Local Coverage Article Billing and Coding

Billing and Coding: Dental Services

A56663

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Article Information

General Information

Article ID
A56663
Article Title
Billing and Coding: Dental Services
Article Type
Billing and Coding
Original Effective Date
07/04/2019
Revision Effective Date
01/01/2023
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2022 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2022 American Dental Association. All rights reserved.

Copyright © 2022, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Title XVIII of the Social Security Act, §1862(a)(12) states no payment may be made for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth, except that payment may be made for inpatient hospital services because of underlying medical condition and clinical status or because of the severity of the dental procedure, requires hospitalization in connection with the provision of such services.

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

42 CFR Part 411.15(i) states no payment may be made for dental services in connection with care, treatment filling, removal, or replacement of teeth, or structures directly supporting teeth, except for inpatient services in connection with dental procedures when hospitalization is required because of an underlying medical condition and clinical status or the severity of the dental procedures.

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Dental Services L34574.

 

Coding Information

CPT/HCPCS Codes

Group 1

(11 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
41820 Excision gum each quadrant
41821 Excision of gum flap
41822 Excision of gum lesion
41823 Excision of gum lesion
41828 Excision of gum lesion
41830 Removal of gum tissue
41850 Treatment of gum lesion
41870 Gum graft
41872 Repair gum
41874 Repair tooth socket
41899 Unlisted px dentalvlr strux

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(290 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
C00.0 Malignant neoplasm of external upper lip
C00.1 Malignant neoplasm of external lower lip
C00.2 Malignant neoplasm of external lip, unspecified
C00.3 Malignant neoplasm of upper lip, inner aspect
C00.4 Malignant neoplasm of lower lip, inner aspect
C00.6 Malignant neoplasm of commissure of lip, unspecified
C00.8 Malignant neoplasm of overlapping sites of lip
C00.9 Malignant neoplasm of lip, unspecified
C01 Malignant neoplasm of base of tongue
C02.0 Malignant neoplasm of dorsal surface of tongue
C02.1 Malignant neoplasm of border of tongue
C02.2 Malignant neoplasm of ventral surface of tongue
C02.3 Malignant neoplasm of anterior two-thirds of tongue, part unspecified
C02.4 Malignant neoplasm of lingual tonsil
C02.8 Malignant neoplasm of overlapping sites of tongue
C02.9 Malignant neoplasm of tongue, unspecified
C03.0 Malignant neoplasm of upper gum
C03.1 Malignant neoplasm of lower gum
C03.9 Malignant neoplasm of gum, unspecified
C04.0 Malignant neoplasm of anterior floor of mouth
C04.1 Malignant neoplasm of lateral floor of mouth
C04.8 Malignant neoplasm of overlapping sites of floor of mouth
C04.9 Malignant neoplasm of floor of mouth, unspecified
C05.0 Malignant neoplasm of hard palate
C05.1 Malignant neoplasm of soft palate
C05.2 Malignant neoplasm of uvula
C05.8 Malignant neoplasm of overlapping sites of palate
C05.9 Malignant neoplasm of palate, unspecified
C06.0 Malignant neoplasm of cheek mucosa
C06.1 Malignant neoplasm of vestibule of mouth
C06.2 Malignant neoplasm of retromolar area
C06.80 Malignant neoplasm of overlapping sites of unspecified parts of mouth
C06.89 Malignant neoplasm of overlapping sites of other parts of mouth
C06.9 Malignant neoplasm of mouth, unspecified
C07 Malignant neoplasm of parotid gland
C08.0 Malignant neoplasm of submandibular gland
C08.1 Malignant neoplasm of sublingual gland
C08.9 Malignant neoplasm of major salivary gland, unspecified
C09.0 Malignant neoplasm of tonsillar fossa
C09.1 Malignant neoplasm of tonsillar pillar (anterior) (posterior)
C09.8 Malignant neoplasm of overlapping sites of tonsil
C09.9 Malignant neoplasm of tonsil, unspecified
C10.0 Malignant neoplasm of vallecula
C10.1 Malignant neoplasm of anterior surface of epiglottis
C10.2 Malignant neoplasm of lateral wall of oropharynx
C10.3 Malignant neoplasm of posterior wall of oropharynx
C10.4 Malignant neoplasm of branchial cleft
C10.8 Malignant neoplasm of overlapping sites of oropharynx
C10.9 Malignant neoplasm of oropharynx, unspecified
C11.0 Malignant neoplasm of superior wall of nasopharynx
C11.1 Malignant neoplasm of posterior wall of nasopharynx
C11.2 Malignant neoplasm of lateral wall of nasopharynx
C11.3 Malignant neoplasm of anterior wall of nasopharynx
C11.8 Malignant neoplasm of overlapping sites of nasopharynx
C11.9 Malignant neoplasm of nasopharynx, unspecified
C12 Malignant neoplasm of pyriform sinus
C13.0 Malignant neoplasm of postcricoid region
C13.1 Malignant neoplasm of aryepiglottic fold, hypopharyngeal aspect
C13.2 Malignant neoplasm of posterior wall of hypopharynx
C13.8 Malignant neoplasm of overlapping sites of hypopharynx
C13.9 Malignant neoplasm of hypopharynx, unspecified
C14.0 Malignant neoplasm of pharynx, unspecified
C14.2 Malignant neoplasm of Waldeyer's ring
C14.8 Malignant neoplasm of overlapping sites of lip, oral cavity and pharynx
C30.0 Malignant neoplasm of nasal cavity
C30.1 Malignant neoplasm of middle ear
C31.0 Malignant neoplasm of maxillary sinus
C31.1 Malignant neoplasm of ethmoidal sinus
C31.2 Malignant neoplasm of frontal sinus
C31.3 Malignant neoplasm of sphenoid sinus
C31.8 Malignant neoplasm of overlapping sites of accessory sinuses
C32.0 Malignant neoplasm of glottis
C32.1 Malignant neoplasm of supraglottis
C32.2 Malignant neoplasm of subglottis
C32.3 Malignant neoplasm of laryngeal cartilage
C32.8 Malignant neoplasm of overlapping sites of larynx
C76.0 Malignant neoplasm of head, face and neck
D00.00 Carcinoma in situ of oral cavity, unspecified site
D00.01 Carcinoma in situ of labial mucosa and vermilion border
D00.02 Carcinoma in situ of buccal mucosa
D00.03 Carcinoma in situ of gingiva and edentulous alveolar ridge
D00.04 Carcinoma in situ of soft palate
D00.05 Carcinoma in situ of hard palate
D00.06 Carcinoma in situ of floor of mouth
D00.07 Carcinoma in situ of tongue
D00.08 Carcinoma in situ of pharynx
D10.0 Benign neoplasm of lip
D10.1 Benign neoplasm of tongue
D10.2 Benign neoplasm of floor of mouth
D10.30 Benign neoplasm of unspecified part of mouth
D10.39 Benign neoplasm of other parts of mouth
D10.4 Benign neoplasm of tonsil
D10.5 Benign neoplasm of other parts of oropharynx
D10.6 Benign neoplasm of nasopharynx
D10.7 Benign neoplasm of hypopharynx
D10.9 Benign neoplasm of pharynx, unspecified
D11.0 Benign neoplasm of parotid gland
D11.7 Benign neoplasm of other major salivary glands
D11.9 Benign neoplasm of major salivary gland, unspecified
D14.0 Benign neoplasm of middle ear, nasal cavity and accessory sinuses
D14.1 Benign neoplasm of larynx
D16.4 Benign neoplasm of bones of skull and face
D16.5 Benign neoplasm of lower jaw bone
S02.400A Malar fracture, unspecified side, initial encounter for closed fracture
S02.400B Malar fracture, unspecified side, initial encounter for open fracture
S02.400D Malar fracture, unspecified side, subsequent encounter for fracture with routine healing
S02.400G Malar fracture, unspecified side, subsequent encounter for fracture with delayed healing
S02.400K Malar fracture, unspecified side, subsequent encounter for fracture with nonunion
S02.400S Malar fracture, unspecified side, sequela
S02.401A Maxillary fracture, unspecified side, initial encounter for closed fracture
S02.401B Maxillary fracture, unspecified side, initial encounter for open fracture
S02.401D Maxillary fracture, unspecified side, subsequent encounter for fracture with routine healing
S02.401G Maxillary fracture, unspecified side, subsequent encounter for fracture with delayed healing
S02.401K Maxillary fracture, unspecified side, subsequent encounter for fracture with nonunion
S02.401S Maxillary fracture, unspecified side, sequela
S02.402A Zygomatic fracture, unspecified side, initial encounter for closed fracture
S02.402B Zygomatic fracture, unspecified side, initial encounter for open fracture
S02.402D Zygomatic fracture, unspecified side, subsequent encounter for fracture with routine healing
S02.402G Zygomatic fracture, unspecified side, subsequent encounter for fracture with delayed healing
S02.402K Zygomatic fracture, unspecified side, subsequent encounter for fracture with nonunion
S02.402S Zygomatic fracture, unspecified side, sequela
S02.40AA Malar fracture, right side, initial encounter for closed fracture
S02.40AB Malar fracture, right side, initial encounter for open fracture
S02.40AD Malar fracture, right side, subsequent encounter for fracture with routine healing
S02.40AG Malar fracture, right side, subsequent encounter for fracture with delayed healing
S02.40AK Malar fracture, right side, subsequent encounter for fracture with nonunion
S02.40AS Malar fracture, right side, sequela
S02.40BA Malar fracture, left side, initial encounter for closed fracture
S02.40BB Malar fracture, left side, initial encounter for open fracture
S02.40BD Malar fracture, left side, subsequent encounter for fracture with routine healing
S02.40BG Malar fracture, left side, subsequent encounter for fracture with delayed healing
S02.40BK Malar fracture, left side, subsequent encounter for fracture with nonunion
S02.40BS Malar fracture, left side, sequela
S02.40CA Maxillary fracture, right side, initial encounter for closed fracture
S02.40CB Maxillary fracture, right side, initial encounter for open fracture
S02.40CD Maxillary fracture, right side, subsequent encounter for fracture with routine healing
S02.40CG Maxillary fracture, right side, subsequent encounter for fracture with delayed healing
S02.40CK Maxillary fracture, right side, subsequent encounter for fracture with nonunion
S02.40CS Maxillary fracture, right side, sequela
S02.40DA Maxillary fracture, left side, initial encounter for closed fracture
S02.40DB Maxillary fracture, left side, initial encounter for open fracture
S02.40DD Maxillary fracture, left side, subsequent encounter for fracture with routine healing
S02.40DG Maxillary fracture, left side, subsequent encounter for fracture with delayed healing
S02.40DK Maxillary fracture, left side, subsequent encounter for fracture with nonunion
S02.40DS Maxillary fracture, left side, sequela
S02.40EA Zygomatic fracture, right side, initial encounter for closed fracture
S02.40EB Zygomatic fracture, right side, initial encounter for open fracture
S02.40ED Zygomatic fracture, right side, subsequent encounter for fracture with routine healing
S02.40EG Zygomatic fracture, right side, subsequent encounter for fracture with delayed healing
S02.40EK Zygomatic fracture, right side, subsequent encounter for fracture with nonunion
S02.40ES Zygomatic fracture, right side, sequela
S02.40FA Zygomatic fracture, left side, initial encounter for closed fracture
S02.40FB Zygomatic fracture, left side, initial encounter for open fracture
S02.40FD Zygomatic fracture, left side, subsequent encounter for fracture with routine healing
S02.40FG Zygomatic fracture, left side, subsequent encounter for fracture with delayed healing
S02.40FK Zygomatic fracture, left side, subsequent encounter for fracture with nonunion
S02.40FS Zygomatic fracture, left side, sequela
S02.411A LeFort I fracture, initial encounter for closed fracture
S02.411B LeFort I fracture, initial encounter for open fracture
S02.411D LeFort I fracture, subsequent encounter for fracture with routine healing
S02.411G LeFort I fracture, subsequent encounter for fracture with delayed healing
S02.411K LeFort I fracture, subsequent encounter for fracture with nonunion
S02.411S LeFort I fracture, sequela
S02.412A LeFort II fracture, initial encounter for closed fracture
S02.412B LeFort II fracture, initial encounter for open fracture
S02.412D LeFort II fracture, subsequent encounter for fracture with routine healing
S02.412G LeFort II fracture, subsequent encounter for fracture with delayed healing
S02.412K LeFort II fracture, subsequent encounter for fracture with nonunion
S02.412S LeFort II fracture, sequela
S02.413A LeFort III fracture, initial encounter for closed fracture
S02.413B LeFort III fracture, initial encounter for open fracture
S02.413D LeFort III fracture, subsequent encounter for fracture with routine healing
S02.413G LeFort III fracture, subsequent encounter for fracture with delayed healing
S02.413K LeFort III fracture, subsequent encounter for fracture with nonunion
S02.413S LeFort III fracture, sequela
S02.42XA Fracture of alveolus of maxilla, initial encounter for closed fracture
S02.42XB Fracture of alveolus of maxilla, initial encounter for open fracture
S02.42XD Fracture of alveolus of maxilla, subsequent encounter for fracture with routine healing
S02.42XG Fracture of alveolus of maxilla, subsequent encounter for fracture with delayed healing
S02.42XK Fracture of alveolus of maxilla, subsequent encounter for fracture with nonunion
S02.42XS Fracture of alveolus of maxilla, sequela
S02.600A Fracture of unspecified part of body of mandible, unspecified side, initial encounter for closed fracture
S02.600B Fracture of unspecified part of body of mandible, unspecified side, initial encounter for open fracture
S02.600D Fracture of unspecified part of body of mandible, unspecified side, subsequent encounter for fracture with routine healing
S02.600G Fracture of unspecified part of body of mandible, unspecified side, subsequent encounter for fracture with delayed healing
S02.600K Fracture of unspecified part of body of mandible, unspecified side, subsequent encounter for fracture with nonunion
S02.600S Fracture of unspecified part of body of mandible, unspecified side, sequela
S02.601A Fracture of unspecified part of body of right mandible, initial encounter for closed fracture
S02.601B Fracture of unspecified part of body of right mandible, initial encounter for open fracture
S02.601D Fracture of unspecified part of body of right mandible, subsequent encounter for fracture with routine healing
S02.601G Fracture of unspecified part of body of right mandible, subsequent encounter for fracture with delayed healing
S02.601K Fracture of unspecified part of body of right mandible, subsequent encounter for fracture with nonunion
S02.601S Fracture of unspecified part of body of right mandible, sequela
S02.602A Fracture of unspecified part of body of left mandible, initial encounter for closed fracture
S02.602B Fracture of unspecified part of body of left mandible, initial encounter for open fracture
S02.602D Fracture of unspecified part of body of left mandible, subsequent encounter for fracture with routine healing
S02.602G Fracture of unspecified part of body of left mandible, subsequent encounter for fracture with delayed healing
S02.602K Fracture of unspecified part of body of left mandible, subsequent encounter for fracture with nonunion
S02.602S Fracture of unspecified part of body of left mandible, sequela
S02.609A Fracture of mandible, unspecified, initial encounter for closed fracture
S02.609B Fracture of mandible, unspecified, initial encounter for open fracture
S02.609D Fracture of mandible, unspecified, subsequent encounter for fracture with routine healing
S02.609G Fracture of mandible, unspecified, subsequent encounter for fracture with delayed healing
S02.609K Fracture of mandible, unspecified, subsequent encounter for fracture with nonunion
S02.609S Fracture of mandible, unspecified, sequela
S02.611A Fracture of condylar process of right mandible, initial encounter for closed fracture
S02.611B Fracture of condylar process of right mandible, initial encounter for open fracture
S02.611D Fracture of condylar process of right mandible, subsequent encounter for fracture with routine healing
S02.611G Fracture of condylar process of right mandible, subsequent encounter for fracture with delayed healing
S02.611K Fracture of condylar process of right mandible, subsequent encounter for fracture with nonunion
S02.611S Fracture of condylar process of right mandible, sequela
S02.612A Fracture of condylar process of left mandible, initial encounter for closed fracture
S02.612B Fracture of condylar process of left mandible, initial encounter for open fracture
S02.612D Fracture of condylar process of left mandible, subsequent encounter for fracture with routine healing
S02.612G Fracture of condylar process of left mandible, subsequent encounter for fracture with delayed healing
S02.612K Fracture of condylar process of left mandible, subsequent encounter for fracture with nonunion
S02.612S Fracture of condylar process of left mandible, sequela
S02.621A Fracture of subcondylar process of right mandible, initial encounter for closed fracture
S02.621B Fracture of subcondylar process of right mandible, initial encounter for open fracture
S02.621D Fracture of subcondylar process of right mandible, subsequent encounter for fracture with routine healing
S02.621G Fracture of subcondylar process of right mandible, subsequent encounter for fracture with delayed healing
S02.621K Fracture of subcondylar process of right mandible, subsequent encounter for fracture with nonunion
S02.621S Fracture of subcondylar process of right mandible, sequela
S02.622A Fracture of subcondylar process of left mandible, initial encounter for closed fracture
S02.622B Fracture of subcondylar process of left mandible, initial encounter for open fracture
S02.622D Fracture of subcondylar process of left mandible, subsequent encounter for fracture with routine healing
S02.622G Fracture of subcondylar process of left mandible, subsequent encounter for fracture with delayed healing
S02.622K Fracture of subcondylar process of left mandible, subsequent encounter for fracture with nonunion
S02.622S Fracture of subcondylar process of left mandible, sequela
S02.631A Fracture of coronoid process of right mandible, initial encounter for closed fracture
S02.631B Fracture of coronoid process of right mandible, initial encounter for open fracture
S02.631D Fracture of coronoid process of right mandible, subsequent encounter for fracture with routine healing
S02.631G Fracture of coronoid process of right mandible, subsequent encounter for fracture with delayed healing
S02.631K Fracture of coronoid process of right mandible, subsequent encounter for fracture with nonunion
S02.631S Fracture of coronoid process of right mandible, sequela
S02.632A Fracture of coronoid process of left mandible, initial encounter for closed fracture
S02.632B Fracture of coronoid process of left mandible, initial encounter for open fracture
S02.632D Fracture of coronoid process of left mandible, subsequent encounter for fracture with routine healing
S02.632G Fracture of coronoid process of left mandible, subsequent encounter for fracture with delayed healing
S02.632K Fracture of coronoid process of left mandible, subsequent encounter for fracture with nonunion
S02.632S Fracture of coronoid process of left mandible, sequela
S02.641A Fracture of ramus of right mandible, initial encounter for closed fracture
S02.641B Fracture of ramus of right mandible, initial encounter for open fracture
S02.641D Fracture of ramus of right mandible, subsequent encounter for fracture with routine healing
S02.641G Fracture of ramus of right mandible, subsequent encounter for fracture with delayed healing
S02.641K Fracture of ramus of right mandible, subsequent encounter for fracture with nonunion
S02.641S Fracture of ramus of right mandible, sequela
S02.642A Fracture of ramus of left mandible, initial encounter for closed fracture
S02.642B Fracture of ramus of left mandible, initial encounter for open fracture
S02.642D Fracture of ramus of left mandible, subsequent encounter for fracture with routine healing
S02.642G Fracture of ramus of left mandible, subsequent encounter for fracture with delayed healing
S02.642K Fracture of ramus of left mandible, subsequent encounter for fracture with nonunion
S02.642S Fracture of ramus of left mandible, sequela
S02.651A Fracture of angle of right mandible, initial encounter for closed fracture
S02.651B Fracture of angle of right mandible, initial encounter for open fracture
S02.651D Fracture of angle of right mandible, subsequent encounter for fracture with routine healing
S02.651G Fracture of angle of right mandible, subsequent encounter for fracture with delayed healing
S02.651K Fracture of angle of right mandible, subsequent encounter for fracture with nonunion
S02.651S Fracture of angle of right mandible, sequela
S02.652A Fracture of angle of left mandible, initial encounter for closed fracture
S02.652B Fracture of angle of left mandible, initial encounter for open fracture
S02.652D Fracture of angle of left mandible, subsequent encounter for fracture with routine healing
S02.652G Fracture of angle of left mandible, subsequent encounter for fracture with delayed healing
S02.652K Fracture of angle of left mandible, subsequent encounter for fracture with nonunion
S02.652S Fracture of angle of left mandible, sequela
S02.66XA Fracture of symphysis of mandible, initial encounter for closed fracture
S02.66XB Fracture of symphysis of mandible, initial encounter for open fracture
S02.66XD Fracture of symphysis of mandible, subsequent encounter for fracture with routine healing
S02.66XG Fracture of symphysis of mandible, subsequent encounter for fracture with delayed healing
S02.66XK Fracture of symphysis of mandible, subsequent encounter for fracture with nonunion
S02.66XS Fracture of symphysis of mandible, sequela
S02.671A Fracture of alveolus of right mandible, initial encounter for closed fracture
S02.671B Fracture of alveolus of right mandible, initial encounter for open fracture
S02.671D Fracture of alveolus of right mandible, subsequent encounter for fracture with routine healing
S02.671G Fracture of alveolus of right mandible, subsequent encounter for fracture with delayed healing
S02.671K Fracture of alveolus of right mandible, subsequent encounter for fracture with nonunion
S02.671S Fracture of alveolus of right mandible, sequela
S02.672A Fracture of alveolus of left mandible, initial encounter for closed fracture
S02.672B Fracture of alveolus of left mandible, initial encounter for open fracture
S02.672D Fracture of alveolus of left mandible, subsequent encounter for fracture with routine healing
S02.672G Fracture of alveolus of left mandible, subsequent encounter for fracture with delayed healing
S02.672K Fracture of alveolus of left mandible, subsequent encounter for fracture with nonunion
S02.672S Fracture of alveolus of left mandible, sequela
S02.69XA Fracture of mandible of other specified site, initial encounter for closed fracture
S02.69XB Fracture of mandible of other specified site, initial encounter for open fracture
S02.69XD Fracture of mandible of other specified site, subsequent encounter for fracture with routine healing
S02.69XG Fracture of mandible of other specified site, subsequent encounter for fracture with delayed healing
S02.69XK Fracture of mandible of other specified site, subsequent encounter for fracture with nonunion
S02.69XS Fracture of mandible of other specified site, sequela
S02.92XB Unspecified fracture of facial bones, initial encounter for open fracture

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

N/A

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
01/01/2023 R4

Under CPT/HCPCS Codes Group 1: Codes the description was revised for 41899. This revision is due to the 2023 Annual/Q1 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 1/1/23.

06/24/2021 R3

Under CMS National Coverage Policy removed regulation CMS Internet-Only Manual, Pub. 100-20, One-Time Notification, Transmittal 477, dated April 24, 2009, Change Request 6338.

10/10/2019 R2

This article is being revised in order to adhere to CMS requirements per Chapter 13, Section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related Dental Services L34574 LCD and placed in this article.

07/04/2019 R1

All coding located in the Coding Information section has been removed from the related Dental Services L34574 LCD and added to this article.

 

Associated Documents

Related Local Coverage Documents
LCDs
L34574 - Dental Services
Related National Coverage Documents
N/A
Statutory Requirements URLs
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Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
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Public Versions
Updated On Effective Dates Status
01/24/2023 01/01/2023 - N/A Currently in Effect You are here
06/15/2021 06/24/2021 - 12/31/2022 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Dental