Oregon Medical Bill Reviewer Training Program Unit 1:Professional Services Module 8: Dental Services & Hearing Aid Services
Hello, in this module, you will learn about Pathology and Laboratory services and guidelines. We’ll start by discussing the general guidelines, then move on to the different types of services. Overview • Dental Guidelines • Hearing Aid Guidelines
Dental Services Guidelines In Oregon, for dental service providers should submit the dental codes listed in the "Health Care Financing Administrative Common Procedure Coding System” (HCPCS). When CDT-1 (Current Dental Terminology) codes are billed, an edit will suspend the CDT-1 codes requiring a change to a valid HCPCS code. If an appropriate HCPCS code cannot be located, deny the charge with the suspending edit. The HCPCS Dental section ranges from D0120-D0478
Dental Services Guidelines Multiple Procedures in Separate Anatomical Fields. • When there are multiple procedures in separate Anatomical fields services must be billed with modifier 50. BR4 is automated to apply the proper reduction for the highest value and each additional field procedure. Dental services: • Are fully automated. • A cross check can be performed to verify pricing by manually pricing the procedures with the following percentages: • Highest valued procedure @ 100% • Each additional field procedure @ 70%
Dental Services Guidelines When multiple procedures are in the same anatomical field, they must be billed with modifier 51. BR4 is automated to apply the proper reduction for the highest value and each additional field procedure.
Hearing Aid Guidelines Hearing aids are considered prosthetic devices that assist in the performance of a natural function. Testing for hearing aids must be performed by a licensed audiologist or an otolaryngologist. The preferred types of hearing aids for most workers are programmable BTE, ITE, and CIC multi channel. Other types of hearing aids will be considered based on justification from the attending physician or authorized nurse practitioner. Without approval from the insurer or director, hearing aids should not exceed $5,000.00 for a pair of hearing aids, or $2,500.00 for a single hearing aid.
Summary Good Job! Dental Guidelines - HCPCS codes Dental Anatomical Fields Multiple Procedures Hearing Aid Guidelines