When is D0605 used?
The D0605 dental code applies to antibody testing for public health pathogens, such as coronavirus (COVID-19). This CDT code is utilized when dental practices conduct point-of-care antibody tests to check whether a patient has built antibodies against a particular pathogen. This code is intended for identifying previous exposure or immune response, not for diagnosing current infections. Dental facilities should apply D0605 only when testing is medically required, follows public health standards, and is conducted on-site by trained staff members.
D0605 Charting and Clinical Use
Proper documentation is essential when submitting claims for D0605. The patient record must clearly show why testing was needed, such as recent contact with a public health pathogen or participation in a community health program. Documentation must include:
Medical justification for testing (e.g., patient background, symptoms, or public health guidance)
Date and specific antibody test administered
Test outcomes
Any subsequent actions or specialist referrals
Typical clinical situations involve screening dental team members or patients following known exposure, or as part of comprehensive infection prevention measures. Always verify that the testing kit has FDA approval and that your state allows dental practices to conduct and charge for this service.
Billing and Insurance Considerations
Processing D0605 claims requires careful attention to prevent rejections and minimize delays in payment collection. Here are recommended practices for effective claim processing:
Confirm benefits: Prior to testing, check with the patient's insurer whether D0605 is covered. Most dental insurance plans don't typically include antibody testing coverage, making pre-authorization crucial.
Apply proper coding: Make sure D0605 appears as an individual line item on claim forms, and include supporting materials as requested by the insurance company.
Include clinical documentation: Provide comprehensive clinical notes and medical necessity proof with claims to justify payment.
Track payment responses: Carefully examine Explanation of Benefits statements for payment confirmation or rejection explanations. When denied, determine if extra documentation or an appeal is needed.
Work with medical coverage: Sometimes medical insurance may pay for D0605. Coordinate benefits and file secondary claims when applicable.
These practices help reduce claim denials and maintain smooth revenue management operations.
How dental practices use D0605
Picture a situation where a dental assistant has contact with a patient who subsequently receives a positive COVID-19 diagnosis. The dental practice chooses to perform antibody testing on all team members using an FDA-approved testing kit. For every staff member tested, the practice records the exposure incident, secures informed consent, conducts the antibody test, and documents findings. The billing department confirms with their group insurance that D0605 coverage applies to workplace exposure, files the claim with necessary documentation, and tracks the payment response. Should the claim face denial, the practice develops an appeal with extra clinical evidence and refiles.
This situation demonstrates how proper record-keeping, insurance confirmation, and active claim management lead to successful payment when applying the D0605 dental code.
Common Questions
Is it possible to bill D0605 with other dental procedures in the same appointment?
D0605 can be billed together with other dental procedure codes during the same visit, provided the antibody test is medically necessary and properly documented. Make sure each service is thoroughly described in the patient's record and verify that your payer's policies don't restrict bundling or require special modifiers.
What consent requirements apply when performing and billing D0605?
Although not universally required, obtaining informed consent from patients prior to antibody testing is considered best practice. Record the patient's comprehension and consent in their chart, particularly when testing is conducted as part of public health programs or could affect insurance benefits.
What should dental offices do about patient costs when D0605 isn't covered by insurance?
When insurance coverage is denied for D0605, notify patients beforehand about possible out-of-pocket expenses. Supply a written cost estimate and secure patient acknowledgment before treatment. Establish clear financial policies for uncovered services to maintain transparency and prevent billing conflicts.