Changes to the “Code on Dental Procedures and Nomenclature,” commonly known as the CDT Code, have been released and will become effective for services provided on or after January 1, 2017.
The CDT Code is the current HIPAA-designated code set used in electronic dental data interchanges. It is the national standard for reporting dental services and is the principal means of communication between dentists and dental benefits payers.
Any dental claim submitted electronically on a HIPAA standard electronic dental claim must use procedure codes from the current version of the CDT Code. This is also true for dental claims submitted on paper.
The CDT Code is reviewed annually by the American Dental Association (ADA) and updated to reflect changes in dental procedures accepted by the dental community. Each revised version takes effect January 1 of each year.
A revised version of the CDT Code, as published by the ADA in the manual, “CDT 2017: Dental Procedure Codes,” will become effective January 1, 2017, for services provided on or after January 1, 2017, through December 31, 2017.
The 2017 version of the CDT Code incorporates a significant number of procedure code changes with 11 new procedure code entries, 37 revised procedure code entries and one deleted code entry. The 2017 CDT Code also includes new subcategory and revised subcategory changes.
With all new code changes, we recommend that dentists and dental offices verify covered services for patients before rendering treatment. Details of individual coverage can be verified by calling our customer service department or by going online with the Dental Office Toolkit® (DOT).
Accurate coding promotes faster claim processing and fewer errors, so Delta Dental recommends that each dental office have a current copy of the CDT Code. To order a copy of the CDT Code, call the ADA at 800-947-4746, or go online at www.adacatalog.org.
The Centers for Medicare and Medicaid Services (CMS) requires dentists to either enroll or opt out as Medicare Part D ordering or referring providers by January 1, 2019. This is an extension of the original deadline date. For more information and how to enroll, click here.
No. The contract amendment, which Delta Dental mailed to participating providers in June 2016, will automatically go into effect on January 1, 2017.
Prescribers of Part D drugs who are eligible to enroll must enroll in Medicare (or have a valid record of opting out). This includes eligible professionals including dentists.
It’s important to note that dentists, including oral surgeons, will not be able to participate in a Medicare Advantage plan if they choose to opt out of Medicare. Upon submission of an opt-out affidavit, a provider has 90 days to change his or her opt-out status. After 90 days, a provider is not able to terminate opt-out designation and will remain in an opt-out status for a period of two years.
Opt-out periods last for two years and cannot be terminated early unless the physician or practitioner is opting out for the very first time and the affidavit is terminated no later than 90 days after the effective date of the physician or practitioner’s first opt-out period.
Opt-out affidavits signed on or after June 16, 2015, will automatically renew every two years. Therefore, physicians and practitioners that sign valid opt-out affidavits on or after June 16, 2015, will no longer be required to file renewal affidavits. Physicians and practitioners that file valid opt-out affidavits effective on or after June 16, 2015, and do not want to extend their opt-out status at the end of a two-year opt-out period may cancel by notifying all Medicare contractors with which they filed an affidavit in writing at least 30 days prior to the start of the next two-year opt-out period.
If you elected to opt out of Medicare prior to June 20, 2016, you WILL still be able to participate with Delta Dental and WILL be listed as a participating provider in our Delta Dental Premier®, Delta Dental PPOSM and/or Delta Dental EPO directories that are used by our commercial clients.
However, because you chose to opt out, and per CMS requirements, Delta Dental cannot issue payment to you for any services provided to Medicare Advantage members, and we are unable to list you in Delta Dental’s directory for Medicare Advantage clients. According to CMS, your opt-out status is effective for two years. Delta Dental will monitor opt-out end dates. Once your opt-out period ends, if you would like to continue your participation agreement with Delta Dental, you will need to make a different Medicare selection (not opt out).
The Medicare enrollment file includes all providers who are currently enrolled in Medicare in an approved status or have a valid opt-out record.
Check out your status by clicking here.
As a reminder, all participating dentists will receive quarterly (four times a year) mailings asking you to confirm dental office information or to make corrections or additions as needed. This helps us ensure our provider records are accurate. If a participating dentist is added or removed from a practice, it is important that you contact us so we may update your record accordingly.
A dozen Cincinnati-area elementary schools will get a hands-on oral health learning experience with the help of the Delta Dental Foundation.
To promote Inside the Grin, a new oral health exhibit at Cincinnati Museum Center’s Duke Energy Children’s Museum, the foundation awarded field trip grants to 12 schools, totaling approximately $25,000.
The grants will cover museum admission for more than 2,400 students in prekindergarten through fourth grade, along with teachers and chaperones. The grants also cover transportation costs and an oral health goody bag for each teacher to use in the classroom.
The foundation provided $55,000 to Junior League of Cincinnati for the development of the Inside the Grin exhibit.
Elementary schools that received the grants include:
This January, you may notice an influx of calls from new members as a result of additions to the SummaCare Medicare Advantage and MediGold Medicare Advantage groups.
SummaCare Medicare Advantage, group 1083, will be adding an embedded preventive plan effective January 1, 2017, and is expected to grow its members by 21,000.
Product |
Network |
|
Preventive dental plan
|
Delta Dental Medicare Advantage PPO network only (no benefit otherwise) |
|
Optional supplemental dental plan
|
Delta Dental Medicare Advantage PPO network and Delta Dental Medicare Advantage Premier network (no benefit otherwise) |
Product |
Network |
|
Included preventive plan
|
Delta Dental Medicare Advantage EPO network |
|
Optional supplemental HMO buy-up plan
|
Delta Dental Medicare Advantage PPO network |
|
Optional supplemental PPO plan
|
Delta Dental Medicare Advantage PPO network |