Update: Crown Prior Authorization (PA) Exception for Endodontic Therapy
On October 19, 2022, the Office of fb88Care Services (OMS) issued a bulletin informing providers that fb88Care will no longer require a PA for crowns provided in conjunction with endodontic therapy when a qualifying diagnosis was included on the dental claim.ÌýThe list of qualifying diagnosis inadvertently listed ICD-10-CM code K04.0-Pulpitis. Official guidance issued by the American Academy of Professional Coders (AAPC) requires the use of a 5th digit when ICD-10-CM code K04.0 is used. Please reference the chart below for qualifying diagnosis codes and descriptions.Ìý
|
Qualifying Diagnosis CodeÌý |
Diagnosis Code DescriptionÌý |
|
°02.53Ìý |
Dental caries on pit and fissure surface penetrating into pulpÌý |
|
°02.63Ìý |
Dental caries on smooth surface penetrating into pulpÌý |
|
°04.01Ìý |
Reversible pulpitisÌý |
|
°04.02Ìý |
Irreversible pulpitisÌý |
|
°04.1Ìý |
Necrosis of the pulpÌý |
|
°04.5Ìý |
Chronic apical periodontitisÌý |
|
°04.6Ìý |
Periapical abscess with sinusÌý |
|
°04.7Ìý |
Periapical abscess without sinusÌý |
|
°04.8Ìý |
Radicular cystÌý |
|
°04.90Ìý |
Unspecified diseases of pulp and periapical tissuesÌý |
|
°04.99Ìý |
Other diseases of pulp and periapical tissuesÌý |
Ìý
As a reminder PA is still required when a crown is not delivered as part of endodontic therapy.ÌýÌý
If you have questions related to the PA requirements regarding crown delivery, please contact your Provider Relations Specialist, Shannon Beggs. Ìý