Negotiated reimbursement rates for D0160 across 37 states, sourced from CMS Transparency in Coverage data. 218 rate records.
D0160 is used for a detailed or extensive oral evaluation, which may be necessary for patients with complex dental issues or those requiring a comprehensive assessment. This evaluation goes beyond the standard examination and may include additional diagnostic tests or consultations. Documentation should reflect the complexity of the case, including detailed findings and treatment considerations. Reimbursement for D0160 can vary significantly by payor and state, with some insurers requiring pre-authorization for extensive evaluations. It's crucial for billing professionals to understand the specific requirements of each payor to facilitate reimbursement.
Reimbursement rates for D0160 vary significantly by state, payor, and provider network. The national average negotiated rate is $95. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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