Billing and Insurance Reimbursement

The BrushTest is covered by most major insurance plans

The dentist may bill dental insurance and/or medical insurance.

Dental Insurance - For all locations in the oral cavity, the ADA CDT-5 code available for reporting this procedure is D7288.

Medical Insurance - CPT codes (procedure codes) are available to report the dentist’s procedure to the patient’s medical insurance. CPT codes are site specific. A list of CPT procedure codes that may be considered to report the biopsy procedure is provided in the adjacent table.

In addition to the procedure codes listed, a diagnosis code (ICD-9-CM) is also required when reporting the procedure to the patient’s medical insurance. The diagnosis code indicates the condition for which the biopsy was taken. A list of ICD-9-CM diagnosis codes that may be considered is provided in the adjacent table.

The choice of an appropriate procedure code and diagnosis code is the responsibility of the dentist considering the clinical circumstances of each case. OralCDx® Laboratories is providing information for educational purposes only. OralCDx® Laboratories offers this information in good faith based upon publicly available information. OralCDx® Laboratories  makes no promises that payers will pay any amount for services performed. You should always consult your local payer if you have any questions.

Combined Billing: Medical and Dental -  After billing to medical insurance and receiving an Explanation of Benefits (EOB), a claim may be submitted to the dental insurance carrier. Submit a copy of medical EOB with claim.

If the patient is covered with a medical insurance PPO/Indemnity/POS (point of service) plan, use a CMS 1500 claim form, available from dental claim form supplier.

Medicare - If the dental office is a Medicare provider (has been assigned a UPIN number), the local Medicare carrier may be billed for the biopsy procedure. If the patient has supplemental medical insurance (providing coverage for co-payment, deductibles or non-covered services), an EOB from Medicare may accompany a claim to the supplemental insurer (this may also be forwarded directly by the local Medicare carrier).

In all cases, attaching a copy of the pathology report to the medical or dental insurance billing form may help avoid delay and speed payment of the claim.

OralCDx® Laboratories’ Fee for Analysis of the Brush Biopsy Specimen

The fee for OralCDx® Laboratories’ computer assisted analysis of the brush biopsy specimen appears on the Test Requisition Form.

With regard to the OralCDx® Laboratory fee:
1)  For non-Medicare patients, the patient’s check or credit card number may be submitted with the specimen. Alternatively, the patient’s medical or dental insurance information should be supplied on the Test Form or copies of the insurance card should be attached to the form.

2) For Medicare patients, OralCDx Laboratories must bill Medicare directly, and payment from patients can only be accepted for applicable deductibles and co-payments.