How do I obtain reimbursement for oral cancer screening?

March 23, 2007
Reader asks for guidance on submitting for insurance reimbursement for Vizilite.

Dear RDH eVillage:

I have been using the Vizilite oral cancer device and was wondering if you could help me with some ideas as to successful reimbursement.

Stephanie, RDH

Dear Stephanie:

Thank you for providing such a valuable service for your patients. In response to your question, and to provide you with the most up-to-date information, I sent your question on to Zila Pharmaceuticals. Below is an example of an insurance reimbursement narrative.

Insurance Reimbursement Narrative

(on office letterhead)

Insurance Company (Address)

Subject: Claim number, date, and patient I.D., CDT-5 Code DO431: adjunctive prediagnostic test that aids in detection of mucosal abnormalities including premalignant and malignant lesions, not to include cytology or biopsy procedures.

On behalf of (patient I.D.):

The American Dental Association (ADA) has assigned CDT-5 code D0431 for adjunctive oral cancer screening. The establishment of this procedure code was based on the clinical efficacy of ViziLite®(1), a chemiluminescent diagnostic device. Subsequently, the FDA cleared(1) the use of the TBlue630™ Oral Lesion Marking System as an adjunct to ViziLite examination, to mark lesions identified during the ViziLite exam.

ViziLite Plus with TBlue630 technology enables me to visualize mucosal abnormalities, including premalignant and malignant lesions that might be missed during my conventional oral cancer exam. Also, based on the most recent clinical data provided to me, ViziLite Plus with TBlue630 dramatically reduces false positive rates of lesions identified during conventional visual examination. As such, I am compelled to offer this to all of my adult patients as more than 25 percent of oral cancer victims have no lifestyle risk factors (tobacco/alcohol use). Moreover, failure to diagnose oral cancer is the second most frequent reason dentists are sued, with some plaintiff awards exceeding policy limits.

Please review the attached report of this procedure, including the mouth map used to document my conventional exam and the ViziLite Plus with TBlue630 exam. Should you need more clarification of the Vizilite Plus technology, please feel free to contact me.



(1) Epstein JB, Silverman S Jr, Epstein JD, Lonky SA, Bride MA. Analysis of oral lesion biopsies identified and evaluated by visual examination, chemluminescence, and toluidine blue. In Press.