Coding and Insurance

The Code on Dental Procedures and Nomenclature (CDT Code) does not include an entry specific to oral cancer screening. An oral cancer evaluation is considered a component of periodic and comprehensive oral evaluations as noted in their CDT Code entries (text highlighted for emphasis).

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CDT Code D0431 may be applicable to delivery of oral cancer special screening. It’s entry, consisting of the code and nomenclature only, follows:

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Please consider the following CDT Codes that became effective January 1, 2013.

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Your medical and dental insurance benefits should not dictate the standard of care that you receive from a healthcare professional when it comes to an oral cancer screening examination. Healthcare professionals that offer oral cancer screening examinations to their patients want their patients to receive the highest quality standard of care available.
Dental Insurance: The American Dental Association has established a dental insurance procedure code that applies to adjunctive pre-diagnostic testing. This code is the CDT D0431 code. Your dental plan may cover this procedure. Increasing numbers of dental and medical insurance plans are covering CDT code D0431. While not all insurance companies are currently reimbursing for it, many insurance carriers are seeing the value and cost savings of early detection and diagnosis. Another resource for coverage is to include a reimbursement narrative letter with each D0431 claim.
The dental insurance code for the "Transepithelial Brush Biopsy" is D7288.

Medical Insurance: Your medical insurance company may also cover the pre-diagnostic exam. There are medical insurance codes that have also been used to obtain insurance reimbursement. These codes are CPT code 82397 for "chemiluminescent assay" and ICD-9 code, V76.42, which refers to a “special screening for malignant neoplasms, oral cavity”. Your medical insurance company can provide you with a claim form.

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Dental professionals can provide necessary information to patients so that they can submit a medical claim to their medical insurance company, or dental professionals may submit a medical claim on behalf of their patient.


MSA/HSA Option
Medical Spending Accounts (MSAs), if offered by patient employers, are an excellent option for patients to use for reimbursement for oral cancer special screening examination. Healthcare Savings Accounts (HSAs), can also be an option for reimbursement of the annual oral cancer special screening exams. In any case, it is important to provide patients with documentation of the exam for submittal, along with payment receipt, for reimbursement.


INVESTMENT IN YOUR PATIENTS AND FOR YOUR PRACTICE

Invest in your practice but more importantly invest in your patient with Oral Cancer Screening (OCS). OCS is a service that you should perform for your patients that can be life-saving for them but rewarding for you. This service is not only revenue producing for the office but also peace of mind for your patients. Early detection is the KEY to hopefully prevent spread of cancer as well as extensive future treatments. OCS is a minimally invasive procedure. Services that you can perform that produce revenue are:

  1. Oral Cancer Screening Examination
  2. Brush Biopsy
  3. Scalpel Biopsy
  4. Adjunctive Testing such as Velscope, Identafi, Vizilite, DOE Light, Oral DNA Testing.

Disclaimer – The reimbursement information contained here is provided to help you understand the reimbursement process. It is intended to assist healthcare providers in accurately obtaining reimbursement for dental health care services. It is not intended to increase or maximize reimbursement by any payer. We strongly suggest that you consult your payer organization with regard to local reimbursement policies. The information contained here is provided for information purposes only and represents no statement, promise or guarantee by OCSF concerning reimbursement, payment or charge. Similarly, all CDT, CPT/HCPCS and ICD-9 codes are supplied for information purposes only and represent no statement, promise or guarantee by OCSF that these codes will be appropriate or that reimbursement will be made.