Content Dam Diq Online Articles 2016 06 Dental Insurance Coding Tmb
Content Dam Diq Online Articles 2016 06 Dental Insurance Coding Tmb
Content Dam Diq Online Articles 2016 06 Dental Insurance Coding Tmb
Content Dam Diq Online Articles 2016 06 Dental Insurance Coding Tmb
Content Dam Diq Online Articles 2016 06 Dental Insurance Coding Tmb

Dental coding with Kyle: Occlusal guards

Jan. 18, 2019
Dental coding can cause a lot of headaches in dental practices, especially when the codes are updated. Staying up-to-date can be hard. Here's a code change for 2019.
Kyle L. Summerford, Editorial Director
The reasons for determining insurance coverage and non-coverage have not changed, but the CDT codes have.

Out with the old CDT code!

D9940 Occlusal guard, by report

In with the new CDT codes!

• D9944 Occlusal guard–Hard appliance, full arch
• D9945 Occlusal guard–Soft appliance
• D9946 Occlusal guard–Hard appliance, partial arch

The reasons that insurance companies may cover include:

• Some plans will provide a benefit for a patient suffering the effects of bruxism.
• Some plans will provide a benefit for an occlusal guard, but only if the patient has a six-month prior to fabrication history of periodontal treatment, such as scaling and root planing and osseous surgery.

The reasons insurance companies may deny include:

• Failure to use one of the new 2019 CDT codes listed above
• Failure to indicate on the ADA claim form the reason for fabrication of the appliance
• Annual maximum has been absorbed
• Frequency and limitations play an important role in coverage. Be sure to find out if the patient has a fabrication history of an occlusal guard appliance.

Always keep in mind that it is recommended the office send in a pretreatment authorization, which includes radiographs and periodontal charting, to ensure a smooth claim determination process.

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