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Hello, I have a medical company that states that they cover surgical treatment for Cleft lip/Palate cases, but the orthodontia services needed in conjunction to prepare the patient for surgery (usually billable under 41899) will not be not covered unless teeth are impacted. Does this make sense? I am not billing for the treatment of the impacted teeth…I think? Maybe? What do you think?
Hi Guest! Great question. I can”t really comment on whether the logic behind that makes sense or not, however yes it is fairly common for a medical insurer to offer coverage for a surgical part of treatment, but not a part of treatment they consider dental or cosmetic in nature. (many medical policies will offer coverage for orthodontic services for medically necessary pediatric ortho (19 & under) or in accident cases as well). If you would like to tell me the name of your insurance company, I would be happy to look up their medical coverage policy for cleft lip/palate and orthodontic procedures to see if I can shed some light on if the policy is in fact written that way or not.
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