Negotiated reimbursement rates for D0425 across 16 states, sourced from CMS Transparency in Coverage data. 77 rate records.
Caries Susceptibility Test is a diagnostic procedure used to assess a patient's risk of developing dental caries. This test typically involves the use of a specific assay or method to evaluate the presence of bacteria associated with caries. Clinical indications for this test include patients with a history of frequent caries, xerostomia, or other risk factors. Documentation should include the patient's caries history, risk factors, and the specific test performed. Reimbursement for this procedure can vary significantly by payor and state, with average payments around $21. Some insurance plans may not cover this test, while others may require prior authorization or specific documentation to justify its necessity.
Reimbursement rates for D0425 vary significantly by state, payor, and provider network. The national average negotiated rate is $21. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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