help you adjust to the new conditions as you prepare for 2021. There are no other changes to the program that is currently in place.

For more details on the supplemental reimbursement program, please see the complete FAQ.

As before, to receive the reimbursement, you must participate in one of the following networks and treat an eligible patient covered by one of these Delta Dental plans:

  • DeltaCare® USA
  • Delta Dental PPO™ and DPO in Texas (see applicable Delta Dental companies below)
  • Delta Dental Premier® (see applicable Delta Dental companies below)
  • Delta Dental Federal (Legion), Medicare Advantage

Applicable Delta Dental companies include Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania, Delta Dental of the District of Columbia, Delta Dental of Delaware, Inc., Delta Dental of West Virginia, Inc. and Delta Dental of New York, Inc.

The Medi-Cal Dental, CDPHP (NY Medicaid) and HSCSN (Washington, D.C. Medicaid) networks are not eligible for this reimbursement.

Return to Care supplemental reimbursement program extended

To help you continue to provide care to your patients during the ongoing COVID-19 pandemic, we’re extending the Return to Care supplemental reimbursement program through October 20, 2020.

As a network dentist, you’ll receive a $10 supplemental reimbursement for performing qualifying evaluation or consultation codes. In June, you received notification about this program. We’ve now extended the original end date of September 20 to October 20 to offer you additional support during this difficult time.

Note: This program has since been extended through December 31, 2020.

Am I eligible?

To receive the Return to Care reimbursement, you must participate in one of the following networks and treat an eligible patient covered by one of these Delta Dental plans:

  • DeltaCare® USA
  • Delta Dental PPO™ and DPO in Texas (see applicable Delta Dental companies below)
  • Delta Dental Premier® (see applicable Delta Dental companies below)
  • Delta Dental Federal (Legion), Medicare Advantage

Applicable Delta Dental companies include Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania, Delta Dental of the District of Columbia, Delta Dental of Delaware, Inc., Delta Dental of West Virginia, Inc. and Delta Dental of New York, Inc.

The Medi-Cal Dental, CDPHP (NY Medicaid) and HSCSN (Washington, D.C. Medicaid) networks aren’t eligible for this reimbursement.

How do I receive the reimbursement?

If you’re a DeltaCare USA dentist with a capitation agreement, simply submit your DeltaCare USA encounter form when you treat a DeltaCare USA enrollee. We’ll add $10 to the encounter fee during processing.

If you’re a dentist in another network, or a DeltaCare USA dentist without a capitation agreement, we’ll reimburse you when you submit a claim for any of these evaluation or consultation codes:

  • D0120
  • D0140
  • D0145
  • D0150
  • D0160
  • D0170
  • D0180
  • D0190
  • D0191
  • D8660
  • D9310
  • D9430

Please submit your usual office fee, not your contracted fee. Charges for sterilization or infection control aren’t billable under Delta Dental plans and can’t be charged to the patient.

Can I use procedure code D1999 to charge a separate fee for personal protective equipment (PPE)?

No. You can’t submit code D1999 to receive reimbursement. Personal protective equipment is considered part of the delivery of care. It’s not separately billable and can’t be charged to the patient.

What if I don’t perform an evaluation or consultation at every visit? Can I receive the reimbursement for other submitted procedure codes?

No. Only the 12 qualifying CDT codes are eligible for the supplemental reimbursement.

Will frequency limitations still apply for evaluation and consultation codes?

Yes. Specific plan benefits and frequency limitations will apply. If a patient exceeds the frequency limitation or has exceeded the plan maximum for one of the qualifying CDT codes, the patient will be responsible for the allowed amount, which will include the temporary supplemental reimbursement.

I still have questions. How do I get more information?

If you’re a DeltaCare USA, PPO or Premier dentist, email your questions to providerconcierge@delta.org. If you participate in Federal Programs (Legion), email FSPS@delta.org.

Processing policy changes in response to COVID-19

To help keep you and your patients safe during the COVID-19 pandemic, we are implementing temporary changes to our processing policy. These changes allow you more options to reduce the spread of infection in your dental practice.

These modifications will be in place until November 30, 2020.

Exceptions for periodontal scaling and root planing (SRP)

Delta Dental’s current policy is that no more than two quadrants of scaling and root planing are benefited on the same date of service in the absence of supporting documentation.

Effective immediately, Delta Dental will consider concerns regarding exposure to COVID-19 as a valid clinical reason to perform more than two quadrants of scaling and root planing on the same date of service.

As always, radiographs and a copy of the patient treatment record (clinical progress notes) are required if more than two quadrants of scaling and root planing are performed on the same date of service.   

Radiographic images for restorative procedures

Radiographic images are required when submitting for crowns, fixed partial dentures and scaling and root planing. Periapical radiographic images depicting the apex are preferable when submitting for crowns and fixed partial dentures.

To avoid the need for additional visits and limit staff and patient exposure, Delta Dental will accept diagnostic panoramic images when submitting for these services.  

Periodontal chart

A periodontal chart is necessary for scaling and root planing and periodontal surgery procedures. Under Delta Dental’s clinical guidelines, a current periodontal chart is one that is taken no more than 12 months prior to the date of service.

To reduce the need for staff exposure and additional appointments, Delta Dental will now accept a periodontal chart that is taken no more than 15 months prior to the date of service.

Receive Return to Care supplemental reimbursement

The COVID-19 pandemic has affected dental practices across the country. To help you deliver valuable care to your patients, Delta Dental is temporarily offering a $10 supplemental reimbursement for each qualifying evaluation or consultation code, from June 22, 2020 through December 31, 2020.

Am I eligible?

To receive the Return to Care reimbursement, you must participate in one of the following networks and treat an eligible patient covered by one of these Delta Dental plans:

  • DeltaCare® USA
  • Delta Dental PPO™ and DPO in Texas (see applicable Delta Dental companies below)
  • Delta Dental Premier® (see applicable Delta Dental companies below)
  • Delta Dental Federal (Legion), Medicare Advantage

Applicable Delta Dental companies include Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania, Delta Dental of the District of Columbia, Delta Dental of Delaware, Inc., Delta Dental of West Virginia, Inc. and Delta Dental of New York, Inc.

The Medi-Cal Dental, CDPHP (NY Medicaid) and HSCSN (Washington, D.C. Medicaid) networks are not eligible for this reimbursement.

How do I receive the reimbursement?

If you’re a DeltaCare USA dentist with a capitation agreement, simply submit your DeltaCare USA encounter form when you treat a DeltaCare USA enrollee. We’ll add $10 to the encounter fee during processing.

For other dentist networks (including DeltaCare USA dentists without capitation agreements), the reimbursement will be provided when you submit a claim for any of the following evaluation or consultation codes:

  • D0120
  • D0140
  • D0145
  • D0150
  • D0160
  • D0170
  • D0180
  • D0190
  • D0191
  • D8660
  • D9310
  • D9430

Please submit your usual office fee rather than your contracted fee.

Any charge for sterilization or infection control is not billable under any Delta Dental plan and cannot be charged to the patient.

Can I use procedure code D1999 to charge a separate fee for personal protective equipment (PPE)?

No, personal protective equipment is considered part of the delivery of care and not separately billable. Additionally, the patient may not be charged.

You cannot submit code D1999 to receive the temporary supplemental reimbursement.

What if I don’t perform an evaluation or consultation at every visit? Can I receive the reimbursement for other submitted procedure codes?

No. Only these 12 qualifying CDT codes are eligible for the supplemental reimbursement: D0120, D0140, D0145, D0150, D0160, D0170, D0180, D0190, D0191, D8660, D9310 and D9430.

Will frequency limitations still apply for evaluation and consultation codes?

Yes, the specific plan benefits and frequency limitations will apply. If a patient exceeds the frequency limitation or has exceeded the plan maximum for one of the qualifying CDT codes, the patient will be responsible for the allowed amount, which will include the temporary supplemental reimbursement.

I still have questions. How do I get more information?

If you’re a DeltaCare USA, PPO or Premier dentist, email your questions to providerconcierge@delta.org. If you participate in Federal Programs (Legion), email FSPS@delta.org.


Note: This post was updated to reflect the extension of the program through December 31, 2020.

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