Hi Guest!
Great question. We generally see coverage for CT scans for surgical cases, or at least when surgery is being contemplated. It depends on the insurer, but here is an example of some language from HealthPartner's medical policy titled:"Cone-beam computed tomography (CT) scan for medically-related dental services”
CBCT is covered for the following indications:
-Evaluation of dental implants when coverage criteria under the accidental dental medical coverage policy are met.
-Evaluation prior to one of the following oral surgery indications:
-Removal of maxillo-facial tumor, non-odontogenic cyst (cyst not originating from a tooth or
the closely surrounding tissues), neoplasm or other pathologic entities that, due to their
size and/or anatomic location, appear to encroach, impinge or are invested in/on critical
anatomic structures (e.g. inferior alveolar nerve, maxillary sinus);
-Arthroplasty of Temporomandibular (TM ) fossae or condyle, TM joint replacement;
-Developmental mid-face syndromes such as cleft palate, Treacher-Collins syndrome, etc;
-Surgical reconstruction after severe oral-facial trauma (such as injuries resulting from motor
vehicle accidents, gunshot wounds, boating accidents or other disfiguring trauma). In
addition, when CBCT is requested prior to an oral surgery listed as A-D above, one of the
following must also be satisfied:
-The panoramic radiograph indicates that a deviation from a routine surgical approach is
probable and further data necessary to plan such an approach; OR
-Information obtained by CBCT is considered critical in determining a surgical plan for
the avoidance of disruption, invasion, or fracture of a surrounding, critical oral-facial
structure.
-Evaluation prior to orthognathic surgery (to correct conditions of the jaw) when coverage
criteria under the orthognathic surgery coverage policy are met AND information obtained by
CBCT is considered critical in determining a surgical plan for the avoidance of disruption,
invasion or fracture of a surrounding, critical oral-facial structure.
Indications that are not covered include but may not be limited to:
-CBCT when used in conjunction with non-covered dental procedures including but not limited to dental implants or bone grafting in preparation for dental implants.
-CBCT for other medically-related dental indications not listed above as covered.
Now, as far as the code to use for a pre-auth:
There is actually not currently a specific CPT code for CBCT……the closest CPT code is: 70486 - Computed tomography, maxillofacial area; without contrast material. Many offices have been using this for some time for CBCT, however, some medical insurers are auditing that code when used for CBCT because the description does not specify “cone beam”.
So, “76497 - Unlisted computed tomography procedure (eg, diagnostic, interventional)” is a good CPT code to use, or, many medical insurers will process the “D” codes for procedures when there is not a specific CPT code available.
For example, here are the “D” codes from HealthPartner’s medical policy:
D0363 - Cone-Beam 3D multi image reconstruction
D0364 - Cone beam CT capture and interpretation with limited field of view - less than one whole jaw
D0365 - Cone beam CT capture and interpretation with field of view of one full dental arc - mandible
D0366 - Cone beam CT capture and interpretation with field of view of one full dental arch
- maxilla, with or without cranium
D0367 - Cone beam CT capture with interpretation with field of view of both jaws, with or without cranium
D0368 - Cone beam CT capture and interpretation for TMJ series including two or more exposures
D0380 - Cone beam CT image capture with limited field of view - less than one whole jaw
D0381 - Cone beam CT image capture with field of view of one full dental arch - mandible
D0382 - Cone beam CT image capture with field of view of one full dental arch - maxilla, with or without cranium
D0383 - Cone beam CT image capture with field of view of both jaws, with or without cranium
D0384 - Cone beam CT image capture for TMJ series including two or more exposures
Here is a link to the full policy:
https://www.healthpartne...?contentid=AENTRY_045861Hope this helps!