Caries Risk Assessment — High Risk (D0603) — National Rates

About D0603 — Caries Risk Assessment — High Risk

Caries Risk Assessment - High Risk is a procedure used to evaluate a patient's likelihood of developing dental caries. This assessment is crucial for patients identified as high risk due to factors such as a history of caries, poor oral hygiene, or dietary habits. Documentation for this procedure should include a detailed patient history, clinical findings, and any relevant risk factors. Billing for this service may vary by payor, with some insurance plans covering it fully while others may require additional documentation or may not reimburse at all. It is essential to check specific payor policies and state regulations to ensure proper reimbursement.

Reimbursement rates for D0603 vary significantly by state, payor, and provider network. The national average negotiated rate is $31. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.