J-6 Similar or Alternate Dental Procedure Codes Accepted Ref & Auths v2.docx
DOCX document 20 KB Posted
- Attached to
- Active Duty Dental Program 3 (ADDP3) Federal contract opportunity
- Solicitation number
- HT9402-20-R-0001
- Issued by
- Defense Health Agency
About this file
This document provides details regarding the draft request for proposal for the Active Duty Dental Program 3 contract. The Defense Health Agency is seeking to award a single indefinite delivery/indefinite quantity contract for fixed unit price dental services to support Active Duty Service Members and TRICARE Overseas Program beneficiaries. The potential 9.5 year contract would consolidate requirements currently under separate contracts and include a 1-year transition period, 7 years for service delivery, 1 year for closeout, and optional 6 month extension. The draft RFP includes sections B through M and attachments outlining covered CDT codes and services. Interested offerors are invited to review the draft documents and provide feedback to help the agency refine its requirements.
View the file
Other files for this federal contract opportunity
Show all 27
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Attachment J-6 Similar or Alternate Dental Procedure Codes Accepted for Referral/Authorization Claims
THIS DOCUMENT IS NOT TO BE RELEASED IN BENEFIT PUBLICATIONS.
1.0. The contractor shall authorize the following dental procedures for referral/authorization claims:
1.1. D0120, D0140, or D0150 may be provided for Active Duty Service Members (ADSMs) once per course of treatment, per provider, if an examination is not prescribed on the referral.
1.2. 1-2 bitewing radiographic images (D0270 or D0272) or 1-2 periapical radiographic images (D0220 and D0230) may be added without DTF referral modification.
1.3. Oral Surgeons may perform a D0330 panoramic radiographic image without Dental Treatment Facility (DTF) referral modification.
1.4. Amalgam may be substituted for composite resin in posterior restoration without DTF referral modification.
1.5. One surface may be added or removed from a restoration without DTF referral modification; however, an alternate material (resin instead of amalgam) cannot be provided without DTF referral modification.
1.6. D2750 or D2753 may be performed as an adequate substitute for D2752.
1.7. D2750 or D2753 may be performed as an adequate substitute for D2790 on teeth #s 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, and 31.
1.8. D2753 or D2790 may be performed as an adequate substitute for D2792 on molars.
1.9. A buildup (D2950) or a prefabricated post & core (D2954) may be placed if performed on the same date the RCT is completed by the same provider.
1.10. D2952 (post & core-custom) and D2954 (post & core-prefab) may be performed as an adequate substitute for buildups D2950 (under single crown) if the tooth has been endodontically treated.
1.11. D7140 may be performed as an adequate substitute for D7210.
1.12. D7210 may be performed as an adequate substitute for D7140 when performed by an oral surgeon (IV Sedation may be added if this substitution has occurred.
1.13. Oral surgery procedure codes D7220, D7230 and D7240 may all be adequately substituted for one another without DTF referral modification to allow for degree of difficulty fluctuations.
1.14. Oral surgery procedure codes D7230, D7240, and D7241 may all be adequately substituted for one another without DTF referral modification to allow for degree of difficulty fluctuations.
1.15. IV sedation and general anesthesia units may be deleted without DTF referral modification.
| ADDP3 | Attachment J-6 |
| HT9402-20-R-0001 | Page 1 of 2 |
File details come from the government source that posted it. Updated .