DentalWriter Forum

Your central resource for DentalWriter posts, blogs, training resources, faq's, and more.

Notification

Icon
Error

Post Reply
pvanwalleghem
#1 Posted : Monday, July 23, 2018 1:34:36 PM(UTC)
Quote
pvanwalleghem

Rank: New Member

Joined: 8/13/2014(UTC)
Posts: 1

Thanks: 1 times


How do I bill 3-d imaging with interpretation & reporting to Blue cross or Medicare, for sleep apnea? Do I bill more then one code? Is the diagnosis code the same? Do I need a modifier?
courtneydsnow
#2 Posted : Tuesday, July 24, 2018 7:40:19 AM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,611

Thanks: 39 times
Was thanked: 51 time(s) in 51 post(s)
Hi

Great question. Many practices use 76376 for the rendering with interpretation & reporting part of the CBCT. For the CBCT itself, many practices use CPT 70486. Here are the full descriptions of 70486, 76376, and 76377 below:

70486 - Computed tomography, maxillofacial area; without contrast material

76376 - 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; 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 postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation

**The codes 76376 and 76377 are both used to report 3D rendering postprocessing. The difference between them is 76376 does not require postprocessing on an independent workstation whereas 76377 does require the use of an independent workstation.

As for billing particular insurers for these imaging services, we do find that some insurers (i.e. medicare) will require that you are actually accredited through a radiology program in order to reimburse providers for what they consider “advanced imaging”.

Also, many insurers will require pre-authorization for these “advanced imaging” services as well.

And just a heads up, while CBCT is often covered for surgical & pre-surgical cases, you may run into medical insurers that say CBCT is not medically necessary for diagnosis or treatment of OSA.

Hope this helps!
Guest
#3 Posted : Wednesday, March 6, 2019 4:28:30 PM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 16,844

Was thanked: 16 time(s) in 15 post(s)
Courntey,

Do you have any idea what the PPO insurance companies are typically paying for the oral appliance(E0486)?

A company reached out to me about becoming in network as they typically get their doctors $4,500 per case as an in network provider.
courtneydsnow
#4 Posted : Thursday, March 7, 2019 12:57:36 PM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,611

Thanks: 39 times
Was thanked: 51 time(s) in 51 post(s)
Hi Guest!

Great question. From polls from our clients and records from our medical billing service, the average allowed amount for E0486 across the nation is approx $3000. (so 4500 is a great offer!). Some insurers allow as low as around $1000 for E0486, while some as high as $5-6,000, although that higher end is fairly rare.

Hope this helps!
Sabrina
#5 Posted : Friday, March 15, 2019 11:34:41 AM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 16,844

Was thanked: 16 time(s) in 15 post(s)
Are the numbers from you poll based off of in network rates or out of network rates?





Originally Posted by: courtneydsnow Go to Quoted Post
Hi Guest!

Great question. From polls from our clients and records from our medical billing service, the average allowed amount for E0486 across the nation is approx $3000. (so 4500 is a great offer!). Some insurers allow as low as around $1000 for E0486, while some as high as $5-6,000, although that higher end is fairly rare.

Hope this helps!


courtneydsnow
#6 Posted : Tuesday, March 19, 2019 7:35:03 AM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,611

Thanks: 39 times
Was thanked: 51 time(s) in 51 post(s)
Hi Sabrina!

The majority of the figures are out of network, but there is a small percentage of in-network figures that go into that.
johnedward
#7 Posted : Friday, May 27, 2022 6:58:13 AM(UTC)
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 16,844

Was thanked: 16 time(s) in 15 post(s)
Message was deleted by a Moderator. | Reason: Not specified
Guest
#8 Posted : Friday, June 14, 2024 11:43:28 AM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 16,844

Was thanked: 16 time(s) in 15 post(s)
Hi Is there a code for impressions for a sleep appliance. I saw a code 21085, is that a code that gets reimbursement or is there one we can use? Thank you in advance
Quick Reply Show Quick Reply
Post Reply
Forum Jump  
You cannot post new topics in this forum.
You can reply to topics in this forum.
You can delete your posts in this forum.
You can edit your posts in this forum.
You cannot create polls in this forum.
You can vote in polls in this forum.