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Will Insurance Allow CariVu Instead of X-rays?

Ask the Expert ForumCategory: Insurance CodingWill Insurance Allow CariVu Instead of X-rays?
Avatarguestuser Staff asked 5 years ago

I work for DEXIS digital X-ray. We recently introduced CariVu, a caries detector that produces an image that can be saved in our software like an X-ray. See http://www.dexis.com/carivu for an example. We have had several dentists ask if insurance would allow the use of these images instead of X-rays for treatment documentation. Can you shed some light on this for us?

1 Answers
Karen Davis, RDH, BSDHKaren Davis, RDH, BSDH Staff answered 1 year ago

This is a really good question and I had to research this a bit, and to be honest, there may be wide variations on how insurance carriers would handle a submission of caries detection images. While there are currently three NEW codes for 2014 related to Caries Risk Assessment and Documentation for Low, Moderate, and High Risk (D0601, D0602 and D0603 respectively) none of the codes describe documentation such as the CariVu although certainly it would be wise to include such data if you have it when using these codes.

Even though these new codes exist, most payers still consider risk assessment as part of a comprehensive oral evaluation or periodic oral evaluation, so reimbursement is limited at best. Regarding submission of caries detection images such as CariVu, Spectra, SoproLife or like images in lieu of radiographs for patients that refuse X-rays, or in cases where you elect to use that data instead of radiographs, my advice would be to submit it with a brief narrative describing what is being documented on the image since those handling claims may not have seen this type of documentation before. Whether or not it will be considered as sufficient data to “replace” radiographic information will simply be determined per carrier, and whether or not you elect to charge a fee for collection of such images would be an individual practice decision. In my experience I mostly have seen caries detection images use of such technology not billed out separately to patients.

Hopefully, in the future we will have additional codes and additional reimbursement considerations for newer (and often better) diagnostic technologies.