Dental Insurance Fee Caps, Self-Funded Plans & How CDT Codes Are Made | Dr. Greg Grobmyer

Do you have to honor an insurance write-off on a service the plan doesn't cover? Dr. Greg Grobmyer of Practice Booster explains why your state's fee-capping law may not apply to half your patients, how to ask a payer about upgrades, why the HITECH waiver can backfire, and how CDT codes actually get made.

In this episode:

- Anyone can propose a new CDT code: how the Code Maintenance Committee works

- Code modifiers, and whether dental coding is turning into medical coding

- Will insurers start paying differently by material?

- Stationary intraoral tomosynthesis, and coding 3D-printed crowns as ceramic

- Self-funded (ERISA) vs fully insured plans, and why it matters for fee caps

- Asking the payer about upgrades, and documenting it

- Why the HITECH waiver is risky, and a safer workaround for big cases

Recorded in late 2022, so check the current CDT manual for today's codes.

Plus 2022 dental news: a topical treatment for bisphosphonate jaw necrosis from UCLA, a planned dental school in Arkansas, dental care for pregnant patients, and the ADA's new wellness ambassadors.

Dr. Greg Grobmyer graduated from the University of Tennessee Health Science Center and practiced in Tennessee for over a decade until cancer treatment ended his clinical career. He edits Practice Booster's Insurance Solutions newsletter and the Coding with Confidence books with Dr. Charles Blair, and speaks nationally on dental coding and insurance.

🙌 Special shout out to Q-Optics for making this episode possible!

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