Policy on PPE Charges

As dental offices throughout New Mexico begin to reopen for business, there have been various inquiries from both members and dentists regarding Delta Dental of New Mexico’s (DDNM’s) billing policies for Personal Protective Equipment (PPE). At this time, DDNM is considering PPE charges not to be billable to the patient. This policy is in accordance with your provider contract. We hope you have received our information about Operation #EnchantedSmiles, a grant program offered in response to COVID-19 by DDNM to provide $1,200 grants to dentists licensed and practicing in New Mexico. We also hope this support will help ease the burden as you return to your practice and safely move beyond providing emergency only care.

As a participating provider with DDNM, you have contractually agreed to abide by the requirements of participation. DDNM issues reimbursements for a particular service as an “all inclusive” payment. With regard to separate charges for PPE, the fees associated with the cost of purchasing and providing PPE are considered to be part of the overall patient management and PPE charges are not billable to the patient. DDNM members and their dependents are not required to sign a separate document confirming they will pay the cost for PPE as this would be in violation of your participation with DDNM. We have listed some FAQs as a reference for the D1999 CDT Code below.
 

Clarification of PPE Reimbursement during Pandemic

The American Dental Association (ADA) released a statement on April 21, 2020, regarding the anticipated increase in PPE costs for dental providers due to the pandemic. As a result, we have received numerous calls asking for DDNM’s approach to the issue.

Here are three key areas we would like to clarify as a result:

Is DDNM paying code D1999 for PPE?

Not at this time. The use of D1999 for the prevention of the spread of COVID-19 is not an appropriate use of the code. According to CDT 2020, code D1999 is for an unspecified preventive procedure. PPE is not a procedure to prevent dental pathologic processes, and the current DDNM policy is that PPE is not billable to the patient.

Why did the ADA mention using code D1999 as an option?

The ADA has not provided a clear explanation. The ADA did not discuss the use of code D1999 with DDNM prior to their communication with providers, and the ADA did not return our emails asking for clarification or correction. The ADA cannot modify our agreements with providers.
 

Is DDNM considering assistance to dentists to cover the cost of PPE?

Yes. DDNM understands that the pandemic has caused dentists to incur additional costs, including those associated with PPE. We recently launched a program to provide a $1,200 grant to every licensed dentist practicing in New Mexico. Click here to learn more about Operation #EnchantedSmiles.

If you should have any additional questions, please contact our Provider Relations department at providerrelations@deltadentalnm.com.