Wiki Dental Question for Medicaid Patient

[JM.Geyer]

Ortho question.
Medicaid is stating that the ortho retention (retainer) is included in the price for the ortho treatment and that it is not billable. My provider is telling my that we can still charge for this appliance even though Medicaid has bundled it. While I do know Medicaid does not cover ortho and we charge the patient the adjusted price because we participate. So do we charge the patient or no. I say no because the price is bundled into what we would collect should they proceed with the ortho.

Thank you.

 

[oknightsims]

There is a code that describes the removal of the appliance and construction and placement of retainers. In this case, your provider may be somewhat correct but not totally. The code is D8680 Orthodontic retention (removal of appliances, construction and placement of retainer(s)) If Medicaid is bundling the procedure, you should not bill it to the patient. I can see this code (D8680) being bundled as well. I think most carriers look at the Ortho codes as global charges. I would only use D8680 if a provider other than the one who placed the braces does the removal.

See description below from Encoder:

D8680 - The orthodontic retention, also referred to as the orthodontic contention is the stabilization or retention period minimizing unwanted dental movements and maintaining the corrections obtained during the initial period following the removal of the braces or other appliances used for correction. The retention period is for a period of at least six months. Code D8680 describes the removal of the fixed appliance and the creation of a retainer. Removal of the previously placed appliance is dependent upon the brace used. After the removal the provider constructs and places a retainer(s), which is dependent upon the retainer used. Code D8681 describes the adjustment of the retainer provided during the orthodontic retention period.

The orthodontic retention, also referred to as the orthodontic contention is the stabilization or retention period minimizing unwanted dental movements and maintaining the corrections obtained during the initial period following the removal of the braces or other appliances used for correction. The retention period is for a period of at least six months. Code D8680 describes the removal of the fixed appliance and the creation of a retainer. Removal of the previously placed appliance is dependent upon the brace used. After the removal the provider constructs and places a retainer(s), which is dependent upon the retainer used. Code D8681 the provider makes adjustments to a previously provided removable orthodontic retainer. Usually made of an acrylic resin, the provider may need to make adjustments to the device for a better fit by heating, filing, or other methods.