Vaccines are the best defence against COVID-19 and other contagious viruses. Based on the permission granted by the state where they practice, licensed dentists may prescribe and administer authorized COVID-19 vaccines. The American Dental Association (ADA) supports authorizing dentists to administer the COVID-19 as one approach to expand patient and public access to vaccinations. Dentists are allowed to provide the COVID-19 vaccine to established patients. As COVID vaccine providers, dentists need to comply with all applicable documentation requirements and report vaccine administration using the latest codes. Outsourced dental billing services can help dentists ensure accurate code assignment on patient records and claims for optimal reimbursement.
CDT’s COVID-19 Vaccination Procedure Codes 2021
The ADA’s Code Maintenance Committee accepted and approved eight pandemic-related CDT procedure codes in CDT 2021 at its virtual annual meeting held in March. CDT’s new vaccination (and molecular testing) codes for documenting and reporting provision of a COVID-19 vaccine in a dental practice are:
D1701 Pfizer-BioNTech COVID-19 vaccine administration – first dose.
D1702 Pfizer-BioNTech COVID-19 vaccine administration – second dose.
D1703 Moderna COVID-19 vaccine administration – first dose.
D1704 Moderna COVID-19 vaccine administration – second dose
D1705 AstraZeneca COVID-19 vaccine administration – first dose.
D1706 AstraZeneca COVID-19 vaccine administration – second dose.
D1707 Janssen (Johnson & Johnson) COVID-19 vaccine administration.
D0606 Molecular testing for a public health related pathogen, including coronavirus.
As part of the current version of the Code on Dental Procedures and Nomenclature – CDT 2021, these codes are included in the Preventive category of service, within their own subcategory.
CDT Vaccination Procedure Guidelines – Key Points
The ADA has issued guidelines to educate dentists and other dental professionals on the public health emergency vaccination procedure codes, reimbursement concerns, and other matters. Here are the key points of the guidance:
- General Rules
- Only a vaccine with Emergency Use Authorization (EUA) or approval from the U.S. Food and Drug Administration (FDA) can be administered in the U.S.
- Dentists’ COVID-19 vaccine allocation and administration status varies by state.
- Though the ADA does not call for mandatory delivery of COVID-19 vaccinations in a dental practice and states that “a dentist’s decision to deliver a vaccination is a professional decision”.
- Reimbursement for Vaccine Administration
- Dentists are responsible for determining the appropriate fee for the service provided. This full fee should be reported on a claim submitted to the patient’s benefit plan.
- Reimbursement for vaccination received by patients depends on their health plan coverage. Insurance eligibility verification is necessary to know what portion of the procedure’s cost would be reimbursed by the plan. Coverage must be checked with the patient medical insurance carrier as well as their dental benefits administrator. Private insurance companies need to meet certain regulatory requirements before they can offer reimbursement. Medicare has issued specific guidelines f payment for COVID vaccine administration across payers. Medicare has issued specific guidelines on payment for COVID vaccine administration by payers.
- Reporting Requirements
- Immunization Information Systems (IIS) applications capture information about COVID-19 vaccine administration. Dentists can use IISs to determine which vaccinations are needed and to care for their patients.
- State/federal reporting requirements on COVID-19 vaccine administration differ across states. Dentists who provide the vaccine for patient must understand and meet the reporting requirements in their state.
- COVID-19 Vaccination Coding
- The CDT codes for the vaccination procedure are product specific codes approved for use by dentists who support vaccinations of the US population during the public health emergency.
- The codes can be loaded into the practice management system (PMS) by the practice staff or via a software update by the system vendor.
- The wording of the nomenclatures and descriptions of these CDT codes are specifically intended to capture the national drug code schema that identifies both the vaccine manufacturer, technology, dose, and sequence of administration and dosage. This data is required for state and federal vaccination monitoring.
- There are different codes for administration of single and multiple doses. The provider must report the unique code that identifies both the vaccine delivered and whether it is for the first dose and second dose for multiple dose protocols, or for a single dose when that procedure applies. The relevant code should be documented in the patient record when the vaccine is administered, along with the actual date of service.
- The cost of care may be covered in full or in part by the patient’s dental or medical benefit plan. If the patient has no dental plan, the dentist can file a claim for the vaccination procedure with the patient’s medical plan. When filing claims with the medical plan, the appropriate CPT codes and ICD-10 codes should be used. There are also unique forms for medical benefit claims. Paper claims are submitted using CMS-Form 1500.
- Providers should refer to the CPT codes for vaccinations from the American Medical Association (AMA) when filing a medical benefit claim.
Dental professionals have been recognized as an important resources in the fight against COIVD-19. Dental offices have a key role to play in promoting vaccine education and awareness, facilitate dentists’ conversations with patients, and importantly in COVID-19 vaccine administration. As they focus on these tasks, practitioners can rely on an experienced dental billing company to ensure accurate reporting with current and active COVID-19 vaccination codes for appropriate reimbursement. Such support can be extremely valuable for busy dental practices as the ADA has indicated that additional codes will be added to CDT when more vaccines become available.
Amber Darst is our Solutions Manager in the Healthcare Division, Practice and RCM. With a rich background in dental services, her expertise ranges from insurance coordination to office management.