FYI

Dentist blog from Delta Dental

Tag: return to care

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.

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.

Upcoming webinars on Provider Tools and National Recovery Month

It’s back-to-school season. In the spirit of ongoing education, we’re announcing a series of webinars in September that will show you how to make the most of Provider Tools. The webinars will also show you how you can talk to your patients about returning to your practice safely and how you can help fight the opioid epidemic that continues to afflict the United States.

Attend a Provider Tools and National Recovery Month webinar to learn:

  • How to use Provider Tools to manage your patients
  • How to talk to your patients about teledentistry and safe in-office visits
  • How to help your patients manage pain without narcotics
  • How you can do your part to fight the opioid epidemic
  • And more!

Don’t miss out — register today!

September 9, 11 am PT / 2 pm ET

September 15, 10 am PT / 1 pm ET

September 24, 11 am PT / 2 pm ET

September 29, 9 am PT / noon ET

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, starting June 22, 2020 and ending October 20, 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.

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