D9985 Dental Code
The D9985 dental code is a specific code used in dental billing and insurance claims to denote a particular type of service or procedure. This code is part of the Current Dental Terminology (CDT) codes, which are maintained by the American Dental Association (ADA). The CDT codes are essential for standardizing dental procedures, ensuring that dental professionals and insurance companies are on the same page when it comes to billing and reimbursement.
The D9985 code is particularly important because it is often used for services that are not covered under standard dental insurance plans. This could include procedures that are considered elective, cosmetic, or not medically necessary. Understanding the nuances of this code is crucial for both dental professionals and patients, as it can significantly impact the cost of dental care.
Why is the D9985 Code Important?
The D9985 code is important for several reasons:
- Billing Accuracy: It ensures that dental procedures are billed accurately, reducing the risk of claim denials.
- Insurance Clarity: It helps insurance companies understand the nature of the procedure, which can affect whether or not the service is covered.
- Patient Transparency: It provides patients with a clear understanding of what they are being billed for, which can help them make informed decisions about their dental care.
D9985 Dental Code Description
The D9985 dental code is used to describe a specific type of dental service that is not covered under standard dental insurance plans. This could include procedures such as:
- Cosmetic Dentistry: Procedures like teeth whitening, veneers, and cosmetic bonding.
- Elective Procedures: Services that are not medically necessary but are requested by the patient for personal reasons.
- Specialized Treatments: Certain types of orthodontic treatments or periodontal procedures that are not covered under standard plans.
When is the D9985 Code Used?
The D9985 code is typically used in the following scenarios:
- Non-Covered Services: When a dental procedure is not covered by the patient’s insurance plan, the D9985 code is used to indicate that the service is elective or cosmetic.
- Out-of-Network Providers: If a patient receives care from an out-of-network provider, the D9985 code may be used to indicate that the service is not covered under the patient’s insurance plan.
- Patient-Pay Services: When a patient opts for a service that they will pay for out-of-pocket, the D9985 code is used to indicate that the service is not covered by insurance.
Example of D9985 Code Usage
Consider a patient who wants to undergo teeth whitening, a procedure that is typically considered cosmetic and not covered by most dental insurance plans. In this case, the dental office would use the D9985 code to bill the patient directly for the service. The patient would then be responsible for the full cost of the procedure, as it is not covered by their insurance.
Dental Codes for Procedures
Dental codes, such as the D9985 code, are part of a larger system of Current Dental Terminology (CDT) codes. These codes are used to standardize dental procedures, making it easier for dental professionals and insurance companies to communicate about the services provided.
Common Dental Codes
Here are some common dental codes that you might encounter:
| Code | Description | Covered by Insurance? |
|---|---|---|
| D0120 | Periodic Oral Evaluation | Yes |
| D1110 | Adult Prophylaxis (Cleaning) | Yes |
| D2140 | Amalgam Filling (1 surface) | Yes |
| D2750 | Crown – Porcelain/Ceramic | Sometimes |
| D9985 | Non-covered Service | No |
How Dental Codes are Used
Dental codes are used in several ways:
- Billing: Dental offices use these codes to bill insurance companies for services provided to patients.
- Insurance Claims: Insurance companies use these codes to determine whether a service is covered under a patient’s plan.
- Record Keeping: Dental codes are also used for record-keeping purposes, helping dental offices maintain accurate records of the services provided to each patient.
D9985 Dental Code Meaning
The D9985 dental code has a specific meaning within the context of dental billing and insurance. It is used to indicate that a particular service is not covered under the patient’s insurance plan. This could be because the service is considered elective, cosmetic, or not medically necessary.
Implications for Patients
For patients, the D9985 code means that they will be responsible for the full cost of the procedure. This can be a significant financial burden, especially for more expensive procedures like cosmetic dentistry or specialized orthodontic treatments.
Implications for Dental Professionals
For dental professionals, the D9985 code is a way to communicate with insurance companies and patients about the nature of the service being provided. It is important for dental offices to use this code correctly to avoid billing errors and ensure that patients are fully informed about the costs associated with their care.
D9985 Dental Code Reimbursement
Reimbursement for services billed under the D9985 code can be a complex issue. Since these services are typically not covered by insurance, patients are usually responsible for the full cost of the procedure. However, there are some scenarios where partial reimbursement may be possible.
Out-of-Network Providers
If a patient receives care from an out-of-network provider, they may be able to submit a claim to their insurance company for partial reimbursement. In this case, the D9985 code would be used to indicate that the service is not covered under the patient’s plan, but the patient may still be eligible for some level of reimbursement.
Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs)
Patients with FSAs or HSAs may be able to use these accounts to pay for services billed under the D9985 code. These accounts allow patients to set aside pre-tax dollars for medical expenses, including dental care. However, it is important for patients to check with their FSA or HSA provider to confirm that the service is eligible for reimbursement.
Payment Plans
Some dental offices offer payment plans for services billed under the D9985 code. This can help patients manage the cost of expensive procedures by spreading the payments out over time. Patients should discuss payment options with their dental office to determine what is available.
Conclusion
The D9985 dental code is a crucial part of dental billing and insurance claims, particularly for services that are not covered under standard insurance plans. Understanding this code is essential for both dental professionals and patients, as it can significantly impact the cost of dental care. By using the D9985 code correctly, dental offices can ensure accurate billing and provide patients with the information they need to make informed decisions about their dental care.
FAQs
1. What does the D9985 dental code mean?
The D9985 dental code is used to indicate that a particular dental service is not covered under the patient’s insurance plan. This could include elective, cosmetic, or non-medically necessary procedures.
2. Will my insurance cover a procedure billed under the D9985 code?
No, procedures billed under the D9985 code are typically not covered by insurance. Patients are usually responsible for the full cost of the procedure.
3. Can I use my FSA or HSA to pay for a procedure billed under the D9985 code?
Yes, patients with Flexible Spending Accounts (FSAs) or Health Savings Accounts (HSAs) may be able to use these accounts to pay for services billed under the D9985 code. However, it is important to check with your FSA or HSA provider to confirm eligibility.
4. Are there payment plans available for procedures billed under the D9985 code?
Some dental offices offer payment plans for services billed under the D9985 code. Patients should discuss payment options with their dental office to determine what is available.
5. How can I find out if a procedure will be billed under the D9985 code?
Patients should ask their dental office about the billing codes that will be used for their procedure. This information can help patients understand whether the service will be covered by their insurance.
Additional Resources
- American Dental Association (ADA): https://www.ada.org
- Current Dental Terminology (CDT) Codes: https://www.ada.org/en/publications/cdt
- Flexible Spending Accounts (FSAs): https://www.irs.gov/publications/p969
- Health Savings Accounts (HSAs): https://www.irs.gov/publications/p969
