1 of 46 documents new jersey administrative code


§ 10:56-3.10 D7000-D7999 ORAL SURGERY



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§ 10:56-3.10 D7000-D7999 ORAL SURGERY
(a) Extractions--includes local anesthesia and routine post-operative care:




Maximum Fee




HCPCS







Allowance

IND

Code

Mod

Procedure Description

S

$

NS




D7110




Single Tooth

32.00




30.00




D7120




Extraction--each additional tooth

32.00




30.00




D7130




Root Removal--Exposed Roots

19.50




18.00

NOTE 1: Per tooth.

(b) Surgical extractions--includes local anesthesia and routine post-operative care:



1. Prior authorization for the removal of impacted teeth is necessary for those beneficiaries up to and including 17 years of age as denoted by those codes with the "#" (cross-hatch) indicator.

#

D7210




Surgical Removal of Erupted Tooth

33.00




31.00










Requiring Elevation of



















Mucoperiosteal Flap and Removal of



















Bone and/or Section of Tooth










#

D7220




Removal of Impacted Tooth--Soft

43.00




40.00










Tissue










#

D7230




Removal of Impacted

114.00




106.00










Tooth--Partially Bony










#

D7240




Removal of Impacted

114.00




106.00










Tooth--Completely Bony










#

D7250




Surgical Removal of Residual Tooth

43.00




39.00










Roots (Cutting Procedure)










NOTE: Includes cutting of soft tissue and bone, removal of tooth structure and closure.

(c) Other surgical procedures:






D7260




Oroantral Fistula Closure

108.00




99.00

NOTE 1: Code may also be used for antral root recovery.

NOTE 2: Excision of fistulous tract between maxillary sinus and oral cavity and closure by advancement flap.






D7270




Tooth Re-implantation and/or

93.00




85.00










Stabilization of Accidentally



















Avulsed or Displaced Tooth and/or



















Alveolus













D7280




Surgical Exposure of Impacted or

101.00




94.00










Unerupted Tooth for Orthodontic



















Reason (Including Orthodontic



















Attachments)













D7281




Surgical Exposure of Impacted or

45.00




41.00










Unerupted Tooth to Aid Eruption










d

D7285




Biopsy of Oral Tissue--Hard

30.00




26.00

NOTE: Independent procedure (laboratory must bill separately).

d

D7286




Biopsy of Oral Tissue-Soft

18.00




16.00

NOTE: Independent procedure (laboratory must bill separately).

(d) Alveoloplasty surgical preparation of ridge for dentures:

1. Reimbursement will be based upon quadrants.




D7310




Alveoloplasty in Conjunction with

62.50




56.50










Extractions--Per Quadrant










NOTE 1: In conjunction with extractions of at least three teeth or the roots of at least three teeth in the same quadrant.

NOTE 2: Specify quadrant.






D7320




Alveoloplasty Not In Conjunction

62.50




56.50










with extraction--Per Quadrant










(e) Vestibuloplasty--including revision of soft tissues on ridges, muscle reattachment, tongue, palate, and other oral soft tissues (complete description including size and position must be submitted). Reimbursement will be based upon quadrants.




D7340




Vestibuloplasty--Ridge Extension

65.00




59.00










(Secondary Epithelialization)










NOTE: Including management of hypertrophied and hyperplastic tissue, per quadrant.




D7350




Vestibuloplasty--Ridge Extension

169.00




153.00










(Including Soft Tissue Grafts,



















Muscle Re-attachments, Revision of



















Soft Tissue Attachment, and



















Management of Hypertrophied and



















Hyperplastic Tissue)










NOTE: Per Quadrant.

(f) Surgical excision of reactive inflammatory lesions (scar tissue or localized congenital lesions):

NOTE: Biopsy report must be available upon request for review by the Division's dental consultants.

1. Includes lesions of skin, subcutaneous or mucous membranes, pyogenic granulomata and opercula.






D7410




Radical Excision--Lesion Diameter

30.00




26.00










Up to 1.25 cm.













D7420




Radical Excision--Lesion Diameter

42.00




37.00










Over 1.25 cm.










NOTE: Up to and including three cm.




D7420

22

Radical Excision--Lesion Diameter

100.00




86.00










Over 3 cm.










(g) Removal of tumors, cysts, and neoplasms:

1. In the excision and management of this type of lesion, a biopsy report must be available for review by the Medicaid/NJ FamilyCare dental consultants.






D7430




Excision of Benign Tumor--Lesion

30.00




26.00










Diameter Up to 1.25 cm.













D7431




Excision of Benign Tumor--Lesion

42.00




37.00










Diameter Over 1.25 cm.















D7431

22

Excision of Benign Tumor--Lesion

100.00




86.00










Diameter Over 3 cm.













D7440




Excision of Malignant

100.00




86.00










Tumor--Lesion Diameter Up to 1.25



















cm.













D7441




Excision of Malignant

274.00




256.00










Tumor--Lesion Diameter Over 1.25



















cm.










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