As of January 1, 2022 the American Dental Association’s (ADA’s) procedure code changes will be in effect. There are associated changes to Northeast Delta Dental policies that also will be effective January 1, 2022. There are sixteen (16) new codes, and six (6) deleted codes that have been replaced by several of the new codes. Many of the new codes further define existing procedures.
Please be surenotto submit claims for the new codes with dates of service prior to January 1, 2022, and do not submit claims for the deleted codes for dates of service on or after January 1, 2022. Your claims will be returned to your office for resubmission with the correct codes for the dates of service involved.
The following are definitions of terms used in this article:
- Denied/Deny: The procedure or service is not covered and the approved amount is collectable from the patient.
- Not Billable to the Patient (NBTP): The procedure is not benefited by Delta Dental nor is it billable to the patient by a participating dentist.
- General Policy – This policy is already in place,anycharges related to office overhead, including infection control/PPE, are included in the fee for the dental services provided. Separate fees are not billable to the patient.
New 2022 Standardly Covered Codes and Standard Delta Dental Processing Policies:
- D5227Immediate maxillary partial denture - flexible base (including any clasps, rests and teeth) Covered once in a seven year period.
- D5228Immediate mandibular partial denture - flexible base (including any clasps, rests and teeth) Covered once in a seven year period.
- D5725Rebase hybrid prosthesis, Covered once in a seven year period.
- D5765Soft liner for complete or partial removable denture – indirect, Covered twice in a twelve (12) month period.
New 2022 Standardly Non-Covered Codes and Standard Delta Dental Processing Policies:
Non-covered codes which are denied and billable to the patient:
- D3921Decoronation or submergence of an erupted tooth
- D9947Custom sleep apnea appliance fabrication and placement
- D9948Adjustment of Custom sleep apnea appliance
- D9949Repair of Custom sleep apnea appliance
New 2022 Non-covered Codes which are not billable to the patient
- D3911Intraorifice barrier
- D4322Splint - intra-coronal; natural teeth or prosthetic crowns
- D4323Splint - extra-coronal; natural teeth or prosthetic crowns
- D6198Remove interim implant component
- D7298Removal of temporary anchorage device [screw retained plate], requiring flap
- D7299Removal of temporary anchorage device, requiring flap
- D7300Removal of temporary anchorage device without flap
- D9912Pre-visit patient screening
Revised Standard Delta Dental Processing Policies for Existing Codes as of January 1, 2022:
The following oral evaluations performed without an intent to provide dental services to meet the patient’s needs will be processed as a D0190 (screening of a patient):
- D0120Periodic oral evaluation – established patient
- D0150Comprehensive oral evaluation – new or established patient
- D0180Comprehensive periodontal evaluation – new or established patient
Oral evaluations are only a benefitwhen the elements included in the descriptor are completed.
- D0140limited oral evaluation – problem focused
The following codes will be changing from non-covered to a covered code under Diagnostic & Preventive once every 12 months:
- D0190Screening of a patient.
- When reported in conjunction with an evaluation/screening (D0120, D0140, D0145, D0150, D0160, D0170, D0171, D0180, D0190 and D9310) the fees for D0190 are NOT BILLABLE TO THE PATIENT as integral to the evaluation by the same dentist/dental office on the same date of service
- D0191Assessment of a patient.
- When reported in conjunction with an evaluation/screening (D0120, D0140, D0145, D0150, D0160, D0170, D0171, D0180, D0190 and D9310) the fees for D0190 are NOT BILLABLE TO THE PATIENT as integral to the evaluation by the same dentist/dental office on the same date of service
The age limitation for individualsages 6 and older, will be removed for:
- D0330Panoramic radiographic image
Benefits for restorations placed within two (2) months will be denied (used to be within three (3) months) for:
- D1354Application of caries arresting medicament
When D3473, D3501-D3503 are performed on the same tooth by the same dentist/dental office, the fees for scaling and root planning are NOT BILLABLE TO THE PATIENT for:
- D4341Periodontal scaling and root planning - four or more teeth
- D4342Periodontal scaling and root planning – one to three teeth
The fee for D7410 is NOT BILLABLE TO THE PATIENT as included in the fee for another surgery in the same area of the mouth on the same day by the same dentist/dental office
- D7410Excision of benign lesion up to 1.25 cm
The fee for D7411 is NOT BILLABLE TO THE PATIENT as included in the fee for another surgery in the same area of the mouth on the same day by the same dentist/dental office.
- D7411Excision of benign lesion greater than 1.25 cm
The fee for D7415 is NOT BILLABLE TO THE PATIENT as included in the fee for another surgery in the same area of the mouth on the same day by the same dentist/dental office
- D7415Excision of malignant lesion, complicated
The fee for D7450 is NOT BILLABLE TO THE PATIENT as included in the fee for another surgery in the same area of the mouth on the same day by the same dentist/dental office
- D7450Removal of benign odotogenic cyst or tumor – lesion diameter up to 1.25 cm
The fee for D7451 is NOT BILLABLE TO THE PATIENT as included in the fee for another surgery in the same area of the mouth on the same day by the same dentist/dental office.
- D7451Removal of benign odotogenic cyst or tumor – lesion diameter up to 1.25 cm
When covered, benefit D9613 once per date of service when submitted with extractions (D7220-D7241), and any additional D9613 submitted on the same date of service are NOT BILLABLE TO THE PATIENT.
- D9613Infiltration of sustained release therapeutic drug, per quadrant
Deleted Codes as of January 1, 2022:
- D4320provisional splinting – intracoronal
- D4321provisional splinting – extracoronal
- D8050interceptive orthodontic treatment of the primary dentition
- D8060interceptive orthodontic treatment of the transitional dentition
- D8690orthodontic treatment (alternative billing to a contract fee)
Be sure to order your new CDT 2022 book from the ADA! You may also order the CDT 2022 App and/or the Coding Companion Guide. These are all great resources!
