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Dental charges in an ASC

  1. #1
    Coeur D'Alene, Idaho
    Question Dental charges in an ASC
    Exam Training Packages
    We're looking to add dental to our services, and I am trying to get some ideas about how you bill your self pay patients.

    Do you bill a flat fee based on CPT 41899? Or do you bill based on the time spent in the OR? If you bill with the CPT flat fee, do you change your fee based on how extensive the procedure(s) are?

    I would greatly appreciate any advice you can offer. I'm at a total loss!


  2. #2
    Brownsville, Texas
    Default 41899
    Hi Ashley,

    I bill 41899 cpt code flat fee for dental procedures in our surgery center. We always verify with insurance if this code is payable and our manager let's us know if we have to let the patient pay us flat fee in full if a certain insurance doesn't cover 41899 cpt code. We still bill insurance and if they pay we reimburse patient.

    Hope this helps you,


  3. Default
    Proceed with caution. Many payers don't reimburse the 41899 - or, if they do, they allow a whopping $100-$200 total - regardless of your flat fee ....which won't be enough to cover your costs. You could also try to negotiate a higher allowed amount for the 41899 when you renew your contracts with payers, or see if they'll consider letting you charge facility fees for the "D" codes.

    Some states have legislation that allows medical insurance to be billed for facility and anesthesia charges for dental surgery for certain patients - such as 'children ages 4 and under.' However, payers don't have to necessarily follow the state mandates.... out of state plans and federal plans and government plans, etc.

  4. #4
    Coeur D'Alene, Idaho
    Thanks so much for the feedback! It seems to be really hit and miss with insurance actually paying on these procedures in an ASC...what a bummer.

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