CDT codes vs CPT codes: What’s the difference?

Among dental professionals, it’s not always clear whether to assign CDT codes or CPT codes when reporting procedures on dental claims. These two code sets serve similar purposes, and since codes are listed by letters and numbers, some confusion is understandable. 

But mixing up CDT codes and CPT codes can result in inaccurate reporting on claims, which will lead to denials, which then lead to delays in your revenue. We’re here to clear up the confusion, so your team can avoid the extra work of appeals, and your dental business gets paid promptly.

For this article, we tapped into our billing experts, who are part of what we call The DCS Knowledge Network. It’s our pool of insurance billing specialist who confidently stay up to date on all things dental insurance — including coding.

Now, let’s walk through these two types of procedural codes… 

What are CDT codes?

CDT stands for Current Dental Terminology — the standard code set for dental diagnoses and treatments. This code set meets HIPAA requirements for reporting dental services to other parties, including a patient's dental insurance plan. Insurance companies use CDT codes to determine which dental procedures are eligible for reimbursement under the patient’s plan.

These CDT codes are used to report dental procedures on the American Dental Association (ADA) claim form, and are organized into the following 12 categories based on the type of service:

The core components of a CDT code are: 

1. A 5-digit alphanumeric procedure code that always starts with the letter D and is followed by 4 digits.
2. Nomenclature: The title of the procedure code, which may be abbreviated on the printed claim form or other documents that are subject to space limits. The abbreviation will not change the nomenclature.
3. Descriptor: Details that define the nature and intended use of the single procedure code. These follow the applicable procedure code and its nomenclature, and they are not always present if the nomenclature is self-explanatory.

Related: CDT Codes: Current Dental Terminology explained

CDT codes are maintained by the ADA Council on Dental Benefit Programs. They are reviewed and updated on a yearly basis to align with changes in dental technology and to clarify where needed. Annual CDT code updates may include:

1. Additional codes
2. Deletion of codes
3. Editorial revisions (spelling errors, clarifications)
4. Edits to the Nomenclature
5. Edits to the Descriptors

These changes can be a challenge for your dental team, as codes they’ve become familiar with will disappear or be redefined, while codes they’ve never seen before will come into use.

It’s wise to keep up-to-date reference materials on hand, as it’s your dental team’s responsibility to use the current codes to avoid insurance claim denials — or accusations of fraud — due to inaccurate use of codes.

What are CPT codes?

CPT stands for Current Procedural Terminology — the standard code set for medical diagnoses and treatments. CPT codes meet HIPAA’s requirements to report medical procedures to medical insurance plans, rather than dental plans. CPT codes are reviewed annually by the American Medical Association (AMA), similar to how CDT codes are by the ADA. 

When dentists perform medical procedures, they must report those with CPT codes to file claims with medical insurance providers for payment. CPT codes describe the services provided and are reported to the medical carrier on a CMS 1500 claim form. 

Whether a procedure should have a medical or dental code is often a point of confusion for dental teams. Dental billing education can help you determine whether to file a medical or dental claim. You can also bring on a full-service revenue cycle management provider like DCS, with billing experts who’ll partner with your team for cleaner claim submissions.

Related: 3 times a dentist should file a medical claim versus a dental claim

Medical-oriented CPT codes commonly used in dentistry are called Category I codes.

CPT codes range from 00100 to 99449, and Category I CPT codes are organized into six groups:

1. Evaluation and management: 99201–99499
2. Anesthesia: 00100–01999
3. Surgery: 10021–69990
4. Radiology: 70010–79999
5. Pathology and laboratory: 80047–89398
6. Medicine: 90281–99607

Now you know what CPT codes are and what they look like. So, what’s the difference between CDT codes and CPT codes?

CDT codes vs CPT codes: What are the differences?

Essentially, CDT codes report dental procedures to dental payers, while CPT codes report medical treatments to medical plans. 

Each code set also requires a different claim form depending on whether your care team provided medical or dental services. Some dental practice management software (PMS) includes both medical and dental claim forms. If you’re not sure, contact your software support to see if your PMS includes both forms. 

You can tell CDT from a CPT codes because CDT codes are alphanumeric — the letter D followed by four digits — and Category I CPT codes are fully numeric five-digit codes.

Another difference between these codes is the order in which they are processed when filed on claims. If a patient’s care involves both medical and dental benefits, you will have two types of insurance claims to submit, and in a specific order. This is where the coordination of benefits (COB) comes in.

Medical claims containing CPT codes are typically filed as primary insurance, while dental claims containing CDT codes are usually filed as secondary insurance. It is always best to check with the medical carrier to determine the primary and secondary payers for a claim. 

Example: Let’s break it down for both medical and dental insurance claims

Here are examples of how to bill for medical insurance and dental insurance using CPT and CDT codes. 

First, you’ll need to use an additional code set to report the medical diagnosis: the ICD-10-CM code set. Appropriate ICD-10-CM diagnosis codes are required with CPT codes when submitting claims to the medical carrier. The ICD-10 code will be the listed first in the patient's dental record and on the claim.

1. Medical insurance billing example

Diagnostic and Therapeutic Procedures:

Step 1: Dentist selects the appropriate diagnosis code or codes (ICD-10) in the correct order:

1. S09.93xA Injury to Mouth, initial encounter 
2. S02.5xxB Fractured tooth, open fx, initial encounter 
3. R68.84 Jaw pain 
4. W01.0xxA Fall on the same level, from tripping, initial encounter 

Step 2: Dentist lists the procedure code(s) (CPT) 

1. 99203 NP, detailed exam 
2. 70486 Diagnostic maxillofacial CT scan 
3. 70300 Single X-ray, teeth 
4. 21089 Interim prosthesis, MX

Step 3: Include the necessary documentation: 

1. Letter of Medical Necessity (LMN) indicating all future possibilities for treatment 
2. Head & Neck evaluation

2. Dental insurance billing example

Evaluation, Diagnostic Services, and Interim Removable Prosthodontics: 

Step 1: Dentist lists the procedure code(s) (CDT) 

Step 2: Dentist may select the (ICD-10) in the correct order (Optional):

1. S09.93xA Injury to Mouth, initial encounter 
2. S02.5xxB Fractured tooth, open fx, initial encounter 
3. R68.84 Jaw pain 
4. W01.0xxA Fall on the same level, from tripping, initial encounter 

1. D0150- comprehensive oral evaluation
2. D0367- Cone beam CT capture and interpretation with field of view of both jaws; with or without cranium
3. D0220 Intraoral Periapical first radiographic image
4. D5820 Interim partial denture, maxillary Tooth #7

Step 4: Include the necessary documentation: 

1. Narrative 
2. Radiograph

When in doubt, contact the patient’s medical insurance to clarify how the payer wants the claim to be filed for prompt reimbursement. Sometimes the ADA claim form with CDT codes will be accepted by the medical insurance, but it is best to check with the medical insurance company as to their current requirements for your claim. 

Most practice management software will offer support for setting up the CDT and CPT cross-code linking and the medical plan. Some software handles this better than others, and ideally, you set up the medical and dental plans such that your software prompts you on whether to submit a medical or dental claim first.

Why is it so important that your team understands this?

Why it’s crucial that your dental team understands the difference between CDT codes and CPT codes

Inaccurate coding delays payment while the claim is resubmitted on appeal, and it also opens the door to legal problems due to alleged fraud.

On the other hand, accurate coding leads to prompt claim reimbursement for your dental business, and it can also help your patients. As dental office professionals, you have a duty to tap into all available benefits for your doctors and patients, which is why your dental team files both medical and dental claims.

When you fully use their benefits, the goodwill and trust you build will be invaluable. Your patients will consider you a billing expert with their best interest in mind, and will appreciate all the coverage they can get!

The revenue insurance billing brings into your practice is just as vital. When you know the importance of collecting all available revenue, and have the skills to do it, you increase your value as a dental professional.

Related: Here's why dental insurance claims are so hard to get reimbursed in 2023

Code confidently and collect what you’re owed with the DCS Knowledge Network on your side

To recap, in this article we covered:

• What CDT and CPT codes are
• The difference between CDT and CPT codes
• Examples for medical insurance billing and dental insurance billing
• Why it’s important that your dental team uses the correct code set

Recognizing the difference between CDT codes and CPT codes can feel challenging, but this knowledge used correctly can be hugely beneficial to your practice. Correct code utilization is a key part of the overall claims process that impacts your revenue and your relationship with your patients. 

When you work with DCS, you can turn to the DCS Knowledge Network if you’re having doubts about CDT codes vs CPT codes. Our experts will review the claims you create before submitting them to ensure accuracy for quick reimbursement. 

To learn more about how DCS can help you code confidently, book a free 30-minute call about our full revenue cycle management services.