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:
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 email@example.com. 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.