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Ver 1.3 August 6 , 2020
CHARGING FOR PPE AND REIMBURSEMENT
ADA has issued a statement on third party payer reimbursement for costs associated with increased standards for PPE .
Some insurance companies have announced a rate that will be provided per patient visit for PPE so it is important to check with the companies that you participate with for that rate .
Or , until that adjustment has been made , use CDT code “ D1999 - unspecified preventive procedure , by report ” to document and report the use and cost of additional PPE . Dentists can use this code once per patient visit / claim to attempt to cover the cost of PPE . Whether a given dental plan will reimburse for PPE billed under this code is an evolving situation . Dentists may want to check with a plan ' s online provider portals or provider representatives before assuming any particular plan will reimburse for this .
PDA recommends that members giving consideration to charging patients a PPE fee should :
• Disclose and explain such fees prior to treatment .
• Ensure charging such a fee is not prohibited by any relevant contract with a third party payer .
• Not bill a third party payer for PPE and also charge such a fee to the patient .
PPE
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PDA ’ S ADVOCACY WITH THE DEPARTMENT OF INSURANCE AND ATTORNEY GENERAL ’ S OFFICE
In June , the Pennsylvania Insurance Department released a notice to insurance companies advising them on actions that may be taken with health care providers , including dentists , who are changing for the increased costs of personal protection equipment ( PPE ). The department recommended that insurers consider making a referral to the Office of the Attorney General under certain circumstances and inferred that health care providers should not be charging any PPE costs to patients .
PDA communicated our concerns to the department and the Office of the Attorney General , citing the additional cost dentists are incurring to be in compliance with CDC guidelines and government ’ s PPE mandate . PDA has provided information on PPE costs and insurers ’ policies related to reimbursement . It is our understanding that charging for PPE is not considered price gouging so long as the fee is reasonable and a provider is not violating the terms of their PPO contract .
PDA offers the following advice to members :
• Review the terms of PPO contracts for compliance .
• Only charge a reasonable fee when applicable .
• Retain invoices and other documentation on PPE purchases .
• Most patients are unaware of how much dentists now have to spend on PPE . Discuss any PPE charges prior to treatment and make note of patients ’ consent in their record . The ADA ’ s Patient Return Resource Center provides valuable tips for communicating with your patients .
• Consider posting a notice regarding your office policy on PPE charges in your lobby or front desk .
• Review ADA ’ s COVID-19 Coding and Billing Interim Guidance on PPE including all payer programs and policies .
20 Third Party Reimbursement , PDA Lobbying