Billing Guide for D0230 (Intraoral - periapical each additional radiographic image)
Solutions
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Description
Billing Guidelines, Tips and Reminders for D0150 (Intraoral - periapical each additional radiographic image)
February 02, 2025
WARNING
The use of a dual pack (two images taken with a single radiation) is not reported as an additional radiograph.
COMMENTS
1. Report D0230 for each additional periapical radiographic image taken after the first image on the same service date.
2. Periapicals associated with an endodontic diagnosis on a date prior to endodontic definitive treatment are typically reimbursed. If the diagnostic PA is taken on the day endodontic treatment is started, report the (PA) periapical radiograph as it still may be reimbursed. "Working and post-treatment" images associated with endodontic treatment are part of the global endodontic fee. Post-operative diagnostic images taken of the treated tooth within 30 days of the completion of a root canal are typically included in the overall, global endodontic fee.
3. The type and sequence of diagnostic images should be determined and ordered by the dentist based on the patient's needs. This determination is based on risk assessment, observation, and dental necessity. Images should not be taken based on the patient's plan benefits or limitations. Patient documentation should contain the dentist's written evaluation of the diagnostic images taken.
4. Enter the tooth number or range of teeth numbers being evaluated in Box 27 of the 2024 ADA Dental Claim Form.
LIMITATIONS
1. Periapical radiographic images at emergency visits are routinely reimbursed. However, the taking of routine periapicals with bitewings at checkups may require a narrative (required more and more). A caries risk assessment demonstrating increased risk, if appropriate, (D0602/D0603) may help justify periapicals at the recare visit taken in conjunction with bitewings. Several payors are cracking down on periapicals routinely taken with bitewings at a recare visit by some payors.
2. If a number of periapicals and bitewing radiographic images are taken on the same service date and the fee for those images is equal to or greater than the comprehensive series, the fee reimbursed will generally be limited to that of the comprehensive series. The payment of the comprehensive series will trigger the "once every 3-5 year limitation." If a comprehensive series is reimbursed, a notation should be made in the patient's billing record for future reference.
3. Reimbursement for periapical images, if reported in conjunction with bitewing images, may be limited by some players. Some plans now require a narrative for periapicals and the findings for periapicals taken at the recare visit.
4. For intraoral periapical radiographic image, image capture only, see D0707.
5. For intraoral tomosynthesis - periapical radiographic image, see D0374. For image capture only, see D0389.
TIPS
1. One, two, or three periapical images may be reimbursed on a problem focused evaluation (D0140) service date. Periapical images taken at the problem focused visit typically do not affect the "once per year/12 months" limitations for bitewing images associated with recare visits.
2. Intra-oral periapical first image (D0220) and an additional periapical image(s) (D0230) are often payable at any visit (including recare), if medically necessary. At an emergency, problem focused oral evaluation (D0140) or periodic oral evaluation (D0120) recare visit, the periapical image reimbursement may be subject to a deductible as well as the maximum fee limitation for multiple diagnostic images. Some plans limit reimbursement for periapical images taken in conjunction with bitewing images on the same service date.
3. Periapicals, particularly at different "angles," are often necessary to provide alternate views of the anatomy of an area for a complete diagnosis. Two periapicals may be a better choice at the emergency visit from a reimbursement perspective as well as from the clinical perspective. A billed single bitewing at the emergency visit may trigger limitations, affecting two/four bitewing reimbursement at the recare visit.
The use of a dual pack (two images taken with a single radiation) is not reported as an additional radiograph.
COMMENTS
1. Report D0230 for each additional periapical radiographic image taken after the first image on the same service date.
2. Periapicals associated with an endodontic diagnosis on a date prior to endodontic definitive treatment are typically reimbursed. If the diagnostic PA is taken on the day endodontic treatment is started, report the (PA) periapical radiograph as it still may be reimbursed. "Working and post-treatment" images associated with endodontic treatment are part of the global endodontic fee. Post-operative diagnostic images taken of the treated tooth within 30 days of the completion of a root canal are typically included in the overall, global endodontic fee.
3. The type and sequence of diagnostic images should be determined and ordered by the dentist based on the patient's needs. This determination is based on risk assessment, observation, and dental necessity. Images should not be taken based on the patient's plan benefits or limitations. Patient documentation should contain the dentist's written evaluation of the diagnostic images taken.
4. Enter the tooth number or range of teeth numbers being evaluated in Box 27 of the 2024 ADA Dental Claim Form.
LIMITATIONS
1. Periapical radiographic images at emergency visits are routinely reimbursed. However, the taking of routine periapicals with bitewings at checkups may require a narrative (required more and more). A caries risk assessment demonstrating increased risk, if appropriate, (D0602/D0603) may help justify periapicals at the recare visit taken in conjunction with bitewings. Several payors are cracking down on periapicals routinely taken with bitewings at a recare visit by some payors.
2. If a number of periapicals and bitewing radiographic images are taken on the same service date and the fee for those images is equal to or greater than the comprehensive series, the fee reimbursed will generally be limited to that of the comprehensive series. The payment of the comprehensive series will trigger the "once every 3-5 year limitation." If a comprehensive series is reimbursed, a notation should be made in the patient's billing record for future reference.
3. Reimbursement for periapical images, if reported in conjunction with bitewing images, may be limited by some players. Some plans now require a narrative for periapicals and the findings for periapicals taken at the recare visit.
4. For intraoral periapical radiographic image, image capture only, see D0707.
5. For intraoral tomosynthesis - periapical radiographic image, see D0374. For image capture only, see D0389.
TIPS
1. One, two, or three periapical images may be reimbursed on a problem focused evaluation (D0140) service date. Periapical images taken at the problem focused visit typically do not affect the "once per year/12 months" limitations for bitewing images associated with recare visits.
2. Intra-oral periapical first image (D0220) and an additional periapical image(s) (D0230) are often payable at any visit (including recare), if medically necessary. At an emergency, problem focused oral evaluation (D0140) or periodic oral evaluation (D0120) recare visit, the periapical image reimbursement may be subject to a deductible as well as the maximum fee limitation for multiple diagnostic images. Some plans limit reimbursement for periapical images taken in conjunction with bitewing images on the same service date.
3. Periapicals, particularly at different "angles," are often necessary to provide alternate views of the anatomy of an area for a complete diagnosis. Two periapicals may be a better choice at the emergency visit from a reimbursement perspective as well as from the clinical perspective. A billed single bitewing at the emergency visit may trigger limitations, affecting two/four bitewing reimbursement at the recare visit.