Code updates effective in January 2025

 

Starting January 2025, updates to the Code on Dental Procedures and Nomenclature (the Code), commonly known as Current Dental Terminology, or CDT, is the current HIPAA-authorized code set used in electronic dental data interchange. As such, the Code is the national standard for reporting dental services and is the principal means of communication between dentists and dental benefits payers.

Any dental claim submitted electronically on a HIPAA-standard electronic dental claim must use procedure codes from the current version of the Code. The Code is also used on dental claims submitted on paper.

The Code is regularly updated to reflect changes in dental procedures accepted by the dental community. The Code is now reviewed and revised by the American Dental Association (ADA) on an annual cycle, with each revised version effective on January 1 every year.

A revised version of the Code, as published by the ADA in the manual titled CDT 2025: Dental Procedure Codes, will be effective January 1, 2025, for services provided on or after January 1, 2025, through December 31, 2025.

The 2025 version of the Code incorporates a significant number of procedure code changes, with 10 new procedure code entries, 9 revised procedure code entries, and 2 deleted procedure code entries.

Newly added codes include:

  • a code for removal of an indirect restoration on a natural tooth

  • a code for implant maintenance procedures when a full arch fixed hybrid prosthesis is not removed, including cleansing of prosthesis and

  • a code for replacement of an implant screw

  • a code for partial extraction for immediate implant placement

  • a code for nerve dissection

  • a code for comprehensive orthodontic treatment with orthognathic surgery

  • a code for periodic orthodontic treatment visit associated with orthognathic surgery

  • a code for administration of neuromodulators

  • a code for administration of dermal fillers

  • a code for unspecified sleep apnea services procedure, by report

Along with the CDT 2025 procedure code changes, the following claim and processing procedures will be effective January 1, 2025:

 

Benefit coverage

  • Code D6180 (implant maintenance procedures when a full arch fixed hybrid prosthesis is not removed, including cleansing of prosthesis and abutments) will be covered once per arch in a 12-month period when there is coverage for implants.

  • Code D6193 (replacement of an implant screw) will be covered once every 24 months when there is coverage for implants.

  • Code D7252 (partial extraction for immediate implant placement) will be covered once per tooth per lifetime in conjunction with immediate implant placement when there is coverage for implants.

  • Code D8091 (comprehensive orthodontic treatment with orthognathic surgery) will be covered when there is coverage for orthodontics and benefits are determined by client contract.

 

New procedure codes and associated processing policies:

Restorative:

D2956 (removal of an indirect restoration on a natural tooth) is included in the definitive treatment, and the fees are NOT BILLABLE TO THE PATIENT.

 

Implant Services:

D6180 (implant maintenance procedures when a full arch fixed hybrid prosthesis is not removed, including cleansing of prosthesis and abutments) When implants are covered by the group/individual contract, the fees for D6180 are NOT BILLABLE TO THE PATIENT within 12 months of D6114 and D6115.

D6193 (replacement of an implant screw) When implants are covered by the group/individual contract, the fee for D6089 are NOT BILLABLE TO THE PATIENT on the same date of service as D6193. Fees for D6193 are NOT BILLABLE TO THE PATIENT within six months of the initial placement of the prosthesis by the same dentist/dental office.

 

Oral & Maxillofacial Surgery:

D7259 (nerve dissection) Benefits are DENIED as specialized technique. The fees for D7259 are NOT BILLABLE TO THE PATIENT when done on the same date of service as D7241.

 

Orthodontics:

D8091 (comprehensive orthodontic treatment with orthognathic surgery) Fees for D8010-D8040 and D8070-D8090 are NOT BILLABLE TO THE PATIENT on the same date of service as D8091. Benefits are DENIED when the supporting documentation does not meet the criteria for coverage.

D8671 (periodic orthodontic treatment visit associated with orthognathic surgery) Fees for D8671 are NOT BILLABLE TO THE PATIENT on the same date as D8091.

 

Adjunctive General Services:

D9913 (administration of neuromodulators) Benefits are DENIED unless covered by group/individual contract.

D9914 ((administration of dermal fillers) Benefits are DENIED unless covered by group/individual contract.

D9959 (unspecified sleep apnea services procedure, by report) Benefits are DENIED unless covered by group/individual contract.

 

With all the new code changes, we recommend that dentists and dental offices verify covered services for patients before rendering treatment. Details of individual coverage can be verified by logging in to the Dental Office Toolkit®.

Accurate coding promotes faster claim processing and fewer errors, so Delta Dental recommends that each dental office have a current copy of the Code to stay up to date with procedure coding. To order a copy of the 2025 Code, call the ADA at 800-947-4746, or visit www.adacatalog.org.