Coverage and Claim Reporting

July 29, 2010

Dental Coverage and Claim Reporting of Brush Biopsy

Delta Dental of Iowa covers the dentist's fee, up to the Maximum Plan Allowance (MPA), to perform the brush biopsy and collect the tissue sample. Dental charges are disallowed for any inadequate test specimens as identified by OralCDx. The level of coverage is determined by the group and will often be the same as other oral surgery procedures. Generally, the laboratory fee to analyze the tissue sample is covered by the patient's medical plan. However, it is encouraged to contact the medical carrier for confirmation of coverage.

Dentists should submit the brush biopsy procedure to Delta Dental using CDT code D7288 - Brush Biopsy - transepitherial sample collection. A copy of the patient's Oral Brush Biopsy Test Report (i.e. lab report from OralCDx) must be submitted with the claim form.

Frequently Delta Dental is asked what the fee should be for this new procedure. While it is not Delta Dental's role to specify a fee amount, observations indicate a fee range that approximates a problem focused evaluation. This information is provided solely as a guide; dentists should set their fees based on their individual costs of time and materials.