N.J. Admin. Code § 10:56-3.5

Current through Register Vol. 56, No. 11, June 3, 2024

Section 10:56-3.5 - D3000-D3999 ENDODONTICS

(a) Therapeutic Pulpotomy:

				Maximum Fee
HCPCS	Allowance
IND	Code	Mod	Procedure Description	S	$	NS
D3220	Therapeutic Pulpotomy (Excluding	28.00	26.00
Final Restoration)--removal of
pulp coronal to the
Dentinocemental junction and
application of medicament
D3221	Gross pulpal debridement, Primary	28.00	26.00
and Permanent teeth
D3230	Pulpal therapy (resorbable	74.00	67.50
filling)--Anterior, Primary Tooth
(excluding final restoration)
D3240	Pulpal therapy (resorbable	95.00	86.50
filling)--Posterior, Primary Tooth
(excluding final restoration)

(b) Root Canal Therapy (including treatment plan, clinical procedures, and follow-up care):

1. For emergency endodontic procedures, use code D3220.

D3310	Anterior (excluding final	148.00	135.00
restoration)

NOTE: Code to be used for incisors and cuspids (permanent).

D3320	Bicuspid (excluding final	190.00	173.00
restoration)

NOTE: Code to be used for premolars and all primary teeth without permanent successors.

D3330

Molar (excluding final restoration)

247.00

225.00

NOTE: Code to be used for molars (permanent).

D3346	Retreatment of previous root canal	148.00	135.00
therapy--anterior
D3347	Retreatment of previous root canal	190.00	173.00
therapy--bicuspid
D3348	Retreatment of previous root canal	247.00	225.00
therapy--molar
D3351	Apexification/ recalcification--In	31.00	27.00
itial visit (apical
closure/calcific repair of
perforations, root resorption,
etc.)

NOTE 1: Treatment may extend over a period of six to 18 months.

NOTE 2: Maximum--two visits.

(c) Apicoectomy/periradicular Services:

1. Periradicular surgery is a term used to describe surgery to the root surface, for example, apicoectomy, repair of a root perforation or resorptive defect, exploratory curettage to look for root fractures, removal of extruded filling materials or instruments, removal of broken root fragments, sealing of accessory canals, etc. This does not include retrograde filling material placement.

D3410	Apicoectomy/periradicular	79.00	72.00
surgery--anterior

(d) Apicoectomy performed in conjunction with endodontic procedure:

1. Single stage nerve extirpation and canal filling. Services provided at same visit.

D3421	Apicoectomy/periradicular	79.00	72.00
surgery--Bicuspid (first root)
D3425	Apicoectomy/periradicular	79.00	72.00
surgery--Molar (first root)
D3426	Apicoectomy/periradicular	44.00	36.00
surgery--(Each additional root)
D3430	Retrograde Filling--Per Root	9.00	7.50

NOTE 1: Reimbursable only in addition to apicoectomy.

NOTE 2: Maximum per tooth--three roots.

D3450

Root Amputation--Per Root

55.00

48.00

NOTE 1: Surgical resection of entire root(s).

NOTE 2: Maximum two roots.

(e) Other endodontic procedures:

D3920	Hemisection (Including Any Root	55.00	48.00
Removal), Not Including Root Canal
Therapy
D3950	Canal Preparation and Fitting of	16.00	14.00
Preformed Dowel or Post

NOTE: Should not be in conjunction with D2952, D2954, by the same practitioner.

D3950	22	Canal Preparation and Fitting of	23.00	20.00
Preformed Dowel or Post

NOTE 1: Can be used when the final restoration is an amalgam or composite resin.

NOTE 2: With cementation.

d*	D3999	Unspecified Endodontic Procedure,	BR	BR
By Report

N.J. Admin. Code § 10:56-3.5

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).
Changed Maximum Fee Allowances throughout; and in (d), inserted a reference to NJ KidCare fee-for-services programs.
Amended by R.2001 d.268, effective 8/6/2001.
See: 33 N.J.R. 1554(a), 33 N.J.R. 2666(b).
In (c)2, substituted references to beneficiaries for references to recipients; in (d)1, substituted "NJ FamilyCare" for "NJ KidCare.
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.