News

Cone Beam CT – Medicare Changes

From November 1 2014, Medicare will replace the existing Cone Beam CT (CBCT) item numbers with new ones.

CBCT dental items 56025 & 56026 will be replaced with 57362 & 57363

 

The new Medicare Description for items 57362 & 57363:

Cone Beam Computed Tomography – dental and temporo-mandibular joint imaging (without contrast medium) for diagnosis and management of any of the following:

a) mandibular and dento-alveolar fractures;

b) dental implant planning;

c) orthodontics;

d) endodontic conditions;

e) periodontal conditions;

f) temporo-mandibular joint conditions

Payable once per patient per day, not being for a service to which any of items 57959 to 57969 apply, and not being a service associated with another service in Group I2

Summary of Medicare Changes:

  • General Dentists can no longer request CBCT services under Medicare, 57362 and 57363 can be referred by medical practitioners and specialised dentists
  • To be Medicare eligible, services must be delivered in practices accredited under the Diagnostic Imaging Accreditation Scheme, and performed on dedicated (rather than hybrid) CBCT units
  • Claims for more than one CBCT per patient per day are excluded; and
  • Claiming with two-dimensional imaging in the same episode (items 57959-57969) and with CT in the same episode (items 56001-57361) is also excluded

 

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