COVID-19 Coding and Billing Interim Guidance : PPE
Completing the Claim Form
Because D1999 is a “ by report ” code , Box 35 of the ADA Claim Form must include the explanation for charges reported against this code . When additional charges for PPE are being billed , an entry of “ PPE ” may suffice for Box 35 .
Frequently Asked Questions ( UPDATED )
What PPE should I use ?
The use of PPE is dependent upon professional judgment based on hazard assessment including community transmission , administrative & engineering controls , availability of PPE as well as any states laws or regulations . Consult the ADA ’ s Return To Work Interim Guidance Toolkit for guidance on appropriate infection control procedures and PPE . The ADA has also issued guidance on Extending the Use of N95 Masks .
How much can I charge for PPE ? The ADA does not provide fee guidance . Please note that :
• A dentist individually determines whether to charge and his or her full fee for any procedure delivered and reported with a CDT code .
• Neither the ADA nor the CDT Code establish fee schedules for the listed procedures .
• Third-party payers determine their own reimbursement amounts for services covered by the applicable dental benefit plan .
It is always best to inform patients of any additional charges to avoid any surprise bills . Providing a documented financial policy and seeking consent is desirable .
How do I document charges for PPE ?
Dentists should develop a standard office policy to document the additional infection control procedures or specific PPE that will be used across all patients . This documentation methodology will help justify a standard fee across all patients . Alternatively , dentists may wish to add a note in the patient ’ s record to document the details of the PPE uniquely necessary for the visit when charging different fees based on the level of PPE used .
How much will I be paid for PPE ?
For dentists who have signed participating provider agreements with third party payment programs , payment for PPE is dependent upon the contract signed between the carrier and the dentist . You may want to call the toll-free number on your patient ’ s identification cards to determine what coverage may be available for additional costs of PPE and to verify if you can bill the patient if there is no coverage . For Medicaid patients , please check with your state Medicaid agency .
I don ’ t think the payment that the third party payer paid me covers the exorbitant costs of PPE I am facing . Can I balance bill my patients separately ?
If you are not a participating provider : yes , you are able to balance bill the patient up to your full fee . Inform the patients prior to the visit on any changes to your charges or financial policy .
© 2020 American Dental Association All rights reserved . Last Reviewed : July 7 , 2020 3