Date

Dental Examination:

  • D0120 – Periodic Oral Evaluation
    • Not included in the Adult Dental Limited Package
    • Would require a letter of medical necessity from the patient’s primary care provider The medical necessity must meet MO HealthNet policy in Section 13 of the Dental Manual.
  • D0140 – Limited Oral Evaluation Problem Focused
    •  Code could be used with appropriate documentation of the problem.
  • D0150 - Comprehensive Oral Evaluation - new or established patient.
    • This is generally billed once per patient per provider.  
    • Per the ADA CDT Coding book: “Applies to new patients; established patients that have had a significant change in health conditions or other unusual circumstances by report or established patients that have been absent from active treatment for 3 or more years”. This examination includes periodontal charting.

X-rays

  • D0210 – Intraoral-complete series of radiographic images
    • Not included in the Adult Dental Limited Package

The following codes are covered for adults:

  • D0330- Panoramic Radiographic Image
  • D0220- Intraoral-Periapical first radiographic image
  • D0230- Intraoral-Periapical each additional radiographic image
    •  Limit of 4 per Date of Service

Sedation

  • Only 1 Sedation code approved for Limited Adult Dental Program
  • D9423  - Intravenous Moderate (conscious) Sedation

Note:  May use Propofol, but only at the Moderate level of sedation.

Adults: Medical Necessity Patients

  • Patients are still able to access other Medically Necessary Dental Services as outlined in Section 13 of the Dental Manual.

Note: You must have adequate documentation of the patient’s Medical Necessity and have a physician’s referral in the participant’s file.

Patients 0-21years

Common Errors

  • D0240- Intraoral-Occlusal radiographic image x-ray

    Note: Only 1 allowed per Date of Service

  • D9223 (not covered for adults) and D9423 Sedation codes
    • Preoperative assessment time and post-operative recovery time are not covered under this code. 
    • “Anesthesia time begins when the doctor administering the anesthetic agent initiates the appropriate anesthesia and non-invasive monitoring protocol and remains in continuous attendance of the patient.  Anesthesia services are considered completed when the patient may be safely left under the observation of trained personnel and the doctor may safely leave the room to attend to other patients or duties” (Per the 2016 CDT Code Book)
    • These codes have a limit of 3 per date of service. Additional units will require justifying documentation to be submitted.

Adults and Patients 0-21 years

Prior-authorization

  • D4341- Periodontal Scaling and Root Planning- four or more teeth per quadrant
  • D4342- Periodontal Scaling and Root Planning- one to three teeth per quadrant 

Note: Please submit periodontal charting for the above codes or any periodontal procedure codes

Important Billing Reminders

Adequate Documentation

  • Only bill for services you have documented proof of providing.

Section 2.3.A of the Dental Provider Manual

13 CSR 70-3.030, Section (2)(A) defines “adequate documentation” and “adequate medical records” as follows:

  • Documentation of rendered services
  • Some procedure codes require certain services to be performed. Document what services were provided.
  • Be sure they match the code being billed.
  • Ensure that reimbursement can be readily justified by documentation of key information, such as symptoms, conditions, diagnoses, treatments, and prognosis.
  • Identify the patient who was treated.