Code updates effective in January 2023

 

The Code on Dental Procedures and Nomenclature (the Code), commonly known as Current Dental Terminology, or CDT, is the current HIPAA-designated code set used in electronic dental data interchange. As such, the Code 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 Code. The Code is also used for dental claims submitted on paper.

The Code is regularly updated to reflect changes in dental procedures accepted by the dental community. The Code is now reviewed and revised by the American Dental Association (ADA) on an annual cycle, with each revised version effective on January 1 every year.

A revised version of the Code, as published by the ADA in the manual titled “CDT 2023: Dental Procedure Codes,” will be effective January 1, 2023, for services provided on or after January 1, 2023, through December 31, 2023.

The 2023 version of the Code incorporates a significant number of procedure code changes, with 22 new procedure code entries, two deleted code entries and 14 revised procedure code entries.

 

Newly added codes include:

  • six codes in regards to intraoral tomosynthesis radiographic images
  • four new 3D dental and facial surface scans (direct and indirect)
  • three new codes for the human papillomavirus vaccinations
  • a code to be used for the removal of a non-resorbable barrier
  • a code to be used in regards to the removal of an implant body not requiring bone removal or flap elevation
  • four new codes for guided tissue regeneration for implants or an edentulous (resorbable and non-resorbable barriers)
  • a code to be used for the replacement of restorative materials used to close an access opening of a screw-retained implant-supported prosthesis
  • a code for marsupialization of an odontogenic cyst
  • one code for the reline of sleep apnea appliance

 

Along with the CDT 2023 procedure code changes, the following claim and processing procedures will be effective January 1, 2023:
 

Benefit coverage:
*When implants are a covered benefit:

  • Code D6105 will be covered once in a five-year period
  • Codes D6106-D6107 will be covered once in a 36-month period along with other guided tissue regeneration procedures
  • Code D6197 will be covered once in a 24-month period
  • Codes D7956-D7957 will be covered once in a 36-month period along with other guided tissue regeneration procedures

New procedure codes and associated processing policies:
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Diagnostics:

D0372–D0374 (intraoral tomosynthesis—comprehensive series; bitewing; periapical) Intraoral tomosynthesis images will be subject to review; fees for traditional radiographic images (D0210/D0270–D0277/D0220–D0230) will be not billable to the patient when billed in conjunction with intraoral tomosynthesis images.
D0387–D0389 (intraoral tomosynthesis—comprehensive series; bitewing; periapical—capture only) The fee for an image-capture only code is considered a part of the total fee for the corresponding radiographic image and is not billable to the patient

 

Periodontics:
D4286 (removal of non-resorbable barrier) Fees for removal of barrier membrane by the same dentist/dental office who placed the barrier are not billable to the patient

 

Implant services:
D6105 (removal of implant body not requiring bone removal nor flap elevation) The fee for D6105 when performed within 6 months of D6010/D6013 on the same tooth by the same dentist/dental office is not billable to the patient
D6197 (replacement of restorative material used to close an access opening of a screw-retained implant supported prosthesis, per implant) Fees for replacement of restorative material to close an access opening of a screw retained implant supported prosthesis when performed by the same dentist/dental office within 6 months placement of the implant prosthesis are not billable to the patient. Fees for D6197 are not billable on the same date of service by same dentist/dental office as D6080 or D6090

 

Adjunctive general services:
D9953 (reline custom sleep apnea appliance (indirect) Fees for reline of custom sleep apnea appliance, if performed within six months of initial placement by the same dentist/dental office are not billable to the patient


With all the 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 logging in to the Dental Office Toolkit®.

Accurate coding promotes faster claim processing and fewer errors, so Delta Dental recommends that each dental office have a current copy of the Code. To order a copy of the 2023 Code, call the ADA at 800-947-4746, or visit www.adacatalog.org