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Dentist blog from Delta Dental

Tag: reimbursement

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.

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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