Date Issued: [04/14/2023]
American Dental Association (ADA), Current Dental Terminology (CDT) codes are used when submitting claims to dental benefit plans. There may be occasions where a dental provider will render medical services and submit a claim to the patient’s medical plan. When this happens, it is appropriate to submit medical procedure codes provided by either the American Medical Association (AMA), known as Current Procedural Terminology (CPT) codes, or the federal government’s Healthcare Common Procedure Code Set (HCPCS) codes.
EmblemHealth will not accept CDT codes submitted on a medical claim under HMO plans.
If a dental provider renders a medical service for which there is no corresponding CPT/HCPCS code, use an appropriate unlisted code such as 41599: Unlisted procedure, tongue, floor of mouth or 40799: Unlisted procedure, lips. In addition, the dental provider must follow the EmblemHealth’s Unlisted Code policy and submit the Unlisted Procedure or Service Code form including the corresponding CDT code, its description, operative note, and supporting documentation. This information will be used to determine appropriate payment and claim adjudication in conjunction with the member's medical benefit plan.
