Negotiated reimbursement rates for D0423 across 4 states, sourced from CMS Transparency in Coverage data. 19 rate records.
D0423 is the code for a caries risk assessment for patients aged 6 and older. This procedure assesses the likelihood of caries development based on various factors such as oral hygiene, dietary habits, and previous dental history. It is clinically indicated for patients who may be at increased risk for caries, allowing for targeted preventive measures. Proper documentation should include the assessment results, identified risk factors, and any follow-up recommendations. Reimbursement for this procedure varies by payor and state, with some insurers providing coverage under preventive services, while others may have restrictions. The average reimbursement for this code is about $59.
Reimbursement rates for D0423 vary significantly by state, payor, and provider network. The national average negotiated rate is $59. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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