N.J. Admin. Code § 10:56-3.11

Current through Register Vol. 57, No. 1, January 6, 2025

Section 10:56-3.11 - D8000-D8999 ORTHODONTICS

(a) Minor treatment for tooth guidance:

1. Includes all necessary adjustments.

2. Code may also be used for Orthodontic Retention Appliances following comprehensive treatment by a previous dentist.

				Maximum Fee
HCPCS	Allowance
IND	Code	Mod	Procedure Description	S	$	NS
D8010	Limited orthodontic treatment of	595.00	590.00
the primary dentition
D8020	Limited orthodontic treatment of	595.00	590.00
the transitional dentition
D8030	Limited orthodontic treatment of	595.00	590.00
the adolescent dentition
D8040	Limited orthodontic treatment of	595.00	590.00
the adult dentition
D8050	Interceptive orthodontic treatment	595.00	590.00
of the primary dentition
D8060	Interceptive orthodontic treatment	595.00	590.00
of the transitional dentition

(b) Minor treatment to control harmful habits:

1. Includes all necessary adjustments.

D8210	Removable Appliance Therapy	595.00	590.00
D8220	Fixed Appliance Therapy	595.00	590.00

(c) Comprehensive orthodontic treatment--adolescent dentition:

1. Treatment of permanent dentition. Indicate anticipated time under treatment--maximum treatment reimbursable including retention--three years. Reimbursement for comprehensive orthodontic treatment will include removal and retention as required at no additional charge.

D8080	Comprehensive orthodontic	2,581	2,581
treatment of the adolescent
dentition

(d) Other orthodontic services:

D8660

Pre-orthodontic treatment visit

11.00

10.00

NOTE 1: This code is to be used for comprehensive orthodontic evaluation and assessment.

NOTE 2: Definition and Criteria for Assessing Handicapping Malocclusion Permanent Dentition form (FD-10) must be available in patient records.

D8691	Repair of orthodontic appliance	49.50	45.00
D8692	Replacement of lost or broken	115.00	110.00
retainer
*	D8999	Unspecified Orthodontic Procedure,	BR	BR
By Report

NOTE: Complete description, diagnosis and treatment plan must be submitted.

N.J. Admin. Code § 10:56-3.11

Public notice: Pursuant to the provisions of N.J.S.A. 30:4D-2, 3, 5, 6 and 7 and the New Jersey Appropriations Act (P.L. 1988, c.47), maximum fee allowance increased at (c), effective 8/1/1988.
See: 20 N.J.R. 2101(a).
Amended by R.1996 d.428, effective 9/16/1996.
See: 28 N.J.R. 3069(a), 28 N.J.R. 4243(a).
Amended by R.2000 d.426, effective 10/16/2000.
See: 32 N.J.R. 2411(a), 32 N.J.R. 3836(a).
In (c) and (d), changed Maximum Fee Allowances.
Amended by R.2003 d.16, effective 1/6/2002.
See: 34 N.J.R. 2681(a), 35 N.J.R. 232(a).
Rewrote the section.