D0145 Processing

July 01, 2019

D0145 - Oral evaluation for a patient under three years of age and counseling with primary caregiver

Descriptor: Diagnostic services performed for a child under the age of three, preferably within the first six months of the eruption of the first primary tooth, including recording the oral and physical health history, evaluation of caries susceptibility, development of an appropriate preventive oral health regimen and communication with and counseling of the child's parent, legal guardian and/or primary caregiver.

 

D0145 is not identified as either comprehensive or periodic and can be used as an initial visit with the child as well as on subsequent visits that include an oral evaluation. This code is appropriate as long as the child remains under the age of three and includes preventive counseling provided to the primary caregiver. Otherwise, D0120 is used when no counseling is provided to the primary caregiver during the visit.

If D0150 comprehensive oral evaluation new or established patient is submitted on a claim for a patient under the age of three, you will receive a response on the remittance advice stating “Patient is over/under the age limitation allowed for this procedure”. A new claim is required that lists the correct ADA procedure code.

Please note, we are currently working on updating our system process so that in the future, we will automatically benefit D0145 when a claim includes D0150 for a child under the age of three.