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:
- 4270, 4271, 4273, 4275, 4276 (all perio services - perio chart is needed)