Oral Evaluation for Patient Under 3 (D0145) — National Rates

About D0145 — Oral Evaluation for Patient Under 3

D0145 is designated for oral evaluations of patients under the age of three. This procedure focuses on assessing the oral health of very young children, including the examination of teeth, gums, and oral hygiene practices. Documentation should include the child's developmental history, any parental concerns, and findings from the examination. Reimbursement for D0145 tends to be lower than for other evaluation codes, and coverage can vary by payor. Some insurance plans may have specific guidelines for pediatric evaluations, so it's important for billing professionals to verify coverage details to ensure appropriate reimbursement.

Reimbursement rates for D0145 vary significantly by state, payor, and provider network. The national average negotiated rate is $57. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.