Negotiated reimbursement rates for D8030 across 19 states, sourced from CMS Transparency in Coverage data. 104 rate records.
D8030 is designated for Limited Orthodontic treatment in adolescent dentition, which applies to patients who are in the early stages of permanent dentition. This procedure is often indicated for adolescents who require targeted orthodontic care to correct specific malocclusions or to facilitate future dental treatments. Proper documentation for billing must include a comprehensive treatment plan, clinical justification for the limited approach, and any relevant diagnostic imaging. Reimbursement for D8030 can vary widely among payors and states, with some plans providing minimal coverage while others may offer more favorable rates based on the clinical necessity. The average reimbursement for this code is approximately $2, but it is crucial to check with individual insurance companies for specific coverage details.
Reimbursement rates for D8030 vary significantly by state, payor, and provider network. The national average negotiated rate is $2. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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| State | Avg Rate |
|---|---|
| North Dakota | $5,600 |
| Connecticut | $4,580 |
| New Jersey | $4,460 |
| Michigan | $4,208 |
| Illinois | $4,200 |
| State | Avg Rate |
|---|---|
| South Carolina | $2,172 |
| Virginia | $1,933 |
| Nevada | $1,770 |
| Washington | $1,688 |
| Arizona | $1,646 |