Are you prescribing Perio Trays™ in your dental practice?
Many of you may be prescribing and placing carriers, or trays, for the periodontal patient filled with a medicament developed to decrease harmful, disease causing pathogens. Perio Trays™ by Perio Protect® is the brand we are familiar with for fabricating the custom carriers or trays. Use of the custom lab fabricated carrier is a non-invasive treatment and can reduce the need for more invasive treatments for patients with periodontal disease.
You may be asking, what makes these trays different from other trays such as fluoride trays? These custom made trays cover not only the teeth but also, the alveolar mucosa. The design of the tray enables delivery of the medication below the gum line aiding in the treatment of periodontal disease. The treatment outcome has been proven effective in preventing harmful bacteria from entering the patient’s bloodstream. The more we learn about the oral systemic link to periodontal disease, the more we, as dental professionals,can provide improved and new treatments which in turn improves the overall health of our patients.
How are periodontal medicament trays documented and reported at a dental practice?
Previous versions of CDT included the code D5994 periodontal medicament carrier with peripheral seal – laboratory processed. The Code Maintenance Committee (CMC) accepted into CDT 2021, two new codes replacing code D5994. The addition of D5996/D5995 provides consistency in alignment with recent changes to CDT codes delineating the arch treated. D5994 was broad and often caused denials when reported twice on the claim. Most patients receiving periodontal medicament carriers are treated with carriers for each arch. This will allow payors to auto adjudicate claims, reducing payment delays for providers. The new codes D5995 and D5996 became effective for all dates of service beginning on January 1, 2021.
D5995 periodontal medicament carrier with peripheral seal – laboratory processed – maxillary
A custom fabricated, laboratory processed carrier for the maxillary arch that covers the teeth and alveolar mucosa. Used as a vehicle to deliver prescribed medicaments for sustained contact with the gingiva, alveolar mucosa, and into the periodontal sulcus or pocket.
D5996 periodontal medicament carrier with peripheral seal – laboratory processed – mandibular
A custom fabricated, laboratory processed carrier for the mandibular arch that covers the teeth and alveolar mucosa. Used as a vehicle to deliver prescribed medicaments for sustained contact with the gingiva, alveolar mucosa, and into the periodontal sulcus or pocket.
Claim documentation for codes D5995 and D5996
Include in your documentation the reason for prescribing the trays and medication; the periodontal diagnosis specific to the patient. Additionally, include any medical conditions such as diabetes and how this treatment can improve the patient’s overall health. Include a narrative with the claim to ensure the medical necessity can be determined for the best chance of reimbursement consideration.
Reimbursement for D5995 and D5996
Coverage varies greatly amongst dental plans for D5995 and D5996. A review of several PPO processing policy manuals indicate this procedure is billable to the patient when denied by the patient’s dental plan.
How do I keep up with updated CDT codes?
Be sure to inactivate the deleted code D5994 in your software and make your team aware that the two new codes are effective now and that they distinguish the arch treated. While many dental plans may not provide reimbursement for this procedure at this time, the more we submit this procedure, the greater the likelihood of dental plans adding these codes to their list of covered procedures.
Don’t let navigating dental codes keep you down, we have webinars that will help you on your journey to understanding all things coding. They are available to attend on our Dental Claims Academy website every month, then available on demand for those who can’t make it to the event.
Current Dental Terminology, © 2020 American Dental Association. All rights reserved.
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