Many dental services can be billed to medical plans. Dental insurance billing becomes much easier if you know exactly which services these are. For instance, there is no uncertainty when it comes to trauma-related or emergency dental services – these can be and are often required to be billed to medical plans. However, there are some other services that can also be billed under medical plans, that is, those that have been diagnosed as medically necessary. These include:
- Temporomandibular joint dysfunction (TMD) procedures
- Oral-facial conditions through exams and consultations
- Procedures for myofascial pain conditions
- Oral dysfunction related procedures
- Oral surgery procedures like hard and soft tissue biopsies
- Periodontal procedures
- Medically necessary radiographs, and many more
There are important benefits to filing medically-related dental services with medical insurance plans:
- Dental plans usually have a yearly maximum while medical plans do not. Health care law prevents insurance companies from restricting lifetime coverage for essential health benefits. In 2014, this also applies to yearly limits.
- If the patient has had emergency dental services and these are covered by both the dental and medical plan, the patient’s out-of-pocket expenses are reduced to a great extent.
- If the patient does not have dental insurance, the dental specialist usually gets easily reimbursed for procedures that come under medical claim filing.
- Patients would see the filing of dental claims that are medically-related under their medical plan as a value-added service provided by their dental specialist.
Dental insurance billing is based on the Current Dental Terminology (CDT) codes developed by the American Dental Association (ADA) and the version currently in use is CDT-2013. The best way to ensure efficient, accurate and timely dental insurance billing practices is to entrust the task to a professional medical billing and coding company. Its team of expert AAPC-certified medical coders and billing professionals, the right firm can ensure the right diagnosis and procedures codes, as well as carry out to maximize reimbursement and minimize claim denials.