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:
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.