This month we feature D1999 —unspecified preventive procedure, by report. The ADA statement found here states: “Dentists can use this code once per patient visit/claim to attempt to cover the cost of personal protective equipment (PPE). Dentists should develop a standard office policy to document the additional PPE that will be used across all patients. This documentation methodology will justify a standard fee across all patients. Alternatively, dentists may wish to add a note in the patient’s record to document the details of PPE uniquely necessary for the visit when charging different fees based on the level of PPE used.”
Although to date no exact reimbursement schedule has been established by most dental insurance PPO carriers, I encourage you to send this letter along with your dental claims in an attempt to help persuade dental insurance carriers to provide benefits toward the excessive use of PPE in the dental practice.
Here is the letter, and you can download the letter here.
Date:
Attention: (Insurance company name)
As I am sure you are aware, the COVID-19 pandemic has created many new challenges for those of us who work in the dental field due to the high risk associated with the spread of aerosol contaminates during dental procedures. As a result, many third-party payers have heeded the recommendations of the American Dental Association and have begun providing additional compensation to dental providers in order to offset increased overhead demands required to furnish adequate personal protective equipment (PPE) for our patients, ourselves, and our staff members.
We are writing this letter to urge you to join the growing list of insurance companies that are answering the call for help from their dental providers. As dental professionals, we want to be a part of the solution to mitigate the spread of COVID-19. Without added protection, however, dental offices could become a nidus or breeding ground for this horrible virus. As a result, patients will begin to avoid dental treatment, leading to an epidemic of dental deterioration.
The following is a statement from the ADA that was finalized April 21: “Third-party benefit programs should either adjust the maximum allowable fees for all procedures or allow a standard fee per date of service per patient to accommodate the rising costs of PPE.”
“Safety is of utmost importance and all dentists are taking steps to protect patients, staff, and themselves,” said Dr. Randall Markarian, chair of the ADA Council on Dental Benefit Programs. “While necessary, new PPE requirements increase the overhead for every dental practice. Our Health Policy Institute analysis notes that most offices report less than 5% collections during the weeks of limited service, and recovery is anticipated to be slower with depressed patient volume. The anticipated increase in overhead was not included in negotiated fees in place before the pandemic. Together these factors create an environment that may be unsustainable for dental practices. We encourage both fully-insured third-party plans, as well as employers sponsoring self-insured plans, to pay attention to these consequences and support payment for PPE as we all strive to keep our patients and communities healthy.”
The ADA statement continues: “When adjudicating such claims, the ADA believes that it is inappropriate for any third-party benefit program to unfairly place the cost burden on dentists by disallowing or bundling charges for PPE on the pretext that the payment for additional required PPE is included in the payment for any other procedure billed for the visit.”
We take the safety and protection of our patients very seriously. Therefore, we urge you to work with us during these trying times to take the proper precautions for patients enrolled in your dental plan. We want our patients to feel comfortable and confident that we are taking every necessary measure to protect them as we move forward.
Sincerely,
Dental Office Name
