Negotiated reimbursement rates for D0478 across 2 states, sourced from CMS Transparency in Coverage data. 6 rate records.
D0478 pertains to consultations provided by a pathologist for outside materials, which may include specimens not submitted directly by the referring dentist. This procedure is indicated when a dentist seeks a pathologist's expertise on a specimen obtained from another source. Documentation must include the clinical context for the consultation, details about the outside material, and any relevant patient history. Reimbursement for D0478 varies by payor and state, with an average payment of around $95. It is essential for dental billing professionals to confirm coverage policies with individual payors, as some may have specific criteria for reimbursement or require prior authorization.
Reimbursement rates for D0478 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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