While OMSs and dentists are included in Phase 1 of federal priority lists for receipt of the COVID-19 vaccine, states and even local governments may adjust these recommendations to fit the requirements of their own communities. Most jurisdictions include OMSs and dentists somewhere in Phase 1. Check with state and local health departments for information applicable to individual situations.

Only a vaccine with emergency use authorization (EUA) or approval from the FDA can be administered in the U.S. There are currently two vaccines that have received EUA from the FDA:

Pfizer/BioNTech – EUA granted Dec. 11

Authorized for individuals 16 years of age or older. Not recommended for those who have had a severe allergic reaction after a previous dose of this vaccine or those who have had a severe allergic reaction to any ingredient of this vaccine. Vaccine is delivered in a series of two doses given three weeks apart.

• FDA fact sheet for recipients and caregivers
• FDA EUA Review Memorandum
• Pfizer-BioNTech COVID-19 Vaccine Website for U.S. Healthcare Professionals

Moderna – EUA granted Dec. 18

Authorized for individuals 18 years of age or older. Vaccine is delivered in a series of two doses given 28 days apart.

• FDA briefing document
• FDA fact sheet for recipients and caregivers
• FDA EUA Review Memorandum
• Moderna Vaccine Information

Additional information on vaccines is available through the World Health Organization.

Health insurance providers and state plans offer limited-time changes to payer coverage to provide relief of cost-sharing, waived deductibles, and additional coverage.

• American Health Insurance Plans-AHIP
  • United HealthCare: Waiving cost-share for Medicare Advantage Members
• ADA
  • Third-party payer reimbursement for costs associated with increased standards for PPE
  • COVID-19 Coding and Billing Interim Guidance: PPE
  • Tips for Handling Contract Negotiations
  • Third-party payer reimbursement for temporary procedures
• CMS
  • COVID-19 FAQs on Medicare-Fee-For Service Billing
  • Medicaid Plans

AAOMS is providing this list of resources to assist members with the evolving changes with COVID-19 coding and billing and related services.

• ADA CDT Coding and Contract Guidance
• AMA CPT Coding Guidance
• ICD-10-CM coding

COVID-19 Testing

• The ADA has created two new CDT codes for testing taking effect Jan. 1, 2021. Details are provided in the CDT 2021 coding book.
• AMA CPT Coding
  • CPT Assistant: Reporting Coronavirus Laboratory Testing
  • CMS Modifier QW claim guidance
  • CMS Modifier CS claim guidance

AAOMS COVID-19 Resources

• Coding and Billing for COVID-19 Testing and PPE
• COVID-19 Guide for OMS Practices
• COVID-19 Guidance and FAQs

Specific directives related to urgent/non-urgent services are given on the federal and state levels as well by the AMA and ADA to help define and navigate emergency procedures through the COVID-19 pandemic.

• CMS
• States
• AMA
• ADA
  • Interim Guidance for Management of Emergency and Urgent Dental Care
• AAOMS FAQs

  Both the ADA and CMS have issued guidance on what they deem to be emergent and/or urgent services. States also are continuing to issue their own recommendations on what constitutes an emergency. Check your local laws and/or directives. View AAOMS daily state-by-state updates. Coding for dental emergencies should be coded and treated the same way as before the current health crisis. You may bill medical and/or dental only if the procedure applies to both. Two CDT codes may be considered. However, the ADA’s Coding Companion states not all dental plans will cover these codes; therefore, contractual obligations may apply:

  D9440 for office visit after regularly scheduled hours OR
  D9430 for office visit for observation (during regularly scheduled hours – no other services performed)

  Some states have laws that may prohibit balance billing by a non-participating provider in an emergency. Also, some states have defined what is considered an emergency during the pandemic.

Recommendations to Reopen Healthcare System

• CMS Recommendations

In an effort to increase cash flow and provide financial assistance to providers impacted by COVID-19, CMS and many dental payers have stepped forward to extend temporary payment relief as many are experiencing significant disruption in claim submissions and reimbursements.

Advanced Payments Loans

• CMS
  • Accelerated and Advance Payments
• AMA
  • AMA defines qualifications and process
  • AMA FAQs
    • Check with individual commercial medical payers to confirm loan availability
• ADA
  • Financial Assistance for Dental Practices from Third Party Payers

Emergency Provider Relief Payments

• CARES Act Provider Relief

As the COVID-19 crisis continues to create unprecedented challenges, several AAOMS Advantage Partners are working to offer additional assistance and special offers exclusively for AAOMS members. Visit the AAOMS Advantage News page for the latest offers and updates.

The CARES Act suspended payments, principal and interest (without penalty to the borrower) for all federally owned loans through Sept. 30. The U.S. Department of Education’s office of Federal Student Aid has developed an FAQ webpage with more information.