Insurance’s Support Behind PPE- A Guide to Reimbursement

As dental healthcare providers, our number one goal is to treat all patients to the best of our ability following appropriate standards of care. As a result of current COVID-19 pandemic climate and recent regulations, dental providers are providing additional personal protection equipment than pre COVID-19 . Historically dentists have had the stigma of being an ‘intimidating persona behind the mask’. Dental providers are now being forced to up the ante to supply multiple masks, including N95, face shields, gowns, etc.  This challenges the practice to create warm and inviting energy with patients, let alone breathe. Many offices are installing air purification systems at a cost in the multiple thousand dollar range. As dental professionals, we do what is necessary to protect our patient but also our team members who we spend countless hours with, their families, ourselves and our families at home.

The most common questions that have everyone buzzing… ‘What are insurance payors doing to support dental practices? Does my insurance pay for it?’ For many years participating providers have taken discounted rates, while major insurance companies profit more and more from patient premiums. You might ask, where is the support? According to the American Dental Association, it is unfair for the cost to fall on dentists and has urged third party payors to consider an increase in allowable fees or in some way assist dentists in recouping these expenses.  Many payors have responded in a positive manner. It is clear that the ADA has the best interest of our profession during this pandemic.  Dental ClaimSupport is here to assist dental practices and dental professionals navigate through this pandemic as you continue to provide quality of care and a safe environment for your patients and team. 

Some payors have asked for the following code, D1999, unspecified preventive procedure, by report be reported for the additional PPE. As with all CDT codes that include by report in the nomenclature,  a narrative describing the PPE used is required. Not all payors have responded in this manner.  Because unspecified CDT codes are flagged by software to automatically require a review by a dental consultant, some payors have implemented other reimbursement provisions or are increasing allowable fees in an effort to offset the practice’s increased expenses

The following insurance payors have stepped up to the plate to provide assistance. The ADA has published  “COVID-19 Coding and Billing Interim Guidance: PPE”. This document is updated daily, as indicated by the ADA.  Your trusted dental specialists here at Dental ClaimSupport will do our due diligence at keeping all providers updated with any news on a regular basis as well.. Visit 

https://success.ada.org/~/media/CPS/Files/COVID/PPE_Coding_Billing_Guidance.pdf

As the news regarding PPE reimbursement is constantly evolving, please evaluate insurance payor bulletins and newsletters for details. This guide is not a guarantee for direct reimbursement and should you have any questions, please contact the insurance payor directly. 

Word of caution: Some states prohibit charging a fee for PPE. Be sure to check with your state dental board or state dental association prior to implementing a fee for the additional PPE and sterilization procedure as recommended by the Centers for Disease Control (CDC) in your practice. Consumers have begun to file complaints with their state, and there could be legal implications under the state Consumer State Protection Act. There is much to consider before a practice decides to charge for PPE and the additional costs associated with implementing the recommendations from the CDC. 

Additionally, PPO contracts prohibit charging for PPE and sterilization procedures. PPO providers should review their PPO Processing Policy Manuals for clarity. Many PPO payers are providing supplemental reimbursements as indicated below (i.e., Delta Dental in some states are providing a bulk payment monthly at a set amount per procedure encounter). Contact your PPO provider relations if you are unclear as to if the PPO payer is providing a temporary program to assist dental practices with these unexpected expenses. 

Ultimately, it is the practice’s decision to implement such a fee in their practice. A practice may consider increasing their procedure fees instead of implementing a separate fee. Is this fee legal in my state? How will charging this additional fee affect my patient relationships, ultimately affecting patient retention? So much to consider…