Print Page   |   Contact Us   |   Sign In
News & Press: Advocacy

Denti-Cal Announces Changes to Oral Examination Billing Codes

Tuesday, November 22, 2016   (0 Comments)
Posted by: CSPD
Share |

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


Membership Management Software Powered by YourMembership  ::  Legal