Negotiated reimbursement rates for D0426 across 15 states, sourced from CMS Transparency in Coverage data. 61 rate records.
Caries Risk Assessment & Documentation (Low Risk) is a procedure that involves evaluating a patient's risk for developing caries and documenting the findings. This assessment is crucial for preventive care and can help guide treatment decisions. Clinical indications include patients with minimal caries history and no significant risk factors. Proper documentation should include the assessment findings, risk factors, and any preventive measures recommended. Reimbursement for this service averages around $37, but it can vary by payor, with some plans offering higher reimbursement for comprehensive assessments, while others may not cover it at all.
Reimbursement rates for D0426 vary significantly by state, payor, and provider network. The national average negotiated rate is $37. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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| State | Avg Rate |
|---|---|
| Missouri | $102 |
| Nebraska | $102 |
| Minnesota | $46 |
| Oregon | $44 |
| Washington | $43 |
| State | Avg Rate |
|---|---|
| Florida | $33 |
| Arkansas | $32 |
| New York | $30 |
| California | $29 |
| Indiana | $20 |