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
• 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

• ADA currently recommends D1999 until a more specific code is available
• AMA CPT Coding
  • CPT Assistant: Reporting Coronavirus Laboratory Testing
  • CMS Modifier QW claim guidance

AAOMS COVID-19 Resources

• 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 Small Business Administration (SBA) has authorized lenders to begin taking Paycheck Protection Program (PPP) applications as of April 3. Guidance for the PPP loan, along with other information, can be found on the SBA’s website. Applications are being taken through June 20 or until funds are exhausted.

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.