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News & Press: Advocacy

Denti-Cal Announces Changes to Oral Examination Billing Codes

Tuesday, November 22, 2016   (0 Comments)
Posted by: CSPD
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According to the October 2016 Denti-Cal Bulletin, effective October 16 the following payment policies will apply to the oral evaluation codes:

D0129 Periodic Oral Evaluation – Established Patient

  • Allowable once every six months for beneficiaries age three through 20 and once every twelve months for beneficiaries age 21 and over.
  • Payable only after procedure D0150 has been billed by the same provider.

D0145 Oral Evaluation for a Patient Under Three Years of Age and Counseling with Primary Caregiver

  • Separately payable benefit for beneficiaries under three years of age.
  • Payable once in each three month period.
  • Maximum fee allowance is $20.00.

D0150 Comprehensive Oral Evaluation – New or Established Patient

  • Allowable for beneficiaries age three and older.
  • Allowable initially and every 36 months after the last comprehensive oral evaluation or last periodic oral evaluation per beneficiary per provider.
  • Allowable more frequently for established patients who present with significant change in health conditions or other unusual circumstances (with documentation).

Paul A. Reggiardo, DDS
CSPD Public Policy Advocate

 

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