Authorization / Coding Req.

Written preauthorization & treatment plans are required for prosthodontic services on teeth 7-10 and 23-26 and for crown lengthening.
Pre–authorization is not required for orthodontics.
Treatment plans should include a detailed statement of the proposed services, CDT codes, fees to be charged, and pre-treatment x-rays.
When indicated, narrative reports may be required supplying additional information.
If preauthorized services are not completed within 12 months a new preauthorization is required.

Codes requiring additional documentation – X-rays are required on the following CDT codes:

2710-2794 (crowns) initial placement
2952, 2953, 2954 and 2957 (cast post and core) if no root canal in history
2960-2962 all teeth (veneer)
6010-6050 (implant)
Initial placement of 6205-6794 (bridge) 2+ abutments billed on either side of the pontic
2332 with facial (filling), 2335 (filling) anterior teeth only

Documentation or Perio chart required for the following CDT codes:

Unlisted codes ending in "99"
4210, 4211 (gingivectomy)
4341, 4342 (scaling and root planing)
4381 (chemo agent)
4910 (perio maintence) - perio chart required if no previous periodontal procedures performed and/or no history of 4910
4355 (full debridment) - Xrays also required

X-ray and documentation are both required for the following CDT codes:

7210, 7220, 7230, 7240, 7241, 7250 (surgical extractions)
4260-4268 (all perio services - perio chart is needed)
2950 (build-up)-If no root canal therapy in history
3346-3348 (Retreatment)
7953 (bone replacement graft for ridge preservation - per site)
4346 (perio chart is required. Narrative may be required, if additional review needed)

Photos and documentation are both required for the following CDT codes: