If a person’s dental and medical plan are by the same carrier and dental paid a certain amount toward three D7111’s but would not cover the sedation (non-IV) portion D9248 how would I submit this as a medical claim? Which CPT codes are equivalent and can this even be done after dental already paid a portion. Do I only include the code that was not a covered benefit? Thank you

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  • If a person's dental and medical plan are by the same carrier and dental paid a certain amount toward three D7111's but would not cover the sedation (non-IV) portion D9248 how would I submit this as a medical claim? Which CPT codes are equivalent and can this even be done after dental already paid a portion. Do I only include the code that was not a covered benefit? Thank you

If a person’s dental and medical plan are by the same carrier and dental paid a certain amount toward three D7111’s but would not cover the sedation (non-IV) portion D9248 how would I submit this as a medical claim? Which CPT codes are equivalent and can this even be done after dental already paid a portion. Do I only include the code that was not a covered benefit? Thank you

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Asked on September 9, 2013
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You will need to submit the claim to medical on a CMS-1500 form and attach a copy of the dental EOB to the claim.

You will use CPT code 41899 in place of the D7111.

For the D9248 you will need to list the drugs used and their appropriate HCPCS code.

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Answered on September 10, 2013
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