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DPAP 212

Prior Placement Date


Provider Administrative Policy

Section
Information
Policy Date
April 2012
Status/Date
Revised/December 2012
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Blue Cross of Idaho works diligently on behalf of our members to develop contracting relationships with Idaho dental providers and Blue Cross Blue Shield dental affiliates (national Dental Grid).

 


Policy

Prior Placement Date

When you submit a claim for a major restoration that is a replacement of an existing dental prosthesis, mark YES in item 43 on the American Dental Association (ADA) Claim Form and enter the prior placement date (PPD) in item 44 of the ADA Claim Form. Please ensure your software isn't set to assign default values to items 43 and 44.

When you submit a claim for multiple services requiring a PPD:

  • You must enter the first claim line requiring a PPD in items 43/44 as indicated above.
  • Enter subsequent claim lines requiring a PPD with the tooth number(s) and additional PPD(s) in Remarks, item 35.

We will deny paper claims you submit without PPD(s) and electronic claims you submit without PPD(s) will error back from the clearinghouse. We will not accept prior placement dates over the phone; you must submit a corrected bill in writing or electronically.

The ADA Claim Form and electronic claim form require a date format of (MM/DD/CCYY). If you are not certain of the specific PPD, please enter a date as close as possible. Example: If patient previously had a tooth replaced by a crown, approximately 20 years ago, you could enter the PPD as 04/01/1992.

Note:  If you submit on a claim form other than the ADA Claim Form, please ensure appropriate items are populated with prior placement date.

The following CDT codes require a prior placement date:

 CDT Code(s)  Dental Procedure(s)
2390,
2710-2794
2929-2934
2970-2974
 Crowns (multiple crowns, and all anterior crowns)
2960 - 2962 Veneers

5110
5120 – 5140
5211 – 5214
5225 – 5226
5281
5860 – 5861

Prosthodontics, removable (dentures)

6205 - 6254
6545 - 6548
6710 - 6795

Prosthodontics, fixed (bridges)

NOTE:  Restorations may require an X-ray for medical necessity; refer to DPAP200 for a list of CDT codes that require an X-ray.


Policy History

Date Action Reason
December 2012 Revised Removed 2006 from ADA Claim Form throughout policy. Added 2013 CDT code D2929.
October 2012 Revised Added NOTE: Claim forms other than 2006 ADA Claim Form