Getting paid for imaging for medically necessary exams and imaging is commonplace in many dental practices. An exam, airway screening and panorex are routinely reimbursed. The good news is that panorex x-rays do not require preauthorization. A cephalometric view may also be covered, subject to a prepayment or post payment review.
Cone Beam Computerized Tomography (CBCT) reimbursement through medical insurance often requires preauthorization. Payment is dependent on many factors. It’s important for the cross-coding dental office to keep up with insurance guidelines, typically posted on their websites. It’s also recommended that you register for insurer newsletters.
Our research into CT scans and cone beam has uncovered 3 guidelines to help pave the way to payments:
- Document! Be diligent about recording your history-taking and exam findings including “Review of Systems” and “Exam Elements” when billing medical for imaging and the associated exam. For instance, a detailed encounter for a current patient is billed as an evaluation and management (E/M) code, such as CPT 99213. Note: Insurers will reimburse for a New Patient E/M (i.e. 99203) only if the patient has not received any professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years. The September 2015 issue of DSP outlines E/M guidelines.
- Preauthorize CT scans. Most CT scans involve a preauthorization process. The majority of medical insurers contract with outside organizations to administrate advanced imaging. One such contractor is National Imaging Associates (NIA). There are similar contractors working with various insurers. As far as the preauthorization process goes, some of the contractors yield same day decisions on the phone. One contractor is known to send a FAX asking for clinical information. Once you send in your SOAP notes, it may take 3-4 days for a written decision. Newer imaging technology, such as the i-CAT, is often reimbursed using CPT 70486, CT Scan, Maxillofacial. Although this is the proper code for CT scans, some insurers started differentiating cone beam technology by listing other codes for CBCT. For example, a BCBS carrier stipulates: There are no specific codes that address the cone-beam technique even for medical claims. Please submit claims with the following unlisted CPT, 76497.
- Look into CBCT Accreditation. Dental offices billing for advanced imaging will want to take a moment to review current medical policies. Many policies specify that for a physician (dentist) to receive reimbursement for CT, they must be accredited as a CT Imaging Accredited facility. Several resources have recently popped up to fill this need. For more information on accreditation, contact us through www.Dentalwriter.com.
Increased access to care through medical insurance benefits will help many OSA sufferers find an alternative to CPAP and receive needed treatment with oral appliances. Anything covered in a medical policy must meet the insurer’s criteria for…you guessed it…medical necessity. Diligent documentation and excellent records will help to bring peace of mind to your practice when billing medical insurance.