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Insurance codes: how is laser paid for?
How laser is paid for with insurance is one of the most fundamental questions in laser dentistry. This chapter reviews hot to pay for a laser with the hygiene applications that are performed with the soft-tissue diode laser. Each state varies as to regulations and codes, so it is imperative that the hygienist verify local and state regulations.
CURRENT CODES AND FEES
Let’s discuss what the fees are in regard to insurance codes used currently in the United States from the CDT handbook provided by the American Dental Association. Examples will be given for California, one of the most aggressive states in incorporating and accepting new technology; Texas, a state that will not allow all the applications in the dental hygiene realm of laser dentistry to be used; and Calgary, Alberta, Canada, a province with strict guidelines as to what can and cannot be done. Please note that these prices are examples and are not used to dictate set prices for individual practices.
California
Hygiene codes
- 4355 Full-mouth debridement initial periodontal therapy (IPT), insurance will pay a portion: $190
- 4999 Services using laser bacterial reduction (LBR) as an adjunct to hygiene service use: $32 full mouth (around the United States, the fee ranges between $25 and $40)
- 01110 Prophylaxis code (performed every 6 months): $109 (insurance will pay every 6 months or twice a year)
- 4341/4342 Scaling and root planing (SRP) codes for localized one to three teeth or per quadrant per session: $175–$225 per session (insurance will pay a percentage)
- 4999.1 SRP/periodontal therapy with laser: $175–$225 per session
- 4999.2 Definitive therapy (DT): $165 (6 weeks after periodontal therapy)
- 4910 Supportive periodontal therapy (SPT): $165 (3 months after periodontal therapy, insurance will pay a percentage)
- 4342 Localized SRP, one to three teeth: $175
- 4341 Quadrant of SRP, periodontal therapy: $225
- 4999 Misc. code, any nonpaid service performed by the hygienist when using the laser. For example, LBR, laser-assisted periodontal therapy (LAPT) or laser de-epithelization-LAPT, or DT.
- Laser de-epithelization one to three teeth: $175
- Laser de-epithelization per session: $225
- 9910/1206 Desensitization (Fl2 varnish): $50
- 7465/9110 Aphthous ulcer/herpetic lesion: $50–$150
Examples of pricing and use of insurance codes
Every state is different, so make sure to understand the regulations and laws within the state of practice. This example is based on four sessions of LAPT.
Phase 1:
4355 IPT full-mouth debridement: $190
Phase 2:
4341: QUAD, code 4342: One to three teeth
SRP: $225, Laser: $225 = $450 LAPT × 4 sessions = $1800
– 720 (insurance pays 80% of $225 × 4 sessions) = $1080 out of pocket
Phase 3:
4999 DT: $165
4910 SPT: $165
Program total: $2320
Insurance pays: $1075
Patient portion: $1245 out of pocket divided by six appointments = $207.50
Block schedules ahead of time for periodontal patients
Scheduling options
Texas
Hygiene codes
- 4355 Full-mouth debridement IPT, insurance will pay a portion: $190
- 4999 Services using LBR as an adjunct to hygiene service use: $32 full mouth (around the United States, the fee ranges between $25 and $40)
- 01110 Prophylaxis code (performed every 6 months): $109 (insurance will pay every 6 months or twice a year)
- 4341/4342 SRP codes for localized one to three teeth or per quadrant: $1/>
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