When do you bill dental insurance for a crown: prep or seat date?

7 minute read

When it comes to claim acceptance, every detail matters. That’s a challenge when documenting dates for multi-stage procedures like crowns, bridges, dentures, root canals, etc. Fortunately, the DCS Knowledge Network is here to help you with guidance on which dates to put where, and also how to bill for a crown, whether you’re in-network and out-of-network.

Let’s get right to the question: When do you bill insurance for a crown? Do you bill for a crown at the prep or seat?

These are common questions among dental professionals who manage and submit dental insurance claims. And these questions also apply to all multi-stage procedures, including crowns, bridges, dentures, night guards, and root canals.

You might be wondering if such a small thing even matters. Well, when it comes to claim acceptance, every detail matters. For prompt reimbursement and consistent cash flow, it’s crucial you get even the little things right.

DCS is an end-to-end revenue cycle management provider to dentists, and we have a pool of experts who specialize in dental insurance claims — we call them The DCS Knowledge Network. They are a fantastic resource for dental teams with questions like when to bill for a crown. And another huge perk of using DCS Insurance Billing? We submit and follow-up on every claim for you.

But more on that later — we’re here to talk about when and how to bill dental insurance for a crown, so let’s get to it.

Key takeaways when billing dental insurance for a crown:

The prep, seat, and completion dates are all different, and they’re all important
The ADA (American Dental Association) is a great resource for up-to-date information on insurance claim forms
You need to know this even if you are an out-of-network dental provider

The date makes a difference: Prep, seat, and completion dates

Most patients aren’t aware that the prep date and seat date are important when it comes to their dental insurance. So, it’s essential for dental professionals to understand how the different treatment dates impact the way insurance benefits are used.

Here are some quick definitions to clarify their purpose:

Prep date: Date the final impression is taken for a tooth that has been prepared for a crown or other prosthetic.
Seat date: Date the definitive crown or other prosthetic appliance is seated or delivered to the patient.
Completion date: Date the service is completed (i.e., date the canal has been filled for root canal therapy).

For some years, the ADA has encouraged insurance companies to consider the prep date for reimbursement. However, most insurers consider reimbursement upon completion of the service date.

To add to the confusion, the ADA’s dental claim form indicates procedures submitted are either in progress or have been completed. You can refer to their website for an image of their standard claim form.

So, what does this mean for both in-network and out-of-network dentists?

How to bill for a crown as an in-network dentist

If you are in-network, your PPO contract likely includes a provision stating that all services are to be submitted on, and will be reimbursed based on, the completion date.

When a dentist participates in a PPO plan, they agree to abide by the insurance company’s processing policy manual, sometimes referred to as the dentist handbook or provider reference guide. This is generally a separate document from the contract. DSC01141-3

It’s in this processing policy document that you’ll find whether the provision requires the claim to be submitted for all services when completed or at prep date.

As mentioned earlier, missing this small detail has large consequences. In addition to claim denials and delayed payments, failure to submit for service(s) at the completion date may result in a legal issue for violation of your PPO contract agreement.

How to bill for a crown as an out-of-network dentist

Out-of-network providers aren’t contracted with insurance companies, so they won't have a policy processing document to refer to. To gather the needed information, they’ll have to call the insurance company directly and ask, “Do you pay on prep or seat date?”

You might think that if you don’t accept insurance, then you don’t need to know insurance, but here are two reasons why these details matter to all dental professionals:

Frequency limits. Let’s say that a crown is covered by insurance every 5 years, and they pay on seat date. You would want to make sure it's seated after the 5-year mark, but you could technically prep it before the 5-year mark.
Eligibility. If a patient's insurance is close to terminating and insurance pays on the seat date, then you want to make sure you schedule the seat day before it's terminated. If the insurer pays on the prep date, there’s more flexibility — you can seat the crown even after the insurance has terminated.

Remember: This applies to all multi-appointment procedures, including crowns, dentures, occlusal guards, and root canal therapy.

How should the completion date of multi-plan procedures be indicated on the claim form?

You may remember the days when you could simply jot a note in the remarks section of the claim and have it addressed by an insurance representative. In this case of crown dates, you’d note that the date entered as the date of service is both the prep date and the seat date.

On the insurance company’s side of the process, a human being would change the date in their system and/or verify that benefits were available on the seat date for accurate claims processing. Unfortunately, this thoughtful human handling is no longer the case… DSC06214 (1)

Now, insurance companies process claims via automation, even when the claims are received by mail. Their software can read the claim and process the payment without human intervention — but it can’t read our written notes or attachments.

These days, without a human helper on the insurance side, it’s essential that every claim submission is “robot-ready,” or you risk inaccurate reimbursement and/or a delay in payment.

So, what do you do when the insurer’s software can’t set the correct date for you? Many insurance companies request that the date of service indicate the completion date. In fact, their software may be programmed to assume that the date entered is the date of service, and not the seat date.

This creates a problem for some dental teams, because there are no ADA codes for crown seats. They must bill out the crown code (D2740) on the prep date with the associated costs attached.

Typically, the PMS will then start building a claim for the date the code was processed on the ledger (the prep date), you'll have to hold that claim until the seat date, and then notate that on the claim form somehow.

We recommend asking your PMS support team how this may be accomplished. This is especially important for compliance when you are an in-network provider.

Whether in-network or out-of-network, you are required to notify the insurance company if treatment is incomplete for a service that has been billed and reimbursed. If reimbursement is received prior to completion, there may be an incurred liability date of the plan to determine if a refund is made to the insurance company.

Accurate details bring better cash flow: Let our RCM experts help you

To recap our suggestions when billing dental insurance for crowns and other multi-appointment procedures:

Properly recorded dates of service on your claim are a key to legitimate and prompt reimbursement
When in doubt, verify with your resources: ask the insurance company, or refer to your PPO contract or policy processing manual, dentist handbook, or provider reference guide
If your PMS is unclear about dates of service, contact the PMS support team
Do not underestimate details when completing an insurance claim — even small errors lead to denied claims and delayed payments

Prompt reimbursement on insurance claims helps your cash flow remain steady and healthy. But if unsubmitted claims are stacking up because the details bog your team down, it’s time to turn to experts for help, like ours in the DCS Knowledge Network.

The DCS Insurance Billing service provides your team with an Account Specialist who will check, submit, and follow up with your insurance claims until they’re paid. Confusing rules like when to bill insurance for a crown? Our Knowledge Network has them all figured out.

Sleep easy knowing your insurance claims are being handled by RCM experts: Book a free 30-minute call with DCS today.

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