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
