Authorization & Coding Requirements

• Written Pre-Authorization & treatment plans are required for Prosthodontic services on teeth 7-10 and 23-26 and for crown lengthening.
• Pre –Authorization is not required for orthodontics except for children nine years and younger.
• Treatment plans should include a detailed statement of the proposed services, CPT codes, and the fees to be charged, pre-treatment x-rays.
• When indicated narrative reports maybe required supplying additional information.
• If Pre-Authorized services are not completed within 12 months a new Pre-Authorization is required.

Codes requiring additional documentation – Xrays are required on the following CDT codes:

• 2710-2794  (crowns) Initial placement
• 2952, 2953, 2954 and 2957 (cast post and core) if no root canal in history
• 2960-2962 all teeth (veneer)
• 6010-6050 (implant)
• Initial placement of 6205-6794 (bridge) 2+ abutments billed on either side of the pontic
• 332 with facial (filling), 2335 (filling) anterior teeth only

Documentation or Perio chart required for the following CDT codes

• Unlisted codes ending in "99"
• 4210, 4211 (gingivectomy)
• 4265 (osseous tissue regeneration)
• 4341, 4342 (scaling and root planing)
• 4381 (chemo agent)
• 4910 (perio maintence)
• 4355 (full debridment)

Xray and Documentation both required for the following CDT codes

• 7210, 7220, 7230, 7240, 7241, 7250 (surgical extractions)
• 4260,4261,4263,4264,4271,4273 (All Perio services - Perio chart is needed)
• 2950 (build-up)-If no Root Canal Therapy in history
• 3346-3348 (Retreatment) Pre-op and Post-op x-rays if no history of Root Canal Therapy