The purpose of D5994: Perio Protect is a prescribed medical device used to treat patients who suffer from periodontal disease. The device is lab-created and used as a “tray” to deliver peroxide into a patient’s periodontal pockets. There are many variables involved when it comes to dental insurance coverage and reimbursement.
• Periodontal case type should be indicated on the claim form to inform the insurance processor what type of disease exists.
• Describing the medicament carrier device as “perio protect” is not enough to ensure insurance plan coverage.
• Submitting a clear written narrative that explains the benefits of the medical device and outlining the treatment plan with desired prognosis can help facilitate approval in some cases.
• Providing x-rays, narrative, recent periodontal charting, and photographs will ensure a smooth
claim approval or denial and alleviate the need to submit additional information to the insurance company at a later date.
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Photo courtesy of: Coding With Kyle
Originally Published On: Coding With Kyle
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