Dental and Oral Surgical Procedures - UNITEDHEALTHCARE Coverage

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
June 19th, 2015

The following procedures are found in Oxfords Dental policy.

The following procedures MAY qualify for coverage under the general benefits package:

Dental services that are medically necessary and incident to a covered medical service including:

Oxford's Dental Department will review requests for dental services rendered:

  1. for the following services when delivered in conjunction with dental services:
    1. Dental services
    2. Oral surgical services
    3. Anesthesia services delivered in conjunction with dental services.

  2. by practitioners of the following specialties:  
    1. oral/maxillofacial surgery
    2. pediatric dentistry
    3. endodontics
    4. orthodontices

NOTE: All other specialties require Medical Director review through Oxford's Medical Management Department.

  1. Precertification with review by a Medical Director or their designee is required.

The codes listed in this policy are for reference purposes only, this listing does not mean teh procedure is covered. Be sure to verify the patients benefits and eligibility.

This list of CPT® Codes may not be all inclusive.

21010 Arthrotomy, temporomandibular joint
21015 Radical resection of tumor (eg, sarcoma), soft tissue of face or scalp; less than 2 cm
21016 Radical resection of tumor (eg, sarcoma), soft tissue of face or scalp; 2 cm or greater
21025 Excision of bone (eg, for osteomyelitis or bone abscess); mandible
21026 Excision of bone (eg, for osteomyelitis or bone abscess); facial bone(s)
21029 Removal by contouring of benign tumor of facial bone (eg, fibrous dysplasia)
21030 Excision of benign tumor or cyst of maxilla or zygoma by enucleation and curettage
21031 Excision of torus mandibularis
21032 Excision of maxillary torus palatinus
21034 Excision of malignant tumor of maxilla or zygoma
21040 Excision of benign tumor or cyst of mandible, by enucleation and/or curettage
21044 Excision of malignant tumor of mandible;
21045 Excision of malignant tumor of mandible; radical resection
21046 Excision of benign tumor or cyst of mandible; requiring intra-oral osteotomy (eg, locally Aggressive or destructive lesion[s])
21047 Excision of benign tumor or cyst of mandible; requiring extra-oral osteotomy and partial mandibulectomy (eg, locally aggressive or destructive lesion[s])
21048 Excision of benign tumor or cyst of maxilla; requiring intra-oral osteotomy (eg, locally Aggressive or destructive lesion[s])
21049 Excision of benign tumor or cyst of maxilla; requiring extra-oral osteotomy and partial maxillectomy (eg, locally aggressive or destructive lesion[s])
21050 Condylectomy, temporomandibular joint (separate procedure)
21060 Meniscectomy, partial or complete, temporomandibular joint (separate procedure)
21070 Coronoidectomy (separate procedure)
21076 Impression and custom preparation; surgical obturator prosthesis
21077 Impression and custom preparation; orbital prosthesis
21079 Impression and custom preparation; interim obturator prosthesis
21080 Impression and custom preparation; definitive obturator prosthesis
21081 Impression and custom preparation; mandibular resection prosthesis
21082 Impression and custom preparation; palatal augmentation prosthesis
21083 Impression and custom preparation; palatal lift prosthesis
21084 Impression and custom preparation; speech aid prosthesis
21085 Impression and custom preparation; oral surgical splint
21086 Impression and custom preparation; auricular prosthesis
21087 Impression and custom preparation; nasal prosthesis
21088 Impression and custom preparation; facial prosthesis
21089 Unlisted maxillofacial prosthetic procedure
21100 Application of halo type appliance for maxillofacial fixation, includes removal (separate procedure)
21110 Application of interdental fixation device for conditions other than fracture or dislocation, includes removal
21116 Injection procedure for temporomandibular joint arthrography
21188 Reconstruction midface, osteotomies (other than LeFort type) and bone grafts (includes obtaining autografts)
21206 Osteotomy, maxilla, segmental (eg, Wassmund or   Schuchard)
21208 Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant)
21209 Osteoplasty, facial bones; reduction
21210 Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)
21215 Graft, bone; mandible (includes obtaining graft)
21240 Arthroplasty, temporomandibular joint, with or without autograft (includes obtaining graft)
21242 Arthroplasty, temporomandibular joint, with allograft
21243 Arthroplasty, temporomandibular joint, with prosthetic joint replacement
21244 Reconstruction of mandible, extraoral, with transosteal bone plate (eg, mandibular staple bone plate)
21245 Reconstruction of mandible or maxilla, subperiosteal implant; partial
21246 Reconstruction of mandible or maxilla, subperiosteal implant; complete
21248 Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial
21249 Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete
21255 Reconstruction of zygomatic arch and glenoid fossa with bone and cartilage (includes obtaining autografts)
21296 Reduction of masseter muscle and bone (eg, for treatment of benign masseterichypertrophy); intraoral approach
21299 Unlisted craniofacial and maxillofacial procedure
21421 Close treatment of palatal or maxillary fracture (LeFort I type), with interdental wire Fixation or fixation of denture or splint
21422 Open treatment of palatal or maxillary fracture (LeFort I type);
21423 Open treatment of palatal or maxillary fracture (LeFort I type); complicated (comminuted or involving cranial nerve foramina), multiple approaches
21431 Closed treatment of craniofacial separation (LeFort III type) using interdental wire fixation of denture or splint
21432 Open treatment of craniofacial separation (LeFort III type); with wiring and/or internal fixation
21433 Open treatment of craniofacial separation (LeFort III type); complicated (eg, comminuted or involving cranial nerve foramina), multiple surgical approaches
21435 Open treatment of craniofacial separation (LeFort III type); complicated, utilizing internal and/or external fixation techniques (eg., head cap, halo device, and/or intermaxillary fixation) internal and/or external fixation techniques (eg., head cap, halo device, and/or intermaxillary fixation) internal
21436 Open treatment of craniofacial separation (LeFort III type); complicated, multiple surgical approaches, internal fixation, with bone grafting (includes obtaining graft)
21440 Closed treatment of mandibular or maxillary alveolar ridge fracture (separate procedure)
21445 Open treatment of mandibular or maxillary alveolar ridge fracture (separate procedure)
21450 Closed treatment of mandibular fracture; without manipulation
21451 Closed treatment of mandibular fracture; with manipulation
21452 Percutaneous treatment of mandibular fracture, with external fixation
21453 Closed treatment of mandibular fracture with interdental fixation
21454 Open treatment of mandibular fracture with external fixation
21461 Open treatment of mandibular fracture; without interdental fixation
21462 Open treatment of mandibular fracture; with interdental fixation
21465 Open treatment of mandibular condylar fracture
21470 Open treatment of complicated mandibular fracture by multiple surgical approaches including internal fixation, interdental fixation, and/or wiring of dentures or splints
21480 Closed treatment of temporomandibular dislocation; initial or subsequent
21485 Closed treatment of temporomandibular dislocation; complicated (eg, recurrent requiring intermaxillary fixation or splinting), initial or subsequent
21490 Open treatment of temporomandibular dislocation
21495 Open treatment of hyoid fracture
21497 Interdental wiring, for condition other than fracture
21499 Unlisted musculoskeletal procedure, head
29800 Arthroscopy, temporomandibular joint, diagnostic, with or without synovial biopsy (separate procedure)
29804 Arthroscopy, temporomandibular joint, surgical
40530 Resection of lip, more than one-fourth, without reconstruction
40654 Repair lip, full thickness; over one -half vertical height, or complex
40700 Plastic repair of cleftlip/nasal deformity; primary, partial or complete, unilateral
40701 Plastic repair of cleft lip/nasal deformity; primary bilateral, 1 stage procedure
40702 Plastic repair of cleft lip/nasal deformity; primary bilateral, 1 of 2 stages
40720 Plastic repair of cleft lip/nasal deformity; secondary, by recreation of defect and reclosure
40761 Plastic repair of cleft lip/nasal deformity; with cross lip pedicle flap (Abbe-Estlander type), including sectioning and inserting of pedicle
40799 Unlisted procedure, lips
40800 Drainage of abscess, cyst, hematoma, vestibule of mouth; simple
40801 Drainage of abscess, cyst, hematoma, vestibule of mouth; complicated
40804 Removal of embedded foreign body, vestibule of mouth; simple
40805 Removal of embedded foreign body, vestibule of mouth; complicated
40806 Incision of labial frenum (frenotomy)
40814 Excision of lesion of mucosa and submucosa, vestibule of mouth; with complex repair
40816 Excision of lesion of mucosa and submucosa, vestibule of mouth; complex, with excision of underlying muscle
40818 Excision of mucosa of vestibule of mouth as donor graft
40819 Excision of frenum, labial or buccal (frenumectomy, frenulectomy, frenectomy)
40820 Destruction of lesion or scar of vestibule of mouth by physical methods (eg, laser, thermal, cryo, chemical)
40840 Vestibuloplasty; anterior
40842 Vestibuloplasty; posterior, unilateral
40843 Vestibuloplasty; posterior, bilateral
40844 Vestibuloplasty; entire arch
40845 Vestibuloplasty; complex (including ridge extension, muscle repositioning)
40899 Unlisted procedure, vestibule of mouth
41000 Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; lingual
41005 Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; sublingual, superficial
41006 Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; sublingual, deep, supramylohyoid
41007 Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; submental space
41008 Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; submandibular space
41009 Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; masti cator space
41010 Incision of lingual frenum (frenotomy)
41015 Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; sublingual
41016 Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; submental
41017 Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; submandibular
41018 Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; masticator space
41114 Excision of lesion of tongue with closure; with local tongue flap
41115 Excision of lingual frenum (frenectomy)
41120 Glossectomy; less than one-half tongue
41130 Glossectomy; hemiglossectomy
41252 Repair of laceration of tongue, floor of mouth, over 2.6 cm or complex
41500 Fixation of tongue,mechanical, other than suture (eg, K-wire)
41512 Tongue base suspension, permanent suture technique
41520 Frenoplasty (surgical revision of frenum, eg, with Z-plasty)
41530 Submucosal ablation of the tongue base, radiofrequency, 1 or more sites, per session
41800 Drainage of abscess, cyst, hematoma from dentoalveolar structures
41805 Removal of embedded foreign body from dentoalveolar structures; soft tissues
41806 Removal of embedded foreign body from dentoalveolar structures; bone
41820 Gingivectomy, excision gingiva, each quadrant
41821 Operculectomy, excision pericoronal tissues
41822 Excision of fibrous tuberosities, dentoalveolar structures
41823 Excision of osseous tuberosities, dentoalveolar structures
41825 Excision of lesion or tumor (except listed above), dentoalveolar structures; without repair
41826 Excision of lesion or tumor (except listed above), dentoalveolar structures; with simple repair
41827 Excision of lesion or tumor (except listed above), dentoalveolar structures; with complex repair
41828 Excision of hyperplastic alveolar mucosa, each quadrant (specify)
41830 Alveolectomy, including curettage of osteitis or sequestrectomy
41850 Destruction of lesion (except excision), dentoalveolar structures
41870 Periodontal mucosal   grafting
41872 Gingivoplasty, each quadrant (specify)
41874 Alveoloplasty, each quadrant (specify)
41899 Unlisted procedure, dentoalveolar structures
42000 Drainage of abscess of palate, uvula
42107 Excision, lesion of palate, uvula; with local flap closure
42120 Resection of palate or extensive resection of lesion
42140 Uvulectomy, excision of uvula
42145 Palatopharyngoplasty (eg, uvulopalatopharyngoplasty, uvulopharyngoplasty)
42182 Repair, laceration of palate; over 2 cm or complex
42200 Palatoplasty for cleft palate, soft and/or hard palate only
42205 Palatoplasty for cleft palate, with closure of alveolar ridge; soft tissue only
42210 Palatoplasty for cleft palate, with closure of alveolar ridge; with bone graft to alveolar ridge (includes obtaining graft)
42215 Palatoplasty for cleft palate; major revision
42220 Palatoplasty for cleft palate; secondary lengthening procedure
42225 Palatoplasty for cleft palate; attachment pharyngeal flap
42226 Lengthening of palate, and pharyngeal flap
42227 Lengthening of palate, with island flap
42235 Repair of anterior palate, including vomer flap
42280 Maxillary impression for palatal prosthesis 
42281 Insertion of pin-retained palatal prosthesis
42299 Unlisted procedure, palate, uvula

References:

Dental and Oral Surgical Procedures - UNITEDHEALTHCARE Coverage. (2015, June 19). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/dental-and-oral-surgical-procedures-unitedhealthcare-coverage-31642.html

© InnoviHealth Systems Inc

Article Tags  (click on a tag to see related articles)


Publish this Article on your Website, Blog or Newsletter

This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. If you would like to publish this article, please contact us and let us know where you will be publishing it. The easiest way to get the text of the article is to highlight and copy. Or use your browser's "View Source" option to capture the HTML formatted code.

If you would like a specific article written on a medical coding and billing topic, please Contact Us.


contact

innoviHealth Systems, Inc.
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (9-5 Mountain)
Email:
free demo
request yours today
pricing
for any budget
sign IN
welcome back!

Thank you for choosing Find-A-Code, please Sign In to remove ads.