As dental practices across the state open their schedules to non-emergency patients, a recurring question we are hearing is “How do I get reimbursed for the additional costs related to personal protective equipment (PPE) and readying operatories”? In a perfect world, a new dental procedure code would be developed, all insurance companies would allow and reimburse that code at a reasonable rate, and self-pay patients would understand and gladly pay the fee. Unfortunately, we do not live in a perfect world.
There are a variety of methods to attempt to obtain reimbursement and the most common, at this point, is to use code “D1999” with a narrative on the claim form explaining the charge. We are seeing charges range from $10-$25 for this code and while this is being reimbursed by some insurance companies, you should be aware it is being met with a level of consternation from some self-pay patients.
Another option being considered and implemented is to increase your fee schedule for impacted procedures to account for the additional costs of providing those services. However, this may have little impact as payers are likely already limiting payment to a usual and customary fee and thus reverting back to the patient via co-pays and self-pay arrangements.
As a result of these issues, many practices have stopped, or never started, charging for these costs and will bear the cost via reduced profitability. We feel the fee is justified and should be charged. The key to success is the advance education of your patients, explaining that this fee allows you to provide them the best possible protection from any potential exposure to the COVID-19 virus. We also highly recommend every dentist continue to contact the American Dental Association for the development of a new PPE-specific code and then apply pressure to payers to adequately reimburse for the code.
(Editor’s note: the ADA and WDA recommend that any PPE surcharge be discussed with patients upfront. Dental offices can use this sign to help alert patients to an additional charge.)
Authored by: Kelly Bradley, CPA, CVA, Principal, SVA Certified Public Accountants