Billing Guide for D0367 (Cone Beam CT Capture and Interpretation with Field of View of Both Jaws, with or without Cranium)
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Description
Billing Guidelines, Tips and Reminders for D0367 (Cone Beam CT Capture and Interpretation with Field of View of Both Jaws, with or without Cranium)
February 03, 2025
COMMENTS
D0367 reports both Cone Beam CT capture and interpretation with a field of view of both jaws, with or without cranium.
1. Cone Beam CT (CBCT) is a relatively new 3D imaging technology adopted by practices that provides a method to evaluate the anatomical positions of teeth and the makeup of the bone in a 3D image. An imaging unit (similar in size to a Panorex machine) has an arm that revolves around the patient's head in about 20 seconds. The CT acquires the axial, coronal, and sagittal data. The patient is exposed to radiation as the data is collected. An actual image is not produced. The data is captured and is stored, collated and compiled into a 2D or 3D data pack. This data may be retrieved, assimilated, and viewed at a later time.
2. 3D imaging allows a dentist to evaluate the exact position of impacted teeth, the position of third molars and their relationship to the inferior alveolar nerve or maxillary sinus, the osseous structure of the TMJ region, etc. While it has endless applications, it is the ultimate diagnostic tool for implant dentistry since the bony architecture and density of edentulous spaces can be clearly visualized.
3. Cone Beam CT scanning technology with 2D or 3D renderings allows the doctor to "see" critical anatomic structures for implant placement, oral surgery, orthodontic, periodontal, endodontic and TMJ procedures.
4. Even when listed as a benefit, coverage is determined by clinical necessity.
5. Situations where Cone Beam CT may be covered include:
i. Impacted third molars positioned close to the inferior alveolar nerve.
ii. Proposed implant placement close to the inferior alveolar nerve or sinus.
iii. Proposed implant placement where there may be inadequate bone.
iv. TMJ abnormalities/pathology.
6. Reimbursement for Cone Beam CT's is highly variable. Cone Beam CT is not generally reimbursed by dental. A Cone Beam CT may be submitted to medical as primary for reimbursement consideration subject to medical provisions.
7. 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.
8. Some dental plans have begun to cover one diagnostic CBCT per year per patient. A question about coverage of CBCT could be added to insurance verification process to identify these plans.
ADDITIONAL INFORMATION
Important: See Author’s Cone Beam Comments prior to code D0360.
D0367 reports both Cone Beam CT capture and interpretation with a field of view of both jaws, with or without cranium.
1. Cone Beam CT (CBCT) is a relatively new 3D imaging technology adopted by practices that provides a method to evaluate the anatomical positions of teeth and the makeup of the bone in a 3D image. An imaging unit (similar in size to a Panorex machine) has an arm that revolves around the patient's head in about 20 seconds. The CT acquires the axial, coronal, and sagittal data. The patient is exposed to radiation as the data is collected. An actual image is not produced. The data is captured and is stored, collated and compiled into a 2D or 3D data pack. This data may be retrieved, assimilated, and viewed at a later time.
2. 3D imaging allows a dentist to evaluate the exact position of impacted teeth, the position of third molars and their relationship to the inferior alveolar nerve or maxillary sinus, the osseous structure of the TMJ region, etc. While it has endless applications, it is the ultimate diagnostic tool for implant dentistry since the bony architecture and density of edentulous spaces can be clearly visualized.
3. Cone Beam CT scanning technology with 2D or 3D renderings allows the doctor to "see" critical anatomic structures for implant placement, oral surgery, orthodontic, periodontal, endodontic and TMJ procedures.
4. Even when listed as a benefit, coverage is determined by clinical necessity.
5. Situations where Cone Beam CT may be covered include:
i. Impacted third molars positioned close to the inferior alveolar nerve.
ii. Proposed implant placement close to the inferior alveolar nerve or sinus.
iii. Proposed implant placement where there may be inadequate bone.
iv. TMJ abnormalities/pathology.
6. Reimbursement for Cone Beam CT's is highly variable. Cone Beam CT is not generally reimbursed by dental. A Cone Beam CT may be submitted to medical as primary for reimbursement consideration subject to medical provisions.
7. 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.
8. Some dental plans have begun to cover one diagnostic CBCT per year per patient. A question about coverage of CBCT could be added to insurance verification process to identify these plans.
ADDITIONAL INFORMATION
Important: See Author’s Cone Beam Comments prior to code D0360.
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