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2018 CDT changes and processing policy updates
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On Jan. 1, 2018, Delta Dental of Alaska (DDAK) will implement the new codes that the ADA has outlined in CDT-18. The chart below shows how the DDAK standard contract will cover these new CDT-18 codes.
Please go to Benefit Tracker for specific benefit information and group limitations of each patient's plan. Some plans may handle the codes differently than the DDAK standard contract.
Additionally, codes D5510, D5610 and D5620 will be deleted with CDT-18. DDAK will no longer accept deleted codes after March 2018.
CDT-2018 code books can be purchased through the American Dental Association at
ada.org
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New CDT codes covered under DDAK Standard Commercial plans. No other new codes will be covered by Standard plans.
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Code
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Description
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Comments
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D5511
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Repair broken complete denture base, mandibular
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Fees for repairs of complete dentures, if performed within six months of initial placement by the same dentist/dental office are disallowed.
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D5512
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Repair broken complete denture base, maxillary
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Fees for repairs of complete dentures, if performed within six months of initial placement by the same dentist/dental office are disallowed.
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D5611
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Repair resin partial denture base, mandibular
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Fees for repairs of resin partial dentures, if performed within six months of initial placement by the same dentist/dental office are disallowed.
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D5612
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Repair resin partial denture base, maxillary
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Fees for repairs of resin partial dentures, if performed within six months of initial placement by the same dentist/dental office are disallowed.
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D5621
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Repair cast partial framework, mandibular
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Fees for repairs of cast partial dentures, if performed within six months of initial placement by the same dentist/dental office are disallowed.
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D5622
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Repair cast partial framework, maxillary
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Fees for repairs of cast partial dentures, if performed within six months of initial placement by the same dentist/dental office are disallowed.
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D9222
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Deep sedation/general anesthesia - first 15 minutes
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a. Deep sedation/general anesthesia
is a benefit only when administered;
(1) with appropriate monitoring by a properly licensed provider who is acting in compliance with applicable State rules and regulations, and
(2) in conjunction with oral surgical procedures (D7000-D7999) when covered, or when necessary due to concurrent medical conditions. Otherwise, the benefit for deep sedation/general anesthesia is DENIED.
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D9239
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Intravenous moderate (conscious) sedation/analgesia - first 15 minutes
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a. Intravenous moderate (conscious) sedation/analgesia is a benefit only when administered;
(1) in a dental office with appropriate monitoring by an appropriately licensed and qualified dentist who is acting in compliance with applicable rules and regulations, and
(2) in conjunction with oral surgical procedures (D7000-D7999) when covered, or when necessary due to concurrent medical conditions.
Otherwise, the benefit for intravenous moderate (conscious) sedation/analgesia is DENIED.
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Questions?
Please contact the Delta Dental of Alaska Dental Customer Service department toll-free at 877-277-7280 or email us at
[email protected].
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Update to D4910 processing policy
In early 2017, Delta Dental of Alaska adopted a national Delta Dental processing policy that disallows D4910 when submitted by the same provider/same dental office within three months of procedure codes D4210-D4212, D4230-D4231, D4240-D4241, D4245, D4249, D4260-D4268, D4270, D4273-D4278, D4283 and D4285.
This means that if the same provider submits D4910 within three months of one of these periodontal therapy codes we will disallow as a provider write-off with
explanation code
90A - Included in fee for periodontal therapy.
If D4910 is submitted within three months of a periodontal therapy code by a different provider, we will allow. However, frequency limitations will apply.
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Thanks for your response
We appreciate each dental office that responded to our
dental provider accuracy update request. Your participation is very important to helping us meet our goal of 100 percent accuracy and providing our members with access to the highest quality dental care throughout the state.
We look forward to working with you in 2018!
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