Billing Guide for D0470 (Diagnostic Casts)
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Description
Billing Guidelines, Tips and Reminders for D0470 (Diagnostic Casts)
February 03, 2025
Also known as diagnostic models or study models.
WARNING
It is improper to report diagnostic casts (D0470) in order to gain reimbursement for an athletic mouthguard, tooth whitening trays, splint, prosthesis, or other appliance.
MATCH
Diagnostic casts (D0470) are considered an individual component of orthodontic records. There is no global code(s) to describe orthodontic records. Report the individual components that make up orthodontic record separately with individual codes. Orthodontic records could include photographs (D0350), diagnostic casts (D0470), and a cephalometric radiographic image (D0340).
COMMENTS
1. For an occlusal analysis of a mounted case, report D9950 in addition to diagnostic casts D0470.
2. For an occlusal adjustment, see both Occlusal Adjustment-Limited (D9951) and Occlusal Adjustment-Complete (D9952).
3. “Virtual” scanned diagnostic casts may be reported as D0470 as long as hard copy can be produced upon request. Alternatively, virtual models may be reported using 3D scan codes, although reporting D0470 often yields better results when reporting orthodontic records. See D0801-D0801 for more information.
4. 3D printing of a dental scan may be reported as D0396, but is in unlikely to be reimbursed in conjunction with D0470. See D0396.
LIMITATIONS
1. Diagnostic casts (D0470) are not typically reimbursed except as a component of orthodontic records.
2. The claim form question, “Is this for orthodontics?” must be answered “yes” (Box 40) to be considered a part of orthodontic records. D0470 is considered to be part of orthodontic records, workup and is typically reimbursed once per lifetime. See cephalometric radiographic image (D0340) and 2D oral/facial photographic images (D0350) for further orthodontic record component details.
3. Reimbursement for diagnostic casts (D0470) may reduce the lifetime orthodontic benefit. If orthodontic benefits are available these photographic images are typically reimbursed 50% of the payor’s fee. Sometimes the general dentist benefit component of the plan will reimburse for photographic images separate from the orthodontic benefit. If reimbursed as part of the general benefits, D0350, may be paid at 50%, 80% or 100% of the payor’s fee.
Photo
These are known as study models, diagnostic casts and diagnostic models.
WARNING
It is improper to report diagnostic casts (D0470) in order to gain reimbursement for an athletic mouthguard, tooth whitening trays, splint, prosthesis, or other appliance.
MATCH
Diagnostic casts (D0470) are considered an individual component of orthodontic records. There is no global code(s) to describe orthodontic records. Report the individual components that make up orthodontic record separately with individual codes. Orthodontic records could include photographs (D0350), diagnostic casts (D0470), and a cephalometric radiographic image (D0340).
COMMENTS
1. For an occlusal analysis of a mounted case, report D9950 in addition to diagnostic casts D0470.
2. For an occlusal adjustment, see both Occlusal Adjustment-Limited (D9951) and Occlusal Adjustment-Complete (D9952).
3. “Virtual” scanned diagnostic casts may be reported as D0470 as long as hard copy can be produced upon request. Alternatively, virtual models may be reported using 3D scan codes, although reporting D0470 often yields better results when reporting orthodontic records. See D0801-D0801 for more information.
4. 3D printing of a dental scan may be reported as D0396, but is in unlikely to be reimbursed in conjunction with D0470. See D0396.
LIMITATIONS
1. Diagnostic casts (D0470) are not typically reimbursed except as a component of orthodontic records.
2. The claim form question, “Is this for orthodontics?” must be answered “yes” (Box 40) to be considered a part of orthodontic records. D0470 is considered to be part of orthodontic records, workup and is typically reimbursed once per lifetime. See cephalometric radiographic image (D0340) and 2D oral/facial photographic images (D0350) for further orthodontic record component details.
3. Reimbursement for diagnostic casts (D0470) may reduce the lifetime orthodontic benefit. If orthodontic benefits are available these photographic images are typically reimbursed 50% of the payor’s fee. Sometimes the general dentist benefit component of the plan will reimburse for photographic images separate from the orthodontic benefit. If reimbursed as part of the general benefits, D0350, may be paid at 50%, 80% or 100% of the payor’s fee.
Photo
These are known as study models, diagnostic casts and diagnostic models.
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