Suggested Fee Guide for Dental Hygienists
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1 Suggested Fee Guide for Dental Hygienists January 1, 2016
2 USER GUIDE FOR DENTAL HYGIENISTS The content, organization and management of dental hygiene care is guided by the principle of accessibility for all Canadians to comprehensive oral health care and the promotion of oral health as an integral component of general health. The purpose of this Fee Guide is to provide guidance to dental hygienists in Ontario in setting the fees that they charge for their professional services. It is a guide only; adherence to the guide is not obligatory. Each dental hygienist will set his or her fees to reflect practice realities and local circumstances and requirements. Dental hygienists must follow their code of ethics and standards of practice when determining the value of a dental hygiene service. This Fee Guide uses the CDHA National List of Service Codes that has been produced by the Canadian Dental Hygienists Association (CDHA). The CDHA states that the National Dental Hygiene System of Service is not intended for use by dental hygienists employed within traditional dental offices or in provinces where this type of public access to dental hygiene care has not been legislated. Dental Hygiene Claim Form To protect themselves from copyright infringements, it is important that all Ontario dental hygienists who are submitting insurance claims use either the standard dental hygiene claim form attached to this Fee Guide and available on the ODHA website or if they are members of CDHA, the CDHA Dental Hygiene Claim Form. Review ODHA will periodically review the suggested fees and will submit any suggestions for the coding system to the CDHA so it can take these under advisement in its own review. Members are encouraged to submit their evidence-based feedback to the ODHA in writing. Members and third parties are reminded that the suggested fees contained in the Fee Guide were prepared by the Ontario Dental Hygienists Association to provide a guideline of fees considered to be fair and reasonable. The suggested fees are a guideline only. The suggested fees are not binding on any dental hygienist or third party billing or paying for dental hygiene services, and there is no obligation to follow the suggested fees in the Fee Guide.. No part of this work covered by the publisher s copyright may be reproduced or copied in any form or by any means (graphic, electronic or mechanical, including photocopying, recording, recording taping, or information and retrieval systems) without the written permission of the publishers. Page 2 of 8
3 In this fee guide: + lab means that an additional laboratory expense may be assessed with the procedure code the code for laboratory expense is exp means that additional expenses such as courier costs may be assessed with the procedure code the code for an additional expense is Code / Service ODHA 2016 suggested fee Examination/Assessment - new client Primary $36.38 Mixed $54.57 Permanent $90.94 Edentulous $36.38 Periodontal $ Examination/Assessment previous client Routine recall $26.53 Specific $26.53 to $59.69 Emergency $26.53 to $59.69 Periodontal, limited $26.53 to $ First dental hygiene visit/orientation $ Radiographs Intraoral bitewing 1 image $ images $ images $ images $ images $ images $ Intraoral periapical 1 image $ images $ images $ images $ images $ images $ images $ images $38.08 each additional image > $ Intraoral, full mouth series minimum 14 images $ Panoramic 1 image $ Cephalometric 1 image $50.08 each additional image > $17.05 Page 3 of 8
4 00260 Duplication of radiographs 1 image $ images $ images $ images $ images $ images $ images $ images $17.73 each additional image > $ Photographs 1 photo $ photos $ photos $23.87 each additional photograph > $ Microbiological and histological tests Caries susceptibility bacteriological test $18.09 to $ lab Periodontal disease activity microbiological test $18.09 to $ lab Cancer testing cytological smear $ lab + exp vital staining $36.17 direct fluorescence $ Study models taking impressions $32.40 fabrication/pouring/preparing casts $ lab Periodontal treatment (each unit of time is 15 minutes) Debridement 1 unit of time $ units of time $ units of time $ units of time $ units of time $ units of time $ ½ unit of time $26.53 each additional unit of time > $ Root planning 1 unit of time $ units of time $ units of time $ units of time $ units of time $ units of time $ ½ unit of time $26.53 each additional unit of time > $ Stain removal 1 unit of time $ units of time $61.39 ½ unit of time $15.35 each additional unit of time > $30.69 Page 4 of 8
5 00540 Subgingival periodontal irrigation 1 unit of time $44.74 ½ unit of time $22.37 each additional unit of time $ Management of oral mucosal disorders 1 unit of time $ units of time $ units of time $ units of time $ ½ unit of time $18.09 each additional unit of time > $ Management of oral manifestations of systemic disease 1 unit of time $ units of time $ units of time $ units of time $ ½ unit of time $18.09 each additional unit of time > $ Gingival curettage 1 sextant $ sextants $ sextants $ sextants $ sextants $ sextants $ Intrasulcular application of chemotherapeutic agents 1 unit of time $ exp ½ unit of time $ exp each additional unit of time $ exp Other oral services (each unit of time is 15 minutes) Sealants 1st tooth in quadrant $21.22 each additional tooth in quadrant $ Application of anticariogenics/antimicrobials 1 unit of time $ exp ½ unit of time $ exp each additional unit of time $ exp Fluoride applications Topical in office $20.46 Supervised, self-administered office $15.34 Home - custom maxillary arch $ lab Home - custom mandibular arch $ lab Home - custom combined $ lab Finishing restoration 1 unit of time $ units of time $ units of time $ units of time $ ½ unit of time $15.35 each additional unit of time > $ Mouth protectors preformed maxillary arch $ exp Page 5 of 8
6 preformed mandibular arch $ exp preformed maxillary & mandibular arches $ exp processed maxillary arch $ lab processed mandibular arch $ lab processed maxillary & mandibular arches $ lab Labeling removable prosthesis labeling removable prosthesis $ exp Desensitization 1 unit of time $ units of time $79.58 ½ unit of time $19.89 each additional unit of time > $ Bleaching vital teeth in office 1 unit of time $ exp 2 units of time $ exp 3 units of time $ exp ½ unit of time $ exp each additional unit of time > $ exp Bleaching vital teeth at home maxillary arch $ lab + exp mandibular arch $ lab + exp maxillary and mandibular arch $ lab + exp Placement temporary restorations 1st tooth in quadrant $57.52 each added tooth same quadrant $ Recementation 1 unit of time $ units of time $ units of time $ ½ unit of time $28.76 each additional unit of time > $ Pulp vitality testing 1 unit of time $37.51 ½ unit of time $18.76 each additional unit of time $ Denture/removable prosthesis prophylaxis and polishing 1 unit of time $ lab ½ unit of time $ lab each additional unit of time $ lab Pain management (each unit of time is 15 minutes) Electronic dental anaesthesia 1 unit of time $ units of time $ units of time $ units of time $48.77 ½ unit of time $31.45 each additional unit of time > $3.75 Page 6 of 8
7 00720 Local anaesthesia regional block $13.64 trigeminal division block $13.64 supraperiosteal infiltration $ Acupuncture 1 unit of time $ units of time $ units of time $ units of time $48.77 ½ unit of time $31.45 each additional unit of time > $ Nitrous oxide, conscious sedation 1 unit of time $ units of time $ units of time $ units of time $ ½ unit of time $28.42 each additional unit of time > $56.84 Education and habit modification (each unit of time is 15 minutes) Counseling for diet 1 unit of time $ units of time $ units of time $ units of time $ ½ unit of time $19.89 each additional unit of time > $ Counseling for tobacco use cessation 1 unit of time $ units of time $ units of time $ units of time $ ½ unit of time $19.89 each additional unit of time > $ Counseling for oral self-exam 1 unit of time $ units of time $ units of time $ units of time $ ½ unit of time $19.89 each additional unit of time > $ Instruction in oral self care 1 unit of time $ units of time $ units of time $ units of time $ ½ unit of time $19.89 each additional unit of time > $39.79 Page 7 of 8
8 00850 Group presentations (including preparation) 1 unit of time $ units of time $ units of time $ units of time $ ½ unit of time $19.89 each additional unit of time > $ Oral myofunctional therapy 1 unit of time $ units of time $ each additional unit of time > $ Outcome evaluation (each unit of time is 15 minutes) Evaluation of dental hygiene care 1 unit of time $ units of time $79.58 ½ unit of time $19.89 each additional unit of time > $ Professional communications / case presentations 1 unit of time $ units of time $79.58 ½ unit of time $19.89 each additional unit of time > $ Mobile services Home visit $33.16 to $66.33 Institutional visit $33.16 to $66.33 Emergency home visit $50.02 to $93.79 Emergency institutional visit $50.02 to $ Exceptional client 1 unit of time $ units of time $ units of time $ units of time $ each additional unit of time > $ Laboratory and expense services + lab exp Page 8 of 8
9 Top section of form is completed by dental hygienist : Standard Dental Hygiene Claim Form CLIENT Last name: First name: Address: Unit/Apt#: Prov: City: Postal Code: DENTAL HYGIENE PRACTICE CDHO Registration # Name: Address: Suite#: Prov: Telephone: City: Postal Code: Fax: I hereby assign my benefits payable from this claim to the dental hygienist identified here and authorize payment directly to him/her. (signature of subscriber) For additional notes, assessment, special considerations: I understand that the fees listed in this claim may not be covered by my plan or may exceed the benefits of my plan. I acknowledge that I am responsible for the total fee shown below to the dental hygienist identified above and further acknowledge that the said fee is accurate. I agree to the release by the dental hygienist of any information necessary with respect to this claim to my insurance company or plan administrator. Service provided: Date of service day mo yr Description of service provided (signature of client/parent/guardian) Procedure code Intl. Tooth code Dental hygienist s fee Laboratory or Expense charge Total This is an accurate statement of services performed and the total fee dues and payable: Total fee for service CDHO reg n# - (dental hygienist signature) Employee/Plan member/subscriber Information: Group policy/plan# Division/section# Employee/plan member/subscriber name (please print) Employer Insurer/agency/plan Certificate#/S.I.N.#/ID# Employee/member/subscriber date of birth day mo year Client Information: Relationship to employee/plan member/subscriber Client date of birth day mo year If child: student disabled Name of school (if not self) Are any of the services provided under any other Group Insurance, Dental, WSIB or Government Plan? yes If yes, plan name and # no Is any of the required treatment as the result of an accident? yes no If yes, provide details separately I hereby authorize the release of any information or records requested in respect of this claim to the insurer/plan administrator and certify that the information given is true, accurate and complete to the best of my knowledge. signature of employee/plan member/subscriber date
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