TMPPM 2007 >19.15.6 Endodontics Services

Root canal fillings cannot be billed in addition to apexification procedures that have been initiated. Codes D3351, D3352, and D3353 include the final root canal filling.

Medical necessity for all endodontic procedures must be documented in the client's chart and be supported by radiographic documentation.

If the client is pregnant and does not want radiographs, use alternative treatment (temporary) until after delivery.


Procedure Code	Limitations	Maximum Fee
Pulp Capping Procedure codes D3110 and D3120 will not be reimbursed when billed with the following procedure codes for the same tooth, on the same day by the same provider: D2952, D2953, D2954, D2955, D2957, D2980, D2999, D3220, D3221, D3230, D3240, D3310, D3320, or D3330.
D3110	A 1-20, N, PXR, CCP	$16.25
D3120	A 1-20, N, PXR, CCP	$30.00
Pulpotomy
D3220*	A 1-20, PXR	$87.96
D3221	Denied as global fee to any endodontic procedure.	NC
Endodontic Therapy on Primary Teeth
D3230*	Will deny as part of any endodontic procedure. TIDs C-H; M-R. A 1-20, PXR	$38.75
D3240*	TIDs A, B, I, J, K, L, S, T. A 1-20, PXR	$43.98
Endodontic Therapy (Including Treatment Plan, Clinical Procedures, and Follow-up Care) Complete root canal therapy-Pulpectomy is part of root canal therapy and includes all appointments necessary to complete treatment. Diagnostic evaluations and radiographs performed at the initial, periodic, or emergency services visits are reimbursed in addition to the root canal. Reimbursement for a root canal includes the pulpotomy and radiographs performed pre, intra-, and postoperatively. Root canal therapy that has only been initiated-or taken to some degree of completion, but not carried to completion with a final filling-may not be billed as a root canal therapy code. It must be billed using code D3999 with a narrative description of what procedures were completed in the root canal therapy. An initial root canal therapy or retreatment of previous root canal therapy: •Is a benefit under the THSteps dental program when provided to a permanent tooth •Is not a benefit under the THSteps dental program when provided to a primary tooth Documentation supporting medical necessity must be kept in the client's record and include the following: the medical necessity as documented through periapical radiographs of tooth treated showing pre-treatment, during treatment, and post-treatment status; the final size of the file to which the canal was enlarged; and the type of filling material used. Any reason that the root canal may appear radiographically unacceptable must be documented in the client's record.
D3310*	A 6-20, PPXR	$355.98
D3320*	A 6-20, PPXR	$412.50
D3330*	A 6-20, PPXR	$624.26
D3331	Not payable, use retreatment codes.	NC
D3332	Not payable, use retreatment codes	NC
D3333	Not payable, use retreatment codes	NC
Endodontic Retreatment
D3346*	A 6-20, PPXR	$156.25
D3347*	A 6-20, PPXR	$206.25
D3348*	A 6-20, PPXR	$275.00
Apexification/Recalcification Procedures
D3351*	A 6-20, N, PXR, CCP	$75.00
D3352*	A 6-20, N, PXR, CCP	$50.00
D3353*	A 6-20, PPXR, CCP	$100.00
Apicoectomy/Periradicular Services
D3410	A 6-20, N, PPXR, CCP	$131.25
D3421	A 6-20, N, PPXR, CCP	$162.50
D3425	A 6-20, N, PPXR, CCP	$162.50
D3426	A 6-20, N, PPXR, CCP	$75.00
D3430	A 6-20, N, PPXR, CCP	$50.00
D3450	A 6-20, N, PXR, CCP	$75.00
D3460	Prior authorization required. Submit request with periapical radiographs, for each tooth involved. A 16-20, N, PPXR, CCP	$212.50
D3470	A 6-20, N, PXR, CCP	$125.00
Other Endodontic Procedures
D3910	A 1-20, N, CCP	$18.75
D3920	A 6-20, N, PXR, CCP	$81.25
D3950	A 6-20, N, PXR, CCP	$50.00
D3999	A 1-20, N, PXR, CCP	Manually priced
A=Age range limitations, N=Narrative required, FMX=Full-mouth radiographs (nonpanoramic), MTID=Missing tooth ID(s), PPXR=Preoperative and postoperative radiographs required, PXR=Preoperative radiographs required, PHO=preoperative and postoperative photographs required, PC=Periodontal charting required, PATH=Pathology report required, CCP=Comprehensive Care Program, NC=No charge to Medicaid and may not bill the client, and *= Services payable to an FQHC for a client encounter