Getting reimbursed by medical insurance as a dental practice for dental imaging for medically necessary exams is a key component of dental-to-medical cross-coding. Incorporating medical billing reimbursement is a win-win for your patients and your dental practice. Medical billing for radiographs and imaging makes treatment more accessible to patients, and increases case acceptance without sacrificing revenue and reimbursement for your services!
A head, neck, and facial exam including upper airway screening are routinely reimbursed for TMJ and sleep apnea (dental sleep medicine) visits. The good news is that panorex x-rays and cephalometric view films may be covered by medical insurance along with the exam. Panorex and cephalometric imaging rarely requires preauthorization.
Depending on the medical insurance carrier, advanced dental imaging codes such as CT scans or Cone Beam Computerized Tomography (CBCT) may be covered as well, however, typically require a preauthorization beforehand.
Dental Imaging Radiographs for 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, Nierman Medical Billing Services, and dental CE provider for cross-coding and medical billing in dentistry, Nierman CE+ — an online medical billing in dentistry course series, dental sleep medicine and TMJ implementation. For more information, contact Nierman Practice Management at 1-800-879-6468 or NiermanPM.com.