Negotiated reimbursement rates for D0431 across 30 states, sourced from CMS Transparency in Coverage data. 112 rate records.
Adjunctive Pre-Diagnostic Test (No Biopsy) is a procedure that aids in the diagnosis of oral diseases without the need for a biopsy. This test may include various diagnostic aids that help identify conditions such as oral cancer or other lesions. Clinical indications include patients presenting with suspicious lesions or symptoms warranting further investigation. Documentation must include the rationale for the test, findings, and any follow-up recommendations. Average reimbursement for this procedure is around $51, but payor policies can differ significantly, with some requiring extensive documentation for coverage.
Reimbursement rates for D0431 vary significantly by state, payor, and provider network. The national average negotiated rate is $51. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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