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Hi DTI2!
Great question. You're correct, it is far less common for a medical insurer to cover CBCT for a diagnosis of Obstructive Sleep Apnea (G47.33). It is typically deemed "not medically necessary" for that diagnosis at this point in time.
And yes, 70486 is the most common CPT code used to represent CBCT at this point in time. Heads up, it does typically require a pre-authorization for coverage!
Hope this helps :)
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Hi Courtney, this thread is great. I am interested in an update on CBCT coverage in obstructive sleep apnea cases, as in the case of a full time dental sleep practice medical billing. It seems like OSA cases are trickier than implants, TMJ, and reconstruction.
The specific medical insurances I'm curious about coverage for sleep tx are the following: BCBS, United, Tricare, and Medicare.
I know Medicare only pays under E0486(the appliance), so doesn't pay for the exam, imaging, etc.
Do the rest use 70486 or an unlisted tomography code or are there new codes for CBCT? Thank you for your help!
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Message was deleted by a Moderator. | Reason: Not specified
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Hi guest!
Great question. 70486 is the most common code used to represent cone beam CT's currently. For example, evicore's head imaging guidelines state the following:
Cone Beam CT: Report with CPT® Codes: CPT® 70486, CPT® 70487, CPT® 70488, CPT® 70480, CPT® 70482
However, we have run into some insurers that do not want cone beam CT reported with 70486 because it does not specify the word "cone beam" in its description, in which we typically suggest to consider 76102 or 76497 (Unlisted computed tomography procedure (eg, diagnostic, interventional))
Hope this helps!
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For TMJ CBCT can a CPT 76102 be used? And if we are taking separate open and closed view at same visit than can we bill 2 units for that code?
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Hi Guest!
I can't say if there is a different code used without knowing what code was submitted, however -
it may be worth it to check into medical insurance coverage for this instead of dental! Many medical insurers indicate CPT (medical)code 70486 for cone beam CT scan (UHC, for example).
Here are the dental codes for cone beam CT's:
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
Hope this helps!
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Hi-
My child needs her wisdom teeth out. She has had a lot of pain. On exam, the in network oral surgeon discovered one or her wisdom teeth had grown into or very close to the facial nerve. The surgeon's office submitted a claim for a cone beam to Northeast Delta Dental but it was denied. Is there another code that can be used to cover this test in this circumstance?
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Hi Guest!
No, it is not appropriate for a provider to bill both dental and medical insurance for the same procedure at the same time. However, it is common practice to bill one insurance first and if denied, bill to the other insurance. (for example, if the CBCT was billed to medical and denied as not medically necessary, may be billed to dental after the medical claim has completed processing).
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My son had a conebeam scan in an orthodontist's office for reviewing whether he needed another bone graft surgery or not ( history of cleft lip and palate ).
The hospital filed a claim for the conebeam with BOTH medical and dental insurance.
My question is this allowed to file two claims for one scan, and if so, is it allowed to submit a different charge for medical v. dental? I feel like they are charging me twice.
The dental code was D0364, cone beam less than whole jaw
The medical code was 70486, CAT scan of face/jaw
Thank you
ps I just got off the phone with the hospital, and they said the medical code was for the reading of the scan and that modifiers to this code would not show up on my eob. So I asked my insurance, and they said there were no modifiers. Still confused.
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Hi Michael!
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, and UHC's radiology medical policy does state this is the correct code to use 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 an option to use (keep in mind you'll need to provide a narrative description for unlisted codes) We also see practices billing out for "76102 - Radiologic examination, complex motion (ie, hypercycloidal) body section (eg, mastoid polytomography), other than with urography; bilateral"
Hope this helps!
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