How To Bill Dental Anesthesia Services
Dental procedures and services are considered outpatient procedures. They are not compensable on inpatient basis. The exception is that there is medical justification. The medical justification is documented in the medical record of the patient.
The only provider types that are eligible to receive payment for dental services are:
Provider type 27: Dentist.
Provider type 31: Physician.
Provider Type 31 For Dental Anesthesia Services
This provider type is only allowed for CPT D7450 until CPT D7471, CPT D7960, and CPT D7970.
Provider type 31 is the only type that is eligable for payment for anesthesia allowance when provided in:
- ambulatory surgical center;
- a hospital short procedure unit; or an
- emergency room or inpatient hospital.
Provider Type 27 For Dental Anesthesia Services
This is the only provider type eligible for payment for orthodontic services. It can only be billed for a dentist who is a board eligible orthodontist and therefore board certified.
Provider type 27 (Dentist) can be used for payment for CDT codes:
- D9220: Deep sedation/general anesthesia;
- D9221: Deep sedation/general anesthesia (bill this code for each additional 15 minutes);
- D9230: Anxiolysis, analgesia and inhalation of nitrous oxide;
- D9241: Intravenous conscious sedation; or
- D9248: Non-intravenous conscious sedation provided in a dental clinic or dentis office.
Make sure to add a copy of the practitioners anesthesia permit.
How To Bill Crowns
Patients of 21 years or older are allowed to receive crowns.
The coverage for crowns is limited to one grown per tooth for five years and four per calender year. No more than two crowns per arch are allowed.
The following procedure codes can be used for crowns:
D2710: Crown – resin (indirec formulated in lab). This code is limited to one crown per three years.
D2710 until D2791 are payable for the fully developed permanent teeth and can also be used for primary teeth with no permanent successors. Payment for these codes can not be made for self-curing or prefabricated dental materials.
D2390, D2930 until D2934: These codes can only be used for crowns for primary/developing permanent teeth. Compensation will be denied for the constructions of a permanent crown and payable for patients of the age of 21 or older.
