Cone beam technology is becoming the standard of care for certain dental procedures. Many patients request doctors to submit the cost to their medical plan.
There are three Current Procedural Terminology (CPT) medical codes available to report CBCT.
- The code 70486 reports the image capture and interpretation. 70486 Computed tomography, maxillofacial area; without contrast material.
When only image capture or interpretation is provided, it is reported with the appropriate modifiers listed below:
TC Technical component
(i.e., image capture only)
26 Professional component
(i.e., interpretation only)
- 76376 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image post-processing under concurrent supervision; not requiring image post-processing on an independent workstation.
- 76377 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image post-processing under concurrent supervision; requiring image post-processing on an independent workstation.
When 3D imaging is performed, it is reported with CPT code 70486 and either 76376 or 76377.
Coverage for CBCT varies by the medical plan. When possible, benefits should be verified prior to providing the service. Some plans require prior authorization. Coverage will be based on the diagnosis — not for routine scans that check for abnormalities.
Medical plans do contain exclusions, and coverage is based on proven medical necessity. A typical exclusion is for dental implants, unless medically necessary due to trauma. The clinical record must include the need for the CBCT, the field of view captured, and the interpretation of the image(s). Thorough documentation will help to increase reimbursement consideration.
The ICD-10-CM diagnosis code(s) must report the patient’s condition and the reason for these services. Medical payers will reimburse for legitimate, covered services when submitted correctly and the criteria for medical necessity is met and documented. Examples of possible diagnoses codes include:
- K01.0—Embedded teeth (soft tissue impacted)
- K01.1—Impacted teeth (bony impacted – partial or full)
- K08.404—Partial loss of teeth due to trauma, unspecified class
- K08.402—Partial loss of teeth due to caries, unspecified class
- K08.403—Partial loss of teeth due to periodontal disease, unspecified class
- K08.401—Partial loss of teeth due to other cause, unspecified class
So, will medical plans reimburse for CBCT? Yes, sometimes, and no, sometimes. Benefits may be
- Impacted third molars positioned close to the inferior alveolar nerve
- Proposed implant placement close to the interior alveolar nerve or maxillary sinus
- Proposed implant placement where there may be inadequate bone
- TMD/TMJ abnormalities/pathology
- Reconstructive surgery due to trauma
The medical plan may reimburse CBCT when medical necessity is proven and the plan is considering reimbursement for the dental procedure associated with it. For example, if it covers dental implants, the CBCT required prior to implant placement may be considered.
For more information regarding reporting CBCT and other dental procedures to the patient’s medical plan, contact your Henry Schein Dental Representative to order Dr. Charles Blair’s Medical Dental Cross Coding with Confidence Manual.