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CDT D2950 Dental Procedure Code
Core buildup (D2950) is misused, and overuse leads to denials. Dental practitioners try to explain to the patients the limitations of their plan before they provide service to avoid any payment delays or denials.
The code description reads as a core build-up procedure necessary for crown retention. It is no longer known as crown build-up. The purpose of the build-up is to rebuild the internal anatomy of the tooth structure to hold the crown. Certain carriers will not cover a build-up unless a proper crown is placed or will not reimburse for the build-up without the seat date of the tooth crown provided.
Dental Service Provider Perspective
- As per the ADA Council on Dental Benefit Programs, the service provider uses this code before restoring a tooth with a crown. While for some dentists, this procedure gets bundled with a crown procedure centered on the lack of benefits.
- Having separate procedures to limit benefits is against the norms of ADA. If a plan selects a bundle, in that case, the sum of the fees for the crown and the crown build-up procedure is the total allowable fee with appropriate benefits. The parameters of the payment plan create a lot of confusion. For patients to avail the benefits, they receive information through a benefits booklet or Explanation of the benefits.
- Many patients do not understand their dental benefits. It becomes incumbent for dentists to deliver care without withstanding a patient’s coverage.
- The reasons insurers choose not to fund core build-ups, such as procedures happening on the same day of the root canal, are considered inclusive of the root canal fee. Also, lack of benefit narrative, code mixed with thousands of other claims, using the code as fillers, etc. In case of denials, submit an appeal with supporting documents outlining the reason for the procedure to improve prognosis.
Dental Industry Perspective
- D2950 and D6973, the core build-up for retainers, including pins, and both the codes create problems for payers due to either lack of supporting documents or limitations in the employer’s group policy.
- The CDT-4 clarifies the procedure as building up of the anatomical crown when the restorative crown gets placed. A material used for the preparation of the crown and to hold the tooth crown due to insufficient tooth strength. However, this coding is not applicable when it involves a filler to eliminate any irregularity or undercut in the preparation.
- Some payers get confused that build-ups come in addition to the crown procedure where the base gets placed to restore the tooth structure and undercuts. Although, by definition and supporting documentation, the dental consultant, on behalf of the payer, decides whether the crown build-up is a part of the crown procedure or not.
- Under the state law or Taft Hartley contracts, the documents meet the grade school readability standards available to insured patients. The language is descriptive to explain the benefit limitations of the patient’s claim and the payer’s action.
- To minimize the claim denials for core build-up, provide all the documents with the initial claim submission.