Getting paid for imaging for medically necessary exams and imaging is the starting point for medical insurance billing. A head, neck, and facial exam including upper airway screening and panorex are routinely reimbursed for the TMJ and Sleep practice. The good news is that panorex x-rays and a cephalometric view films may be covered along with the exam. Panorex and cephalometric imaging rarely requires preauthorization.
Advanced imaging codes such as CT scans or Cone Beam Computerized Tomography (CBCT) may be subject to a prepayment payment review and often requires preauthorization.
Imaging Medical Billing Tips:
Preauthorize CT scans. If you are billing for CT scans these may involve a preauthorization process, typically through third-party companies that insurance carriers use such as National Imaging Associates (NIA). Some preauthorization efforts yield same day decisions on the phone. Others require review. Be ready to send a FAX with your clinical data from your sleep or TMJ medical history taking and exam. Once you send in your notes, it may take 3-4 days for a written decision or longer.
Consider CBCT Accreditation. Many medical policies specify that for a dentist to receive reimbursement for CT, they must be accredited as a CT Imaging Accredited facility. Several resources have recently popped up to fill this need. A recommended resource for CT accreditation is the Intersocietal Accreditation Commission at www.intersocietal.org.
IAC Dental CT accreditation is granted for a three-year period from the original date of decision. Varying per modality and practice setting, IAC Dental CT accreditation is required in some U.S. states and regions, by the Centers for Medicare and Medicaid Services (CMS) and by numerous private insurers.
Author: Rose Nierman, Nierman Practice Management CEO
Rose Nierman has been at the forefront of educating dental practices on medical billing in dentistry, cross-coding and the expansion of TMJ and Dental Sleep services for over 30 years. She is the creator of DentalWriter™ Software and a CE provider for CrossCoding; Unlocking the Code to Medical Billing in Dentistry™. She also launched a comprehensive, online medical billing in dentistry course series. For more information, contact Nierman Practice Management at 1-800-879-6468 or NiermanPM.com.