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Dental coding with Kyle: Occlusal guards

The reasons for determining insurance coverage and non-coverage have not changed, but the CDT codes have.

Out with the old CDT code!

D9940 Occlusal guard, by report

In with the new CDT codes!

• D9944 Occlusal guard–Hard appliance, full arch • D9945 Occlusal guard–Soft appliance • D9946 Occlusal guard–Hard appliance, partial arch

The reasons that insurance companies may cover include:

• Some plans will provide a benefit for a patient suffering the effects of bruxism. • Some plans will provide a benefit for an occlusal guard, but only if the patient has a six-month prior to fabrication history of periodontal treatment, such as scaling and root planing and osseous surgery.

The reasons insurance companies may deny include:

• Failure to use one of the new 2019 CDT codes listed above • Failure to indicate on the ADA claim form the reason for fabrication of the appliance • Annual maximum has been absorbed • Frequency and limitations play an important role in coverage. Be sure to find out if the patient has a fabrication history of an occlusal guard appliance.

Always keep in mind that it is recommended the office send in a pretreatment authorization, which includes radiographs and periodontal charting, to ensure a smooth claim determination process.


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