Rank: Guest
Joined: 9/8/2012(UTC)
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Good afternoon,
My husband had throat & tongue cancer and was doused with radiation on his mouth & neck area. Well like the Dr. mentioned back then it will have adverse affects on his teeth.Now he's faced with teeth falling out and due to the lack of sufficient saliva enamel on his teeth are gone. NOW his teeth are falling out or are infected. We are trying to see how we can get our insurance company to pay a portion of his procedure for implants. We are in the process of getting all the written medical documents form his dentist,radiologist, & from the oral MD doctor. But I know that there are different MEDICAL codes that can be used to get this streamlined to have them pay a portion. Or there has to be a way to present it to them where they accept that he IS NOT using this as a cosmetic procedure it's something that has been caused by a medical condition. HELP????
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Rank: Administration
Joined: 11/21/2012(UTC)
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Hi Guest!
I'm sorry you're going through this, it must be tough. We do see some medical plans offering coverage for dental services needed as a result of radiation or other medical treatments, however there are many medical insurance policies out there that will specify there is coverage available for dental services needed in preparation for radiation treatment, but not as a result of it unfortunately.
I would first check with your medical insurer to see if medically related dental services needed as a result of radiation therapy is a covered benefit or not.
If it is, then yes there are CPT (medical procedure) codes available to submit to your medical insurer for these services if your medical insurers does not process the "D" (dental) codes. For example, the CPT codes available for implants are:
21248 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial(3or less)
21249 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete (4 or more)
And of course there may be additional codes related to other procedures performed, depending on what all services are needed (i.e. office visits, xrays, bone grafts, etc).
Also - exactly what you're going as far as getting notes from the various doctors involved is always a plus in obtaining coverage for services.
Hope this helps!
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