How do you bill for the cost of upgraded services?

2014 11 26 15 37 13 490 Williams Doyle 200 has teamed with a former dental insurance executive to provide expertise to you and your staff for maximizing your patient's benefits. Twice a month, Doyle Williams, DDS, will give nuggets of advice to help your claims get approved.

Doyle Williams, DDS.Doyle Williams, DDS.

In a recent post on, a dentist asked for help in getting reimbursed for services thought to be upgrades to the services covered under a PPO contract. We will list some scenarios and provide advice generally, but each contract as a participating dentist is governed by its own rules, and you should consult an attorney with any specific questions you may have.

With the cost of gold rising, can I charge extra for the cost?

Unfortunately, it's unlikely. The CDT codes for precious metals include the materials, so generally they cannot be billed separately. One exception may be when a patient's schedule of covered services lists "crowns" rather than individual CDT codes. This may be interpreted as a base metal crown benefit, and any upgrades to that base metal could be disclosed to the patient so they can choose to upgrade the material and agree to the upcharge for the new material.

The denture code D5110 does not distinguish between a variety of materials that could be used. If a patient wants customization, a metal palate, porcelain teeth, and so on, how do I code for these things?

There are no codes to distinguish between types of dentures, as there are with types of crowns, implants, and fixed bridges. If you offer several types of removable prosthetics that differ in charges in your practice, you can use the unspecified code D5999 and describe the differences. A great idea is to provide a document to the patient that fully discloses your "base" prosthesis and what upgrades are available. The patient should sign an informed consent for anything they choose.

Doyle Williams, DDS, spent 24 years as an insurance executive.

The comments and observations expressed herein do not necessarily reflect the opinions of, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.

Page 1 of 174
Next Page