CDT 2015 Code Change Summary New codes effective 1/1/2015

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1 CDT 2015 Code Change Summary New codes effective 1/1/2015 Code Nomenclature Delta Dental Policy D0171 Re-Evaluation Post Operative Office Visit Not a Covered Benefit D0351 3D Photographic Image Not a Covered Benefit D1353 Sealant Repair per tooth D6110 D6111 D6112 D6113 D6114 D6115 D6116 D6117 Implant/Abutment Supported Removable Denture for Edentulous Arch Maxillary Implant /Abutment supported removable denture for Edentulous Arch Mandibular Implant /Abutment Supported Removable Denture for Partially Edentulous Arch Maxillary Implant /Abutment Supported Removable Denture for Partially Edentulous Arch Mandibular Implant /Abutment Supported Fixed Denture for Edentulous Arch Maxillary Implant /Abutment Supported Fixed Denture for Edentulous Arch Mandibular Implant /Abutment Supported Fixed Denture for Partially Edentulous Arch Maxillary Implant /Abutment Supported Fixed Denture for Partially Edentulous Arch Mandibular D6549 Resin Retainer for Resin Bonded Fixed Prosthesis D9219 Evaluation for Deep Sedation or General Anesthesia D9931 Cleaning and Inspection of a Removable Appliance Not a Covered Benefit D9986 Missed Appointment Not a Covered Benefit D9987 Cancelled Appointment Not a Covered Benefit Codes with nomenclature and/or descriptor changes There are no policy changes resulting from any nomenclature or descriptor changes D0350 D0481 D1208 D1550 2D oral/facial photographic image obtained intra-orally or extra-orally Nomenclature Changes: electron microscopy diagnostic - Descriptor Changes: An extreme high magnification diagnostic procedure that enables identification of cell components and microorganisms that are otherwise not identifiable under light microscopy. topical application of fluoride - excluding varnish re-cement or rebond space maintainer 1

2 D2910 D2915 D2920 D2975 D3351 D4249 D4260 D4261 D6058 D6059 D6060 D6061 D6062 D6063 D6064 D6065 D6066 D6067 D6068 D6069 D6070 Recement or rebond inlay, onlay, veneer or partial coverage restorations re-cement or rebond cast indirectly fabricated or prefabricated post and core re-cement or rebond crown Descriptor Changes: A thin covering of the remaining coronal portion of a tooth, usually fabricated of metal and devoid of anatomic contour,. This is to that can be used as a definitive restoration. apexification/recalcification initial visit (apical closure / calcific repair of perforations, root resorption, pulp space disinfection, etc.) Descriptor Changes: This procedure is employed to allow restorative procedure or crown on a tooth with little or no tooth structure exposed to the oral cavity. Crown lengthening requires reflection of a full thickness flap and removal of bone to alter the crown to root ratio. It is performed in a healthy periodontal environment, as opposed to osseous surgery, which is performed in the presence of periodontal disease. Where there are adjacent teeth, the flap design may involve a larger surgical area. osseous surgery (including elevation of a full thickness flap and closure) four or more contiguous teeth or tooth bounded spaces per quadrant osseous surgery (including elevation of a full thickness flap and closure) one to three contiguous teeth or tooth bounded spaces per quadrant abutment on an implant; may. stabilized by an abutment on an implant; may. stabilized by an abutment on an implant; may. stabilized by an abutment on an implant. Crown supported by an abutment on an implant; crown may implant. Crown supported by an abutment on an implant; crown may stabilized by an implant. Supported by an abutment on an implant; crown may be screw retained or cemented. Descriptor Changes: A single cast metal or milled crown restoration that is retained, supported and stabilized by an implant. Supported by an abutment on an implant; crown may be screw retained or cemented. Descriptor Changes: A ceramic FPD retainer for a fixed partial denture that gains retention, support and stability from an abutment on an implant. Supported by an abutment on an implant; crown may. crown may. crown may. 2

3 D6071 D6072 D6073 D6074 D6075 D6076 D6077 D6092 D6093 D6094 D6101 D6102 D6103 D6194 D6930 D7285 D7286 crown may. Descriptor Changes: A ceramic cast metal FPD retainer for a fixed partial denture that gains retention, support and stability from an abutment on an implant. supported by an abutment on an implant; crown may Descriptor Changes: A ceramic FPD cast metal retainer for a fixed partial denture that gains retention, support and stability from an abutment on an implant. Supporte4d by an abutment on an implant; crown may Descriptor Changes: A ceramic FPD cast metal retainer for a fixed partial denture that gains retention, support and stability from an abutment on an implant. Supported by an abutment on an implant; crown may. Descriptor Changes: A ceramic FPD retainer for a fixed partial denture that gains retention, support and stability from an implant. Supported by an implant; crown may. Descriptor Changes: A ceramic FPD metal-ceramic retainer for a fixed partial denture that gains retention, support and stability from an implant. Supported by an abutment on an implant; crown may Descriptor Changes: A ceramic FPD cast metal retainer supported by an abutment on an implant; crown may. for a fixed partial denture that gains retention, support and stability from an implant. re-cement or rebond implant/abutment supported crown re-cement or rebond implant/abutment supported fixed partial denture abutment on an implant. May be cast or milled. Supported by an abutment on an implant; crown may debridement of a periimplant defect or defects surrounding a single implant, and surface cleaning of the exposed implant surfaces, including flap entry and closure debridement and osseous contouring of a periimplant defect; or defects surrounding a single implant, and surface cleaning includes surface cleaning of the exposed implant surfaces and,including flap entry and closure bone graft for repair of periimplant defect does not includeing flap entry and closure. or, when indicated, Placement of a barrier membrane or biologic materials to aid in osseous regeneration are reported separately Descriptor Changes: A retainer for a fixed partial denture that gains retention, support and stability from an abutment on an implant. May be cast or milled and is screw. re-cement or rebond fixed partial denture Nomenclature Changes: incisional biopsy of oral tissue-hard (bone, tooth) Descriptor Changes: For partial removal of specimen only. This code procedure involves biopsy of osseous lesions and is not used for apicoectomy/periradicular surgery. This procedure does not entail an excision. Nomenclature Changes: incisional biopsy of oral tissue-soft Descriptor Changes: For partial removal of an architecturally intact specimen only. This code is not used at the same time as codes for apicoectomy/periradicular curettage. This procedure does not entail an excision. 3

4 D7292 D7293 D7294 D8660 D8670 D8693 D9221 D9241 D9242 D9248 Nomenclature Changes: surgical placement: of temporary anchorage device [screw retained plate] requiring surgical flap; includes device removal Descriptor Changes: Insertion of a temporary skeletal anchorage device that is attached to the bone by screws and requires a surgical flap. Includes device removal. Nomenclature Changes: surgical placement: of temporary anchorage device requiring surgical flap; includes device removal Descriptor Changes: Insertion of a device for temporary skeletal anchorage when a surgical flap is required. Includes device removal. Nomenclature Changes: surgical placement: of temporary anchorage device without surgical flap;includes device removal Descriptor Changes: Insertion of a device for temporary skeletal anchorage when a surgical flap is not required. Includes device removal. Nomenclature Changes: pre-orthodontic treatment visit examination to monitor growth and development Descriptor Changes: Periodic observation of patient dentition, at intervals established by the dentist, to determine when orthodontic treatment should begin. Diagnostic procedures are documented separately. periodic orthodontic treatment visit (as part of contract with patient) rebonding or recementing of fixed retainers Descriptor Changes: Anesthesia time begins when the doctor administering the anesthetic agent initiates the appropriate anesthesia and non-invasive monitoring protocol, and remains in continuous attendance of the patient. Anesthesia services are considered completed when the patient may be safely left under the observation of trained personnel and the doctor may safely leave the room to attend to other patients or duties. The level of anesthesia is determined by the anesthesia provider s documentation of the anesthetic s effects upon the central nervous system and not dependent upon the route of administration. intravenous moderate (conscious) sedation/analgesia first 30 minutes Nomenclature Changes: intravenous moderate (conscious) sedation/analgesia each additional 15 minutes Descriptor Changes: Anesthesia time begins when the doctor administering the anesthetic agent initiates the appropriate anesthesia and non-invasive monitoring protocol, and remains in continuous attendance of the patient. Anesthesia services are considered completed when the patient may be safely left under the observation of trained personnel and the doctor may safely leave the room to attend to other patients or duties. Nomenclature Changes: non-intravenous moderate( conscious) sedation Descriptor Changes: A medically controlled state of depressed consciousness while maintaining the patient s airway, protective reflexes and the ability to respond to stimulation or verbal commands. It includes non-intravenous administration of sedative and/or analgesic agent(s) and appropriate monitoring. The level of anesthesia is determined by the anesthesia provider s documentation of the anesthetic s effects upon the central nervous system and not dependent upon the route of administration. Deleted codes D6053** D6054** implant/abutment supported removable denture for completely edentulous arch implant/abutment supported removable denture for partially edentulous arch 4

5 D6078** D6079** D6975 implant/abutment supported fixed denture for completely edentulous arch implant/abutment supported fixed denture for partially edentulous arch coping ** These codes have been broken out into new procedure codes listed above 5

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