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CDT 2019 Changes Are Here!

The American Dental Association (ADA) has published the new procedure code set for 2019.  Be sure to order your new book! There are 26 changes associated with Current Dental Terminology (CDT) 2019: 15 new codes; 4 deletions which are replaced by 9 of the 15 new codes; and 7 modifications to existing codes (nomenclature/descriptor changes).  The four deleted codes are related to space maintainers, unilateral removable partial dentures and occlusal guards, which are being replaced by new codes to further define them by arch and material. Many of the modifications made to specific existing codes are editorial in nature and do not change the meaning of the procedures or impact our coverage status and current processing policies.

The following lists the changes and their related standard National Processing Policies, as well any updated standard National Processing Policies for existing procedure codes.  Processing Policies relate to the Exclusions and Limitations in the dental benefit plans.

(NOTE: “Denied” means no benefit payment is made, but the patient can be charged. “Not billable to the patient” means no benefit payment is made and the participating dentist agrees not to charge the patient.)

Deleted Codes:

Claims for these codes with dates of service on or after January 1, 2019 will be returned to office to be resubmitted with valid 2019 CDT codes.  These codes are now defined by the ADA as being per arch.

  • D1515 Space maintainer - fixed, bilateral
  • D1525 Space maintainer – removable, bilateral
  • D5281 Removable unilateral partial denture - one piece cast metal (including clasps and teeth) 
  • D9940 Occlusal guard, by report 

Standardly Non-Covered New Codes For Which Fees Are Denied:

  • D0412 Blood glucose level test: in office using a glucose meter
  • D5876 Add metal substructure to acrylic full denture – per arch
  • D9130 Temporomandibular joint dysfunction - non-invasive physical therapies
  • D9613  Infiltration of sustained release therapeutic drug - single or multiple sites
  • D9944 Occlusal guard - hard appliance, full arch (Replaces D9940 Occlusal guard)
  • D9945 Occlusal guard - soft appliance, full arch (Replaces D9940 Occlusal guard)
  • D9946 Occlusal guard - hard appliance, partial arch (Replaces D9940 Occlusal guard)
  • D9961 Duplicate/copy patient's records

Standardly Non-Covered New Codes For Which Fees Are Not billable to the patient:

Fees for this standardly non-covered code are not billable to the patient as translation or sign language services are considered part of the overall dental procedures performed. 

  • D9990 Certified translation or sign language services - per visit

Standardly Covered New Codes: 

  • D1516 Space maintainer - fixed - bilateral, maxillary (Replaces D1515 Space Maintainer - fixed, bilateral)
  • D1517 Space maintainer - fixed - bilateral, mandibular (Replaces D1515 Space Maintainer - fixed, bilateral)
  • D1526 Space maintainer - removable - bilateral, maxillary (Replaces D1525 Space maintainer – removable – bilateral)
  • D1527 Space maintainer - removable - bilateral, mandibular (Replaces D1525 Space maintainer – removable – bilateral)
  • D5282 Removable unilateral partial denture - one piece cast metal (including clasps and teeth), maxillary (Replaces D5281 Removable unilateral partial denture) 
  • D5283 Removable unilateral partial denture - one piece cast metal (including clasps and teeth), mandibular (Replaces D5281 Removable unilateral partial denture)

Existing Codes with New Standard National Processing Policies:

  • D0150 Comprehensive oral evaluation - new or established patient: Comprehensive or extensive evaluations (D0150, D0160, D0180) for children under the age of 3 are payable as D0145.  Any fee difference is not billable to the patient.
  • D0160 Detailed and extensive oral evaluation - problem-focused, by report: Comprehensive or extensive evaluations (D0150, D0160, D0180) for children under the age of 3 are payable as D0145.  Any fee difference is not billable to the patient.
  • D0180 Comprehensive periodontal evaluation - Comprehensive or extensive evaluations (D0150, D0160, D0180) for children under the age of 3 are payable as D0145.  Any fee difference is not billable to the patient.
  • D1354 Interim caries arresting medicament application – per tooth: Covered twice in a 12 month period per primary or permanent tooth, with no age limits and no limit to the number of teeth that can be benefited on the same day. Does not count against the fluoride benefit. If a restoration is placed on the same tooth on the same day, fees for the D1354 are not billable to the patient.  If a restoration is performed within 90 days of the D1354, fees for the restoration are denied.
  • D1550 Recementation or re-bond of space maintainer: Benefits are allowed once per space maintainer.
  • D3220 Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction and application of medicament: Fees are not billable to the patient if performed on the same date of service as root canal therapy. A benefit of a palliative treatment is given if performed on permanent teeth and any difference in fees is not billable to the patient.

Fees for more than two teeth being treated in the same quadrant are denied (were not billable to the patient) for the following existing codes:

  • D4263 Bone replacement graft – first site in quadrant
  • D4264 Bone replacement graft – each additional site in a quadrant 
  • D4265 Biological materials to aid in soft and osseous tissue regeneration 
  • D4266 Guided tissue regeneration – resorbable barrier 
  • D4267 Guided tissue regeneration – non-resorbable barrier 
  • D4270 Pedicle soft tissue graft procedure
  • D4273 Autogenous connective tissue graft procedure 
  • D4275 Non-autogenous connective tissue graft procedure 
  • D4276 Combined connective tissue and double pedicle graft, per tooth 
  • D4277 Free soft tissue graft procedure, first tooth 
  • D4278 Free soft tissue graft procedure, each additional contiguous tooth in same site
  • D4283 Autogenous connective tissue graft procedure, each additional contiguous tooth in the same site
  • D4285 Non-autogenous connective tissue graft procedure, each additional contiguous tooth in the same site
  • D4910 Periodontal maintenance: Fees for D4910 when performed within 30 days of periodontal therapy by the same dentist/dental office are not billable to the patient (time limit was 90 days).
  • D7310 Alveoloplasty in conjunction with extractions-four or more teeth or tooth spaces per quadrant: Fees for alveoloplasty are not billable to the patient when performed with any extractions (was only surgical extractions) on the same date of service.
  • D7320 Alveoloplasty in conjunction with extractions- one to three teeth or tooth spaces per quadrant: Fees for alveoloplasty are not billable to the patient when performed with any extractions (was only surgical extractions) on the same date of service.
  • D7960 Frenulectomy: Covered once in a lifetime per site when performed for speech or feeding problems, gingival recession, large diastema, or interference with a prosthetic appliance. 
  • D8660 Periodic observation of patient dentition: Fees are not billable to the patient when submitted with a D8070, D8080 and D8090.
  • D8680 Orthodontic retention (removal of appliances, construction and placement of retainer(s): Fees are not billable to the patient when performed within 24 months of orthodontic appliance by the same dentist/office.
  • D8694 Repair of fixed retainers: Fees are not billable to the patient if performed within 24 months of placement of orthodontic appliance by the same dentist/office.
  • D9932 Cleaning and inspection of removable complete denture, maxillary: Not standardly covered. If covered by contractual exception, counts toward the hygiene (“cleaning”) benefit.
  • D9933 Cleaning and inspection of removable complete denture, mandibular: Not standardly covered. If covered by contractual exception, counts toward the hygiene (“cleaning”) benefit.
  • D9934 Cleaning and inspection of removable partial denture, maxillary: Not standardly covered. If covered by contractual exception, counts toward the hygiene (“cleaning”) benefit
  • D9935 Cleaning and inspection of removable partial denture, mandibular: Not standardly covered. If covered by contractual exception, counts toward the hygiene (“cleaning”) benefit.

If you have any questions, please feel free to contact Eleanor Vien, Director of Professional Relations at 603-223-1305 or by email to evien@nedelta.com