Diagnostic services performed for a child under the age of three, preferably within the first six months of the eruption of the first primary tooth, including recording the oral and physical health history, evaluation of caries susceptibility, development of an appropriate preventive oral health regimen and communication with and counseling of the child's parent, legal guardian and/or primary caregiver.

1. Key elements of D0145:

a. The goal is early intervention/development of a prevention plan - performed on patients under three years of age.

b. Includes diagnostic services:
i. Recording the oral and physical health history.
ii. Evaluation of caries susceptibility (risk assessment).
iii. Does the child have developmental problems?
iv. Does the primary caregiver have active caries?
v. Development of a plan to reduce the child's risk of caries.

c. Must also include counseling with the child's primary caregiver, which might include:
i. Instructions for cleaning child's teeth.
ii. Fluoride recommendations.
iii. Diet recommendations.
iv. Recommendations to reduce transmission of bacteria (e.g., antibacterial rinses, xylitol, saliva substitutes, etc.).

2. D0145 is an oral evaluation code for the patient who has not reached the age of three and must include counseling with the primary caregiver. Note that the D0145 oral evaluation is not identified as either "comprehensive" or "periodic." D0145 should be reported for the initial oral evaluation and may also be used for subsequent oral evaluation visits so long as the child remains under the age of three and counseling is provided at each visit. The code specifically includes preventive counseling with the primary caregiver.

3. Once the child reaches three years of age the periodic oral evaluation (D0120) would be reported. If the child is under three years of age at the time of the periodic oral evaluation, consider D0120 if no counseling is provided to the primary caregiver at the visit.

LIMITATIONS

1. When the child reaches three years of age or older report the comprehensive oral evaluation (D0150) at the first visit, or periodic oral evaluation (D0120), whichever applies to the child's current evaluation status. If D0145 has been reported previously, then a comprehensive evaluation has not technically been performed. However, if D0150 is reported at age three for the patient, many payors will provide the downgraded alternate benefit of D0120.

2. D0145 is often subject to the "one evaluation per six months" or "two evaluations per year" contract limitation each year.

TIPS

1. The descriptor for D0145 does not prevent one from reporting a prophylaxis (D1120) separately when performed on the same day as an oral evaluation of a patient under three years of age. If plaque is removed from a child's teeth, regardless of the technique, it can be reported as D1120. Likewise, if topical fluoride treatment (any type, except fluoride varnish) is applied, regardless of the number of teeth, report D1208. Report D1206 if fluoride varnish is applied. For children under the age of six, fluoride varnish (D1206) is now recommended by both the ADA and AAPD. Preventive procedures such as toothbrush deplaquing and fluoride applications can be reported separately when performed on the same service date as D0145.

2. D0145 may be reimbursed at the D0120 fee level by some payors. However, in most cases the reimbursement for D0145 is higher than D0120. Note that in some states Medicaid reimburses D0145 at a higher Maximum Plan Allowance (MPA) level than