The American Dental Association (ADA) implemented a revised set of Current Dental Terminology (CDT) codes for 2024 [1], to reflect advancements in dental procedures and materials. These codes became effective on January 1st and consist of fourteen new codes, one new category of service, two revised codes, and no deletions. The affected aspects of dental coding include new diagnostic procedures and materials, updated codes for existing restorative and preventative services and codes for emerging technologies in dentistry.
What to look for?
When new codes are added there can be an increase in confusion for providers and payors. With the addition of several more codes specifically associated with Dental Sleep Medicine, there is the potential for improper billing. CDT codes D9954 and D9955 are related to Oral Appliance Therapy (OAT) device fabrication, delivery and evaluation. CDT D9956 is for an at home sleep apnea test while D9957 is for screening for other sleep related breathing disorders. These codes may not be a covered benefit. According to Delta Dental [2], these procedures are “…not a benefit of most Delta Dental plans. The fee for this service is the patient’s responsibility.” With the addition of these codes, payors should review their current medical policies to ensure capturing any new billing patterns.
1) Look for providers billing for services not covered.
2) Look for providers with a history of denials of any non-covered service and a resubmission with a different code.
HCFS has you covered!
Adapting to new codes can be an adjustment, but if you’re using the HCFSPlatform™, we have you covered. Our Artificial Intelligence (AI) models can help identify anomalous dental billing patterns. Additionally, we have dental specific Alerts set up to flag unbundled services, non-covered services and inappropriate number of units billed.
According to dental industry standards, Dental Sleep Medicine procedures are typically not a benefit of most dental plans, unless covered by a specific group or individual contract. Our sleep medicine dental Alerts can flag billing for those new codes with alerts such as:
[4110-01] – NON-COVERED, FABRICATION AND DELIVERY OF ORAL APPLIANCE THERAPY (OAT) MORNING REPOSITIONING DEVICE:
[4111-01] – NON-COVERED, ORAL APPLIANCE THERAPY (OAT) TITRATION VISIT:
[4112-01] – NON-COVERED, ADMINISTRATION OF HOME SLEEP APNEA TEST:
[4113-01] – NON-COVERED, SCREENING FOR SLEEP RELATED BREATHING DISORDERS:
[1] https://www.ada.org/publications/cdt
[2] https://www1.deltadentalins.com/content/dam/ddins/en/pdf/dentists/cdt-dcusa-summary.pdf
If you have questions or comments you may email us at [email protected].