Billing Guide for D0330 (Panoramic Radiographic Image)
Solutions
-
Description
Billing Guidelines, Tips and Reminders for D0330 (Panoramic Radiographic Image)
February 02, 2025
WARNING
1. It is misleading to report or "upcode" an extra-oral panoramic radiographic image (D0330) and bitewing images (D0272/ D0273/D0274) to an intra-oral comprehensive series (D0210) if performed on the same service date. Although payors may "remap" or reimburse at a comprehensive series fee level, the provider should not report a procedure that was not performed. If both (D0330) and (D0272/D0273 or D0274) are taken on the same service date, report the procedures separately. Report the procedure(s) performed on the date the service was performed. Note: It is not illegal or improper for a payor to reimburse a submitted code at a rate assigned another code. These alternate benefit reimbursements are explained in that plan's contract language. Payors routinely convert separately coded extra-oral panoramic image and intra-oral bitewing radiographic images to the lower, global comprehensive series (D0210) UCR fee.
Note: The date of service of any radiograph is the date they are interpreted, not the date they are taken. However, when panoramic and bitewing radiographs are taken on the same service date but then routinely split into different dates for interpretation in order to circumvent remapping by the payor to comprehensive series (D0210), this may be seen as a misrepresentation of treatment dates to gain increased reimbursement.
2. A panoramic radiographic image (D0330) is extra-oral, not intra-oral. A comprehensive series (D0210) is intra-oral.
WATCH
1. Practices should not have a protocol in place to delineate a specific time interval for the panoramic radiographic image (D0330). The panorex interval should be individually prescribed and ordered by the dentist based on ADA/FDA radiographic frequency recommendations, not insurance reimbursements. (D0330 is typically reimbursed every three to five years if deemed dentally necessary.)
2. Do not convert or "upcode" a radiographic image (D0330) and bitewing radiographic image (D0272, D0273 or D0274) to a comprehensive series (D0210). A panoramic radiographic image is an extra-oral radiographic image, not intra- oral. A comprehensive series (D0210) is a set of intra-oral radiographic images. It is improper/misleading to report a panorex and bitewings as a full mouth series. Report D0330 and D0274/D0273 or D0274 separately, as actually performed. The payor is allowed to re-map individual diagnostic images to a comprehensive series code as an alternate reimbursement. The payor may do this in accordance with specific policy limitations and exclusions of the contract. The contract may allow:
a. Conversion or re-mapping a panorex and bitewings to a comprehensive radiographic image series (D0210) payor's fee. (A comprehensive series is typically reimbursed at a lower fee than the panorex and bitewings reimbursed separately.)
b. Reimbursement for the bitewing radiographic images and panoramic radiographic images separately. The best result. c. Reimbursement for a panoramic radiographic image only and nothing for the bitewing radiographic images. This is the worst result.
3. Some CBCT's can generate a 2D panoramic image (D0330) along with the 3D image simultaneously. If so, only one radiograph may be billed per exposure. Consider reporting the panoramic to dental insurance, as the 3D image may not be reimbursed though dental.
LIMITATIONS
1. Panoramic radiographic images (D0330) are typically reimbursed and payable every three to five years, depending on the specific policy limitations. The trend for many contracts is to reimburse the procedure every five years. If D0330 is taken in conjunction with bitewing images on the same service date, it is often converted or "re-mapped" by the payor to a comprehensive series (D0210) and paid at the payor's fee for a comprehensive series. The fee is generally lower than the combined payor's fee for D0330 and D0272/D0273/D0274 when filed separately. Some payors will reimburse D0330, while rejecting payment for the bitewing radiographic images performed on the same service date. Some payors will reimburse the full payor's fee for each procedure D0330 and D0272/D0273/D0274 separately. yielding the best result.
2. Most payors will reimburse either D0330 or D0210 during the limitation period, not both.
3. Panoramic image (D0330) may be considered to be a part of orthodontic records. There are no specific codes for orthodontic records. D0330 may be reimbursed under "orthodontic records; however, the reimbursement may be deducted from either the patient's lifetime orthodontic benefits or general dental benefits. The claim form question, "Is this for orthodontics?" must be answered "yes" to be considered a part of the orthodontic records.
4. There may be an age limitation applicable to the reimbursement for panoramic radiographic image (D0330). Some payors may require that a child be a minimum of five, six or seven years old to provide benefits for this service.
TIPS
1. Some offices take bitewing radiographic images on children at the comprehensive oral evaluation (D0150) and a panoramic radiographic image (D0330) (for growth and development studies) at either a subsequent operative visit or on a later recare service date, as determined by the dentist.
2. Reimbursement for a panoramic radiographic image (D0330) may be better when taken alone on a given service date than when taken in conjunction with bitewing images on the same service date.
3. Some offices establish a standard panoramic radiographic image (D0330) fee for two clinical situations. A lower standard fee for the panoramic radiographic image taken at the comprehensive oral evaluation (D0150) appointment in conjunction with bitewing diagnostic radiographic images. A higher standard fee for the panoramic radiographic image is established for a stand-alone panoramic image. (Set up a D0330A and D0330B fee to reflect whether the panoramic image is stand-alone or in conjunction with bitewings).
4. See full mouth debridement to enable comprehensive oral evaluation and diagnosis (D4355) for diagnostic radiographic image protocol options.
5. For panoramic radiographic image - image capture only, see D0701.
ADDITIONAL INFORMATION
1. Diagnostic images are adjunctive to the diagnosis process, and must be medically necessary.
2. Diagnostic images should be individually ordered by the doctor, following evaluation of the patient and performed for a specific reason(s). The justification for the radiographic image(s) should be documented in the chart.
3. Diagnostic radiographic images should be evaluated and interpreted by the doctor, and the indications documented in the patient's chart.
4. Poor and/or non-existing documentation of the dental necessity for diagnostic radiographic images may result in a demand for repayment of benefits for radiographs taken if audited by the payor, even though the diagnostic radiographic images were taken!
5. Radiographs of diagnostic quality should be dated and labeled in the patient's record.
6. Be careful to note the location, left and right (upper/lower), if not otherwise indicated by the radiograph to avoid review errors.
1. It is misleading to report or "upcode" an extra-oral panoramic radiographic image (D0330) and bitewing images (D0272/ D0273/D0274) to an intra-oral comprehensive series (D0210) if performed on the same service date. Although payors may "remap" or reimburse at a comprehensive series fee level, the provider should not report a procedure that was not performed. If both (D0330) and (D0272/D0273 or D0274) are taken on the same service date, report the procedures separately. Report the procedure(s) performed on the date the service was performed. Note: It is not illegal or improper for a payor to reimburse a submitted code at a rate assigned another code. These alternate benefit reimbursements are explained in that plan's contract language. Payors routinely convert separately coded extra-oral panoramic image and intra-oral bitewing radiographic images to the lower, global comprehensive series (D0210) UCR fee.
Note: The date of service of any radiograph is the date they are interpreted, not the date they are taken. However, when panoramic and bitewing radiographs are taken on the same service date but then routinely split into different dates for interpretation in order to circumvent remapping by the payor to comprehensive series (D0210), this may be seen as a misrepresentation of treatment dates to gain increased reimbursement.
2. A panoramic radiographic image (D0330) is extra-oral, not intra-oral. A comprehensive series (D0210) is intra-oral.
WATCH
1. Practices should not have a protocol in place to delineate a specific time interval for the panoramic radiographic image (D0330). The panorex interval should be individually prescribed and ordered by the dentist based on ADA/FDA radiographic frequency recommendations, not insurance reimbursements. (D0330 is typically reimbursed every three to five years if deemed dentally necessary.)
2. Do not convert or "upcode" a radiographic image (D0330) and bitewing radiographic image (D0272, D0273 or D0274) to a comprehensive series (D0210). A panoramic radiographic image is an extra-oral radiographic image, not intra- oral. A comprehensive series (D0210) is a set of intra-oral radiographic images. It is improper/misleading to report a panorex and bitewings as a full mouth series. Report D0330 and D0274/D0273 or D0274 separately, as actually performed. The payor is allowed to re-map individual diagnostic images to a comprehensive series code as an alternate reimbursement. The payor may do this in accordance with specific policy limitations and exclusions of the contract. The contract may allow:
a. Conversion or re-mapping a panorex and bitewings to a comprehensive radiographic image series (D0210) payor's fee. (A comprehensive series is typically reimbursed at a lower fee than the panorex and bitewings reimbursed separately.)
b. Reimbursement for the bitewing radiographic images and panoramic radiographic images separately. The best result. c. Reimbursement for a panoramic radiographic image only and nothing for the bitewing radiographic images. This is the worst result.
3. Some CBCT's can generate a 2D panoramic image (D0330) along with the 3D image simultaneously. If so, only one radiograph may be billed per exposure. Consider reporting the panoramic to dental insurance, as the 3D image may not be reimbursed though dental.
LIMITATIONS
1. Panoramic radiographic images (D0330) are typically reimbursed and payable every three to five years, depending on the specific policy limitations. The trend for many contracts is to reimburse the procedure every five years. If D0330 is taken in conjunction with bitewing images on the same service date, it is often converted or "re-mapped" by the payor to a comprehensive series (D0210) and paid at the payor's fee for a comprehensive series. The fee is generally lower than the combined payor's fee for D0330 and D0272/D0273/D0274 when filed separately. Some payors will reimburse D0330, while rejecting payment for the bitewing radiographic images performed on the same service date. Some payors will reimburse the full payor's fee for each procedure D0330 and D0272/D0273/D0274 separately. yielding the best result.
2. Most payors will reimburse either D0330 or D0210 during the limitation period, not both.
3. Panoramic image (D0330) may be considered to be a part of orthodontic records. There are no specific codes for orthodontic records. D0330 may be reimbursed under "orthodontic records; however, the reimbursement may be deducted from either the patient's lifetime orthodontic benefits or general dental benefits. The claim form question, "Is this for orthodontics?" must be answered "yes" to be considered a part of the orthodontic records.
4. There may be an age limitation applicable to the reimbursement for panoramic radiographic image (D0330). Some payors may require that a child be a minimum of five, six or seven years old to provide benefits for this service.
TIPS
1. Some offices take bitewing radiographic images on children at the comprehensive oral evaluation (D0150) and a panoramic radiographic image (D0330) (for growth and development studies) at either a subsequent operative visit or on a later recare service date, as determined by the dentist.
2. Reimbursement for a panoramic radiographic image (D0330) may be better when taken alone on a given service date than when taken in conjunction with bitewing images on the same service date.
3. Some offices establish a standard panoramic radiographic image (D0330) fee for two clinical situations. A lower standard fee for the panoramic radiographic image taken at the comprehensive oral evaluation (D0150) appointment in conjunction with bitewing diagnostic radiographic images. A higher standard fee for the panoramic radiographic image is established for a stand-alone panoramic image. (Set up a D0330A and D0330B fee to reflect whether the panoramic image is stand-alone or in conjunction with bitewings).
4. See full mouth debridement to enable comprehensive oral evaluation and diagnosis (D4355) for diagnostic radiographic image protocol options.
5. For panoramic radiographic image - image capture only, see D0701.
ADDITIONAL INFORMATION
1. Diagnostic images are adjunctive to the diagnosis process, and must be medically necessary.
2. Diagnostic images should be individually ordered by the doctor, following evaluation of the patient and performed for a specific reason(s). The justification for the radiographic image(s) should be documented in the chart.
3. Diagnostic radiographic images should be evaluated and interpreted by the doctor, and the indications documented in the patient's chart.
4. Poor and/or non-existing documentation of the dental necessity for diagnostic radiographic images may result in a demand for repayment of benefits for radiographs taken if audited by the payor, even though the diagnostic radiographic images were taken!
5. Radiographs of diagnostic quality should be dated and labeled in the patient's record.
6. Be careful to note the location, left and right (upper/lower), if not otherwise indicated by the radiograph to avoid review errors.