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Step 5: Billing & Reimbursement

October 12, 2021 1780

CDA provides the following billing information and FAQs to help dentists better understand their rights under AB 526, CDA-sponsored legislation that permanently authorizes California dentists to provide influenza and COVID-19 vaccines and obtain required registration to conduct in-office rapid COVID-19 testing.

COVID-19 Testing 

Q. Which current procedural terminology (CPT) codes does one use when billing for COVID-19 testing?

A. You may find up-to-date CPT coding guidance from the American Medical Association.

Q. What are the chart documentation requirements when providing an in-office rapid COVID-19 test?

A.  As with any treatment or testing you provide to a patient, you must document this information in the patient’s record. The ADA offers a comprehensive guide in the COVID-19 & Lab Testing Requirements Toolkit (ADA login required).

Q. Can I bill the patient’s medical or dental plan for the COVID-19 test?

A. According to the federal and state guidance, group health plans and individual health insurance cover administration of a COVID-19 test with the requirement that such tests are FDA-authorized. Therefore, dentists may submit claims to the patient’s medical plan for reimbursement. 

Q. How do I find the COVID-19 testing requirements? 

A. Information on how test results are reported, what must be reported and a sample reporting form are available in the ADA’s COVID-19 & Lab Testing Requirements Toolkit

Q. Is a signed consent form required from the patient prior to administering an in-office rapid COVID-19 test?

A. No, the rapid COVID-19 test is meant for screening the patient prior to dental treatment and does not provide a diagnosis, therefore a signed consent form is not required. If a patient has a positive test result, the dentist should route the patient to medical care, such as the patient’s primary care physician, for an evaluation and confirmation of a COVID-19 diagnosis.  

COVID-19 Vaccination Billing 

Q. Will medical plans reimburse a dentist for administering the influenza and COVID-19 vaccines?

A. The situation regarding vaccine administration remains fluid, and we are working closely with various agencies and partners to ensure the information provided to our members is timely and accurate.

The California Medical Association (CMA) offers the following resource for guidance on COVID-19 vaccine administration reimbursement and how to avoid delays and denials of claims: COVID-19 Vaccine Reimbursement Summary by Payor Type. CMA will be updating this resource as applicable. 

QCan I bill and/or collect payment directly from the patient for administering the influenza and/or COVID-19 vaccine? 

A. Since the federal government is supplying the vaccine at no cost, providers cannot bill for the vaccine itself, only the administration of the vaccine. Dentists may bill the patient’s medical carrier for vaccine administration, but there should be no patient cost for vaccine administration regardless of whether the service is provided by in-network or out-of-network providers. 

Q. Do I bill claims to medical plans the same way I bill dental plans?

A. No, you will need to reach out to your dental software vendor to see if your software is capable of billing medical claims in addition to dental claims. Medical plans process different claims forms - the CMS 1500 claim form. Keep in mind that medical plan claims submission requirements may differ. To avoid payment delay, you will need to inquire with the plan about their claims submission criteria prior to billing.

By clicking on the following hyperlinks you will be directed to information on medical claim billing for both Dentrix & Eagle Soft

Q. What coding system is used for medical coding?

A. Much like the ADA develops and maintains the CDT codes for dentistry, the AMA develops and maintains the Current Procedural Terminology (CPT®) system for medical billing. The system’s descriptive terminology and associated code numbers provide the most widely accepted medical nomenclature used to report medical procedures and services for processing claims. The CPT® system provides a universal coding approach to accurately report medical, surgical, and diagnostic procedures and services to medical plans.

Q. What claims form do I use when billing medical plans?

A. Unless otherwise instructed by the medical plan, utilize the CMS-1500 medical claims form

Q. Which CPT codes does one use when delivering the influenza or COVID-19 vaccine? 

A. You can find up-to-date CPT® coding guidance from the AMA  here; Find your COVID-19 Vaccine CPT Codes

Related Resources: 

Chapter 7 of the CDA Dental Benefit Plan Handbook - Billing Medical Plans 

American Dental Association COVID-19 toolkit 

California Medical Association COVID-19 VACCINE TOOLKIT FOR MEDICAL PRACTICES 

Department of Managed HealthCare ALL PLAN LETTER