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DPAP 213

Clinical Oral Evaluations


Provider Administrative Policy

Section
Information
Policy Date
November 2012
Status/Date
New/November 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

Clinical Oral Evaluations

Clinical oral evaluations include the evaluation, diagnosis and treatment planning for a patient. Dentists (general practitioner or specialist) must perform these services. Clinical oral evaluations also include the examination, components of which can be delegated to ancillary staff. Only one clinical oral evaluation is billable per patient, per provider, per day. Effective for dates of service beginning January 1, 2013 when a dentist bills more than one clinical oral evaluation for the same patient on the same day, we will deny the second clinical oral evaluation as provider liability. Clinical oral evaluations are represented by the following codes:

  • D0120 - Periodic oral evaluation-established patient
  • D0140 - Limited oral evaluation-problem focused
  • D0145 - Oral evaluation for a patient under three years of age and counseling with primary caregiver
  • D0150 - Comprehensive oral evaluation-new or established patient
  • D0160 - Detailed and extensive oral evaluation-problem focused, by report
  • D0170 - Re-evaluation-limited, problem focused (established patient; not post-operative visit)
  • D0180 - Comprehensive periodontal evaluation-new established patient

Policy History

Date Action Reason