When is D8690 used?
The D8690 dental code represents "Orthodontic treatment (alternative billing to a contract fee)." This code differs from standard comprehensive orthodontic codes that encompass complete treatment under one contract fee. D8690 applies when orthodontic services don't follow typical contractual arrangements. This code works best for non-contractual, fee-for-service situations, including patient transfers during active treatment or when providing limited orthodontic procedures.
Dental offices should apply D8690 when:
Patients continue orthodontic treatment that began at another practice (transfer situations).
Only partial orthodontic treatment is delivered.
No comprehensive contract or global treatment fee exists.
D8690 Charting and Clinical Use
Proper documentation remains essential when applying D8690. Dental staff must clearly record the exact services provided, treatment phase dates, and reasons for alternative billing methods. Typical clinical situations include:
Transfer Situations: Patients arrive with existing orthodontic appliances from another office. Record current appliances, treatment status, and any new diagnostic materials obtained.
Partial Orthodontic Care: Only specific treatment aspects are delivered, like appliance removal or retainer creation. Detail which procedures occurred and explain why comprehensive billing wasn't used.
Always maintain thorough clinical records, diagnostic images, and clear claim explanations to justify D8690 usage. This documentation supports insurance reviews and reduces claim rejections.
Billing and Insurance Considerations
Processing D8690 claims needs careful planning to optimize payments and prevent processing delays. Consider these recommendations:
Check Benefits: Prior to claim submission, validate patient orthodontic coverage and any restrictions on alternative billing methods.
Provide Comprehensive Claims: Include supporting materials like clinical records, X-rays, and explanatory notes describing the non-contractual service nature.
Apply Appropriate CDT Codes: When additional treatments occur (such as orthodontic retention), bill these separately using proper codes.
Review EOBs and AR: Carefully examine Explanation of Benefits statements and promptly address denied or underpaid claims. Prepare to file appeals with additional supporting materials when necessary.
Effective communication with patients and insurers regarding billing practices helps prevent misunderstandings and payment issues.
How dental practices use D8690
Clinical Example: A 15-year-old patient moves and continues orthodontic treatment at your office. The patient needs 12 additional months of active care with existing braces. Your practice takes over remaining treatment without establishing a comprehensive contract. Monthly billing covers ongoing adjustments and monitoring.
Billing Approach: Apply D8690 for each monthly service while documenting specific visit procedures. Include explanatory notes about the transfer circumstances and absence of global contracts. Submit progress documentation and photographs as supporting evidence. This method ensures CDT guideline compliance and improves insurance payment probability.
Understanding proper D8690 dental code application helps dental teams manage billing for non-standard orthodontic situations, minimize claim rejections, and maintain efficient revenue processes.
Common Questions
Can code D8690 be utilized for billing orthodontic records or diagnostic procedures?
No, D8690 is exclusively designated for orthodontic treatment delivered outside of a conventional contract fee structure. Diagnostic procedures, orthodontic records, or initial consultations must be billed using their corresponding CDT codes (such as D8660 for pre-orthodontic treatment examination and records).
Is prior authorization necessary when utilizing D8690 for orthodontic billing purposes?
Prior authorization requirements differ depending on the insurance plan. Although not always required, it is strongly advised to verify coverage with the patient's insurance carrier prior to initiating treatment billed under D8690. Securing pre-authorization or written coverage confirmation can help avoid claim rejections and facilitate smoother reimbursement processes.
What is the proper approach for handling payments when a patient pays out-of-pocket without using insurance for D8690 services?
For self-pay patients, the dental practice should provide a comprehensive breakdown of services performed under D8690, including itemized fees and a clear description of the alternative billing arrangement. Clear communication and thorough documentation are essential for patient comprehension and maintaining precise financial records.