**Navigating Dental Insurance: Understanding Crown Coverage And Billing**

Dental crowns are partially covered by insurance, but only when they are medically necessary. The price of a crown depends on the material used, the skill of the dentist, and the location of the tooth. Metal crowns are the cheapest option, while porcelain crowns are more expensive and last longer. Insurance providers generally cover 50% of the cost of a crown, and the patient is responsible for the remaining amount. It's important to note that insurance companies typically require detailed information to determine the necessity of the crown and may request pre-operative and post-operative x-rays. Additionally, the timing of billing insurance for a crown is crucial, with some carriers paying on the prep date and others on the seat date.

Dental insurance covers crowns for health reasons, but not cosmetic reasons

Dental insurance is designed to cover procedures necessary for maintaining oral health. While dental crowns are partially covered by insurance, this typically only applies when they are deemed medically necessary. If a crown is desired for purely cosmetic reasons, insurance is unlikely to cover the procedure.

Dental crowns are caps that are placed on top of damaged teeth to protect, cover, and restore their shape. They are custom-made for each patient and can be made from various materials, including porcelain, metal, and ceramic. The cost of a crown depends on the material used, the expertise of the dentist, and the location of the tooth, among other factors. The price of a single crown typically ranges from $500 to $3,500.

Dental insurance usually covers about 50% of the cost of a crown, with the patient responsible for the remainder. However, this can vary depending on the specific insurance plan and the patient's coverage. Some plans may have a deductible or a waiting period for major procedures like crowns. Additionally, insurance companies may require pre-operative x-rays and detailed information about the necessity of the crown before approving coverage.

When billing insurance for a crown, it is important to use the correct CDT code and be aware of any alternative benefit downgrade clauses that may affect reimbursement. It is also crucial to determine whether the insurance pays on the prep or seat date, as this can impact reimbursement.

In summary, dental insurance covers crowns for health reasons but not for cosmetic reasons. Patients should consult their insurance providers to understand their specific coverage and any requirements for reimbursement.

The cost of a crown depends on the material used, ranging from $500 to $3,500

The cost of a dental crown depends on the type of material used, with prices ranging from $500 to $3,500 per crown.

The cheapest option is a metal crown, which typically costs between $500 and $2,500. Metal crowns are the strongest and most durable option, but they may not look as good as porcelain crowns.

Porcelain-fused-to-metal crowns are another affordable option, ranging from $500 to $1,500 per tooth. These crowns consist of a metal base with a porcelain top that mimics the appearance of natural teeth. However, they are not suitable for patients with metal allergies, and if the gums begin to recede, a grey line may appear between the tooth and gum.

All-ceramic or zirconia crowns are more expensive, ranging from $800 to $3,500 per tooth. These crowns are highly durable and can last for 15-20 years. They are also aesthetically pleasing, as zirconia can reflect natural light in a similar way to enamel or porcelain. Additionally, zirconia is a biocompatible, metal-free material that is suitable for patients with metal allergies.

The cost of a crown also depends on the location of the tooth, with crowns for front teeth generally being more expensive due to the additional time required to achieve a natural appearance. The skill and experience of the dentist, the location of their clinic, and the complexity of the procedure can also impact the overall cost.

It's important to note that dental insurance typically covers only a portion of the cost of a crown, and only when it is deemed medically necessary rather than for purely cosmetic reasons.

The patient usually pays 50% of the cost of the crown procedure

The cost of a dental crown can vary depending on the material used, the complexity of the procedure, and the location of the clinic. On average, a dental crown can cost between $500 and $3,500 per tooth. Metal crowns tend to be the cheapest option, while porcelain and ceramic crowns are more expensive but look more natural and last longer.

Dental insurance typically covers medically necessary crowns, but usually not cosmetic crowns. Most plans offer coverage for major restorative dental care, including crowns, with a maximum coverage of 50% of the total cost. This means that the patient is usually responsible for the remaining 50% of the cost of the crown procedure. However, it's important to note that the coverage amount may vary depending on the specific insurance plan and the patient's case.

Before scheduling a crown procedure, it is recommended to contact the insurance provider to understand the coverage details and any added expenses. Additionally, some insurance plans may have waiting periods for new patients before covering non-emergency procedures like crowns.

Insurance companies require pre-operative and post-operative x-rays to prove the necessity of a crown

The pre-operative x-ray is the most important as it will determine whether the insurance company will cover the cost of the crown. However, it is also beneficial to take a post-operative x-ray. This is because some dental plans may request a post-operative x-ray in the event that the patient files a grievance against the provider via their dental plan.

The necessity of a crown must be proven with detailed information. The clinical note must be specific to the patient’s condition and the reason why they require a crown. This includes the diagnosis, whether the crown is a replacement, and the age of the existing crown.

The cost of a crown depends on the material used. Metal crowns are the cheapest option, but porcelain crowns last longer and look more natural. The cost of a crown can range from $500 to $3,500. Insurance typically covers 50% of this cost.

The correct CDT code must be used when billing for a crown

The Current Dental Terminology (CDT) code is a standardised system used to document and report dental procedures. It is imperative that the correct CDT code is used when billing for a crown, as this will impact the reimbursement received from the insurance company.

There are over 25 different crown CDT codes, each corresponding to a specific type of crown. The CDT code for a crown depends on the material used, the extent of coverage, and whether it is an initial or replacement crown. For example, the CDT code for a resin-based composite crown is D2710, while the code for a full cast high noble metal crown is D2790.

It is important to note that CDT codes are constantly updated, so it is crucial to stay informed about the latest codes to avoid using outdated codes when billing. A coding reference guide, such as the Dental Coding with Confidence from Practice Booster, can be a helpful resource for staying up-to-date with the current crown codes.

In addition to selecting the correct CDT code, there are several other steps that should be followed when billing for a crown. Firstly, it is important to take pre-operative and post-operative x-rays, as these can demonstrate the condition of the tooth and the necessity of the crown procedure. Secondly, detailed information about the necessity of the crown should be provided, including the diagnosis and the age of the existing crown if it is a replacement. Finally, the claim can be submitted electronically through a dental clearinghouse, attaching any relevant documentation.

By following these steps and using the correct CDT code, dental professionals can ensure accurate and efficient reimbursement for crown procedures.

Frequently asked questions