The American Dental Association (ADA) provides a comprehensive set of codes for dental professionals to utilize in their practice and makes annual updates to the CDT code list. In a thriving general dental practice, a variety of CDT codes are utilized. In doing so, the practice is able to accurately and ethically bill for procedures and provide a variety of services to its patients. In addition, annual review of code utilization is essential to maintaining a healthy practice.
In order to maintain a thriving practice, it is essential to review code utilization at least annually. To begin, identify the codes most frequently used within your practice and their corresponding fees. Utilize your practice management software to generate a report of your most used codes. Next, compare the fees associated with these codes to the reimbursement rates provided by your in-network insurance plans. This comparison can not only highlight opportunities for future insurance contract negotiations, but it may also reveal underutilized codes that correspond to services you are providing but are not being reimbursed adequately. Identifying these discrepancies ensures that your practice is properly compensated for all the services rendered, supporting both financial health and the ethical obligation to maintain accurate and fair billing practices.
In addition, it is beneficial to cross-reference these findings with data on average fees within your geographic area. This broader market analysis, often available through your CPA or Practice Management Consultant, can provide valuable insight into whether your fees are aligned with industry standards.
We can sometimes fall into routines or rely on preset codes in our software without re-evaluating them annually to maximize reimbursement. As part of your annual review, check for underused codes to see if any should be utilized more frequently. Assess whether your hygiene team is using a mix of preventative and periodontal codes in line with the patients’ soft tissue health. Accurate coding and billing ensure proper compensation for your team’s efforts and ensure education for patients on the full range of treatments offered.
Lastly, evaluate your fees to ensure they align with local standards and compare them to nearby practices. If your most used codes fall below the 70th percentile, consider adjusting them strategically to improve reimbursement. Review your in-network insurance reimbursements and know your average adjustment percentages for each insurer. This data will help you negotiate better contracts, set realistic revenue goals, and boost practice profitability.
Regularly performing this analysis—ideally on an annual basis—ensures that your practice is both charging competitive, market-driven rates and maximizing reimbursements from insurance providers. Moreover, it is critical to ensuring that billing practices are accurate, transparent, and support the financial health of your practice.
When assessing your practice CDT code utilization, consider the following questions:
- Are you regularly reviewing your most frequently used codes and their associated fees to ensure they align with both in-network reimbursement rates and market standards?
- Have you identified any underutilized codes that reflect services your practice provides but may not be receiving adequate reimbursement for?
- How often do you assess whether your hygiene team is using the appropriate mix of preventative and periodontal codes, receiving CDT code education and engaging in proper billing practices?
- Are your fees competitive within your local market, and are they in line with industry standards for nearby general dental practices?
- Do you have a clear understanding of your average insurance adjustment percentages, and how can this information help you improve contract negotiations and overall profitability?
If you would like help on any of the following topics, please reach out to a member of our team:
- Improving your cash flow through managing the codes you bill out
- Navigating in-network insurance contracts
- Fee Schedule Analysis for your Geographic Area
- Analyzing all of your Adjustments to know your true Adjustment Percentage
If you missed our last post about keeping your practice patient-centered and profitable, you can read it here!
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