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Last 10 Posts (In reverse order)
Guest Posted: Tuesday, June 13, 2017 1:51:15 PM(UTC)
 
Thanks so much for your response. Basically, what the financial counselor was telling me with the exception of the 41899 code. Our insurance is Anthem Blue Cross. Will pass along the info, hopefully will get somewhere.

Thanks again!
mmccormick Posted: Tuesday, June 13, 2017 10:26:22 AM(UTC)
 
Hi Guest,

D8080- Comprehensive orthodontic treatment of the adolescent dentition
D8690- Orthodontic treatment (alternative billing to a contract fee)


The codes listed above does not have a direct crosscode we are aware of, so you can either bill the "D" code on the medical claim (many insurers these days will process "D" codes when they are medically necessary services), or you can try the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures

Having said that, there is now, under the Affordable Care Act, coverage under medical plans for pediatric orthodontics for some diagnoses. Most medical policies i come across indicate coverage for ortho for diagnoses/conditions such as severe malocclusions, speech abnormalities, trauma, etc.
Here’s a really good guide from United Healthcare on the Pediatric Dental Essential Health Benefit in the Affordable Care Act (ACA), which includes “medically necessary orthodontia” (among other things, of course)
https://www2.cbia.com/ie...20Pediatric%20Dental.pdf

Also, here is a link to Aetna's medical policy titled "Medically Necessary Orthodontia Related to the Pediatric Dental Essential Benefit in the Affordable Care Act (ACA"
https://www.aetna.com/he...-bulletins/DCPB039.html#

Aetna even lists out the codes you might use right in the medical policy, and they are "D" codes! Here they are below:
• D8010- Limited orthodontic treatment of the primary dentition
• D8020- Limited orthodontic treatment of the transitional dentition
• D8030- Limited orthodontic treatment of the adolescent dentition
• D8040- Limited orthodontic treatment of the adult dentition
• D8050- Interceptive orthodontic treatment of the primary dentition
• D8060- Interceptive orthodontic treatment of transitional dentition
• D8070- Comprehensive orthodontic treatment of the transitional dentition
• D8080- Comprehensive orthodontic treatment of the adolescent dentition
• D8090- Comprehensive orthodontic treatment of the adult dentition

Hope this helps!
Guest Posted: Thursday, June 8, 2017 2:20:33 PM(UTC)
 
Hi!
My daughter is having orthodontic treatment as part of Craniofacial Team care, and in preparation for further surgeries and treatment. The insurance won't accept:

D8080
D8690

They are asking for Medical Equivalent codes, but the office says there are none.

Help!

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