Code updates effective January 2021
The Code on Dental Procedures and Nomenclature (the Code), commonly known as Current Dental Terminology, or CDT, is the current HIPAA-designated code set used in electronic dental data interchange. As such, the Code is the national standard for reporting dental services and is the principal means of communication between dentists and dental benefits payers.
Any dental claim submitted on paper or on a HIPAA-standard electronic dental claim form must use procedure codes from the current version of the Code.
The Code is regularly updated to reflect changes in dental procedures accepted by the dental community. The Code is reviewed and revised by the American Dental Association (ADA) on an annual cycle, with each revised version effective on January 1 every year.
A revised version of the Code, as published by the ADA in the manual titled CDT 2021: Dental Procedure Codes, will be effective January 1, 2021, for services provided on or after January 1, 2021.
The 2021 version of the Code incorporates a significant number of procedure code changes, with 28 new procedure code entries, four deleted code entries and seven revised code entries. Twenty-two of the revised entries were only editorial changes (e.g. changes in syntax or spelling).
Among the 61 procedure code changes for 2021 are:
- Two codes regarding antigen and antibody testing for public health related pathogens.
- Various image-capture only diagnostic codes.
- A code to be used for counseling for the control and prevention of health effects associated with high-risk substance abuse.
- A code for caries preventive medicament application.
- New prefabricated porcelain/ceramic crown code.
- Six endodontic codes concerning surgical repair of root resorption and surgical exposure of root surface without apicoectomy or repair of root resorption.
- Two arch-specific periodontal medicament carrier codes.
- Two separate codes for placement of a semi-precision abutment and semi-precision attachment.
- Two area-specific frenectomy codes.
- Two oral surgery codes (craniofacial implant placement and zygomatic implant placement).
Along with the CDT 2021 procedure code changes, the following claim and processing procedures will be effective January 1, 2021:
- Codes D0472-D0480, D0485, D0486 and D0502 will require a pathology report upon submission
- Code D9971 will require a single tooth upon submission
New procedure codes and associated processing policies:
D0701–D0709 (various image-capture only codes): The fee for an image-capture only code is considered a part of the total fee for the corresponding radiographic image and is not billable to the patient.
D3471–D3473 (surgical repair of root resorption): Fees for surgical repair of root resorption are not billable when performed on the same tooth by the same dentist/dental office on the same date as D3333, D3410–D3426, D3430, D3450, D4210-–D4212, D4231, D4240, D4241, D4245, D4249, D4260, D4261, D4268, D4270, D4273–D4278, D4283 and D4285.
D3501–D3503 (surgical exposure of root surface without apicoectomy or repair of root resorption): Fees for surgical repair of root resorption are not billable when performed on the same tooth by the same dentist/dental office on the same date as D3333, D3410-D3426, D3430, D3450, D4210–D4212, D4231, D4240, D4241, D4245, D4249, D4260, D4261, D4268, D4270, D4273–D4278, D4283 and D4285.
D7961 and D7962 (buccal/labial and lingual frenectomy): The fee for a frenectomy is not billable to the patient when performed on the same date as any other surgical procedure(s) in the same surgical area by the same dentist or dental office.
With all the new code changes, we recommend that dentists and dental offices verify covered services for patients before rendering treatment. Details of individual coverage can be verified by logging in to your Dental Office Toolkit® account.
Accurate coding promotes faster claim processing and fewer errors, so Delta Dental recommends that each dental office have a current copy of the Code to stay up to date with procedure coding. To order a copy of the 2021 Code, call the ADA at 800-947-4746, or visit www.adacatalog.org.
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Paper vs. electronic claims and payments
The Dental Office Toolkit® (DOT) gives provider offices instant online access to review patient eligibility, check the status of submitted claims and much more at no cost, while helping your office to get paid faster than when you submit paper claims.
When COVID-19 cases began rising in the spring, it led to a temporary closure of Delta Dental’s mail room and print services. For providers using Electronic Funds Transfer (EFT) and DOT for claims submission, there were no delays in claims processing and payment. However, for providers not using these services, claims could not be processed until we were able to reopen. This resulted in a backlog of claims and delayed provider payments.
We recognize that cash flow is vital to the ongoing success of your business, especially during the pandemic. Given the resurgence of COVID-19, Delta Dental recommends that all providers take advantage of DOT and EFT to facilitate faster claims processing and payments as a way to avoid delays should there be another closure due to COVID-19 or any other reason.
If you need assistance using DOT or signing up for EFT, please contact your professional relations representative.
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Henry Schein credit reminder
The Henry Schein credit offered through Delta Dental of Michigan, Ohio, and Indiana in response to the COVID-19 pandemic will be ending soon.
All outstanding applications for a Henry Schein credit must be submitted by December 31, 2020.
- If you have an active account and have not received your credit, you must fill out the form at the link below by December 31, 2020, to apply for this credit.
- If you filled out the form previously and did not receive your credit, the form may have been rejected due to missing or invalid information. We must receive your application with accurate data by December 31, 2020, or your credit will not be issued.
The program ends December 31, 2020, and forms will not be accepted in 2021.
Complete your Henry Schein credit application.
All licensed dentists in Michigan, Ohio and Indiana who are currently practicing and have an active license and Type 1 NPI number are eligible for the $1,000 credit. It may be used toward existing account balances or toward any future purchase of dental products and/or services from Henry Schein.
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Join January CE seminar
Dr. Stephen Sterlitz, DDS, will lead the virtual 2021 Annual Kenneth J. Ryan Memorial on January 13, from 6 to 9 p.m.
His presentation, “WWGVBD? (What would G.V. Black do?): A historical perspective on modern dental procedures,” will discuss:
- A,B, Zs of all-ceramic dental materials
- How to unlock the door to a comprehensive dental practice with a dental key
- Dental adhesion: still a sticky subject
The event, presented by the University of Michigan School of Dentistry with support from the Delta Dental Foundation, will be held via Zoom. Registration is $65 and is open through January 12.
With any questions, call the University of Michigan School of Dentistry at 734-763-5070.
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2020 Oral Health Plan
As the most important part of the team serving the Delta Dental Healthy Kids Dental (HKD) population, Delta Dental of Michigan invites you to become familiar with the goals, objectives and activities put forth in the 2020 Michigan State Oral Health Plan.
The goals of the five-year plan are to improve the oral health and therefore general well-being of the HKD population through:
- Enhanced professional integration between providers (including the medical profession).
- Increased knowledge and awareness of the importance of oral health to overall health.
- Increased access to oral health care among the underserved and/or hard to reach populations.
Despite improvements in the oral health of the general population, disparities persist among individuals with a lower socioeconomic status, among minority racial and ethnic groups, and within special populations whose oral health needs and access to care vary from that of the general population.
Delta Dental of Michigan is pursuing a comprehensive Population Health Management Program using the available social determinants of health to develop and implement a variety of interventions to facilitate the education, activation and empowerment of HKD program enrollees, providers and other mission-aligned stakeholders. Our intent is to identify barriers to care and appropriate outreach activities in order to promote the proper use of available dental benefits with an emphasis on early intervention and prevention. Following the generally accepted standards of dental practice and the guidelines set forth in the 2020 Michigan State Oral Health Plan, Delta Dental develops a yearly Oral Health Promotion and Education Outreach plan designed to aid you in the case management and provision of quality dental services to the HKD population.
We invite you to become more familiar with the 2020 Michigan State Oral Health Plan here and look forward to your comments and suggestions.
Thank you for your commitment to the health of our communities and state.
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Online CE courses
Delta Dental has new continuing education (CE) courses available to you!
These courses are provided online at no cost to our participating providers and their hygienists, assistants and office staff.
New courses for 2021:
- Nutrition for Health and Disease Prevention
- Nutrition for Oral and Overal Health
Courses available now
- Dental Care for Children with Special Health Care Needs
- How to Complete an Age 1 Dental Visit
- HPV and Head and Neck Cancer
- Human Trafficking—Modern Day Slavery
- Infant and Toddler Oral Health Care
- Periodontal and Peri-Implant Diseases and Conditions
- Safe Opioid Prescribing Practices, New Laws and Regulations*
- The Proper Handling of Amalgam and Its Wastes—Complying With the New EPA Rules*
- The Seal Is the Deal*
*These courses were released in 2020
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