CDT Codes Requiring Narratives
Provider Administrative Policy
Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.
Blue Cross of Idaho works diligently on behalf of our members to develop contracting relationships with Idaho dental providers and Blue Cross Blue Shield dental affiliates (national Dental Grid).
Blue Cross of Idaho requires a narrative be included when submitting a claim for the following CDT codes. We will deny claims received without the required information and include a message code indicating, "We cannot make a final benefit determination until we receive the narrative report for your patient."
|D0160||Detailed and extensive oral evaluation-problem focused, by report|
Unspecified diagnostic procedure, by report
|D2990||Resin infiltration of incipient smooth surface lesions|
|D2999||Unspecified restorative procedure, by report|
|D3999||Unspecified endodontic procedure, by report|
|D4212||Gingivectomy or gingivoplasty to allow access for restorative procedure, per tooth|
|D4999||Unspecified periodontal procedure, by report|
|D5899||Unspecified removable prosthodontic procedure, by report|
|D5999||Unspecified maxillofacial procedure, by report|
|D6090||Repair implant supported prosthesis, by report|
|D6199||Unspecified implant procedure, by report|
|D6980||Fixed partial denture repair necessitated by restorative material failure|
|D6999||Unspecified fixed prosthodontic procedure, by report|
|D7950||Osseous, osteoperiosteal, or cartilage graft of the mandible or maxilla-autogenous or nonautogenous, by report|
|D7999||Unspecified oral surgery procedure, by report|
|D8999||Unspecified orthodontic procedure, by report|
|D9110||Palliative (emergency) treatment of dental pain-minor procedure|
|D9940||Occlusal guard, by report|
|D9999||Unspecified adjunctive procedure, by report|