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I have a patient that had her cleft palate repaired, which resulted in her needing an implants placed, which will be restored with an implant bridge. Normally for implant codes I would send the dental codes to the insurance, but this particular insurance company said that they will not process them under the medical policy as a dental code, even though it was medically necessary. From what I read, 41899 could be a possibility for the AMA CPT code. How do I bill it in terms of units? Normally I would bill 2 retainer implant crowns, 1 pontic and 2 abutments, so five procedures in total. Should I bill 41899 as five units or 1 unit?
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Rank: Administration
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Hi Guest!
Great question. Medical insurers tend to handle this differently, however here's what i suggest:
Go ahead and do 1 unit of 41899 for each of the different procedures/services (so you will have 41899 listed more than once on the claim).
Then, uss the "ZZ" qualifier on the line item in the supplemental information area (which is the red shaded line on each line item in field 24 that is typically left blank) and provide a short description of what service each one is being used represent (since 41899 is an "unlisted service" code).
For example, for the abutment, it would read:
ZZabutments
That would show up right above the dates of service in the red shaded line on the line item (the supplemental information area).
Hope this helps!
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