In every issue of our newsletter, we include utilization management tips that alert you to program information that is important to your office. Please read below for this helpful information.

Notes on Select CDT Codes

D0150: Comprehensive Oral Evaluation

• This code is a complete evaluation of a member's dental and medical history, a general assessment, and an evaluation for oral cancer when indicated. It is a thorough evaluation and recording of the extraoral and intraoral hard and soft tissues.
• This code should be used to complete an exam that will enable you to formulate a treatment plan. It may be billed once every three (3) years per member.
• The following exceptions to the three-year limitation apply:
• Special health care needs members seeing a new provider/facility/group
• Any member with an approved referral for a second opinion
• Any member when the record of their first D0150 from a previous provider/facility cannot be transferred due to a circumstance such as the retirement of the previous provider
• If for some reason you are unable to complete a comprehensive visit, you should not submit a claim for D0150.

D9310: Consultation

• This code is to be used when you must refer a member under your care to another dental provider for an opinion or advice on a particular problem. An example of this could be when a member requires treatment in a hospital.

Please contact our Provider Hotline at 1-855-698-6262 if you have a question regarding the information provided here about these two CDT codes.