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Revision of Periodontal Maintenance Policy
By Beverly Hill, RDA, CBM United Healthcare has revised its periodontal maintenance policy and no longer limits payment for D4910 to within the first two years following active therapy. The revised policy is currently effective for all new, fully insured United Healthcare dental plans. Existing plans are being converted as their contracts come up for renewal. This should result in fewer D4910 denials for many United Healthcare members in 2010. According to Michael Weitzner, DMD, MS, Vice President of National Clinical Operations, United Healthcare’s standard D4910 policy language now reads: “Limited to two times per consecutive 12 months following active or adjunctive periodontal therapy, exclusive of gross debridement.” This means that United Healthcare’s fully insured plans will cover D4910 twice per 12 consecutive months (not twice per calendar year) following periodontal scaling and root planing (D4341 or D4342), osseous surgery (D4260/D4261), or a prior periodontal maintenance appointment (D4910). Also remember that self-funded dental plans are not required to adopt United Healthcare’s new standard policy for D4910. So, you may still encounter self-funded dental plans that still deny payment for D4910 when performed more than two years after active therapy. If this happens, the patient should understand that his/her employer has adopted an unusually restrictive policy in their dental plan that does not make sense from a clinical management point of view. Add CommentFill out the form below to add your own comments. |
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