5.5 - General CDT Code Information and Clinic Financial Policies

There is a fee charged for all dental treatment provided at the OU College of Dentistry. The clinic fee schedule lists the fees charged for dental procedures provided by students in the predoctoral program and the dental hygiene baccalaureate program.  It is reviewed and revised periodically. A copy of the current fee schedule is available in axiUm Links, and a laminated copy can be found in every clinic faculty office area.

Fees charged are approximately 1/3 the cost of those in private practice.  Since clinic fees provide a substantial part of our operating funds, the faculty, staff, and students should pay close attention to and adhere to the strict application of published fees. Deviation from the clinic fee schedule requires authorization from faculty and is entered into the axiUm system via a TAR (Treatment Adjustment Request) form adjustment.  The TAR Form workflow can be found in the Clinic Binder in each clinic faculty office. The “official” Clinic Binder is now available in axiUm. The location is axiUm/Links/Clinic Binder.

A 5-digit procedure code number identifies each procedure in the fee schedule and within the axiUm system.  This code is important to identify the diagnosis and nature of the treatment, determine the appropriate fee to charge and facilitate the insurance filing process.

The first digit identifies the health profession - dentistry is designated "D".  The second digit identifies the discipline (restorative dentistry codes begin with "2", endodontic codes begin with "3" and periodontics codes begin with "4", etc.).  The last three digits identify the specific procedure.  Each major code section ends with a "999" code to be used for any procedure that cannot be identified by a specific descriptive code.  The “999” codes are not to be used for no charge or follow-up visit codes and must have a narrative. All codes coincide with the CDT current approved codes booklet, normally updated, and published each year.

Some codes in the axiUm schedule are presented in slightly different formats.  Codes with the letter “D” are ADA- recognized codes.  Codes that contain a “.1, .2”, etc., or any other numerical code or letter after the period, are to differentiate the steps within our process to complete a procedure at the college. These codes will identify, for example, impression steps or other procedural steps for the fabrication of a restoration. 

Only the ADA codes with no additions to the end of the code are used to create a charged procedure, file insurance claims, or any other method of reporting a procedure for which a charge is made.

The fees listed are based on the nature and complexity of the procedure.  The schedule also contains explanatory notes under some code descriptions to help determine when the use of a particular code is appropriate. If unsure which code to use or what fee to assess, consult with your Group Practice Director, assigned faculty, Patient Services Coordinator, or Clinic Manager.

Although published fees are standard for a given procedure, a fee reduction, waiver, or refund may be warranted on occasion. Only authorized faculty or a designated administrative staff member appointed by the Assistant Dean of Clinical Affairs can approve these reductions or refunds.

The amount of the reduction, waiver, or refund must be entered via a TAR form in axiUm (Treatment Adjustment Request; see section 5.4, “Reporting Protocols for Treatment Delivery”) and approved by the attending faculty. 

Unless circumstances warrant otherwise, partial, or full refunds on Prosthodontics or other work involving laboratory charges will not be allowed. The Director of Quality Assurance or assigned administrative staff must approve all fee reductions, waivers, and refunds.

Patients are expected to pay for services when rendered unless financial arrangements have been made with the Patient Services Coordinator and the Central Business Office. All services that are rendered are charged to the patient's account at the start of the procedure. 

For general information, all payments, except as noted below, may be made by cash, personal check, or approved credit card/debit card. Payments can be made to the assigned Patient Services Coordinator in each clinic or the Patient Account Representative in the south hall near the main service elevators on the third floor. Screening fees must be paid in cash or by credit/ debit card. Patients who are not patients of record but who present for treatment (walk-in emergencies, extractions, etc.) are also required to pay in cash or by credit/debit card for services rendered for the procedure to be performed. 

Patients who have delinquent financial plan payments or a delinquent account balance will be suspended from further treatment (and subject to release from the predoctoral program) until their account balance is satisfied. New services will not be scheduled until the outstanding account balance is satisfied. When the financial plan is current, or the account balance is $0.00, treatment can be continued.

If there is no payment activity on an account, a 30-day balance reminder letter of delinquency is sent to the patient.  If payment is still not received, a 60-day balance reminder is sent to the patient.  The patient will be given 15 days to respond, and if no payment is received within the next 15 days, the account is turned over to collections, and the patient is automatically released from the program.  Reinstatement is considered only if the patient agrees to [1] pay the total amount outstanding on the account and [2] maintains a zero balance during the remainder of treatment. Only the Director of Patient Relations can approve reinstatement. If there is a planned appointment, the PSC will be notified via the axiUm mail system when a delinquency letter is sent to one of that group practice’s patients.

Discounts are not available to student family members, College of Dentistry staff, and staff family members screened for patient care in the predoctoral program.

Many of the patients seen at the college have dental insurance. The Patient Services Coordinator assigned to each clinic receives the necessary information to file claims on the patient's behalf. 

A general note on insurance: pre-authorization is required for many large claims.  Your Patient Services Coordinator can provide you with additional information in these situations. 

A proposed treatment plan (with estimated costs) must be provided to the patient via the axiUm system. While the college files the necessary insurance claims, the patient is still responsible for the payment of the account.  As a note of interest for the insured patient, very few procedures are paid-in-full, with many insurance companies limiting the number of procedures during a specific period. Most insurance carriers have deductibles ranging from $25-$100 and maximum reimbursements ranging from $1000-$1500 per calendar year. 

Patients are expected to pay for treatment when rendered. If a patient has insurance, their co-payment is expected at the time of service. Your Patient Services Coordinator will provide any additional information as needed.

Many insurance carriers, for which the College of Dentistry is a non-participating provider, pay the patient directly.  In many cases, even though the patient has dental insurance coverage, the patient may not have any benefits if a non-participating provider provides services.  Clarification can be requested from your Patient Services Coordinator.

Complete information must be in the axiUm record for proper filing of the insurance claim. The Patient Services Coordinator will request any further information that is required for the claim to be filed. Please keep in mind insurance carriers may need some additional information, such as the initial placement of full coronal restorations or a filling. If dentures or partials are replaced, insurance carriers require the original date they were placed and the date and tooth numbers originally extracted. All insurance claims are filed automatically once the procedure has been completed via the axiUm system. 

Program Overview

Delta Dental of Oklahoma’s Charitable Foundation (DDOK) sponsors funding for our indigent care patients. Funding is available for the spring and fall semesters to those patients who have incomes 100%, 150%, and 200% above the federal poverty level until the funds are depleted for each semester. An income matrix is used to determine the maximum funding amounts of $375, $750, or $1500 to be applied toward the patient’s comprehensive treatment plan based on the current poverty levels. An assigned patient will be provided with the required application to begin the process. Detailed criteria for covered and non-covered services can be obtained from your Patient Services Coordinator. In general, any esthetic treatment is not covered by charitable funds.

The college from time to time will engage in other charitable funds programs. You will receive information at the appropriate time if these programs are in place.

As mentioned, patients are expected to pay in full for services when rendered (initial appointment).

• For fixed prosthodontic treatment, 50% of the fee must be paid when the procedure is initiated and the other half before delivery or cementation.
• For single crowns and bridges, the business office must give approval, via axiUm, before the Support Laboratory can issue any gold for procedures.
• Complete and partial dentures must be paid in full prior to sending the case to the lab for processing.

Note: the metal issued to students for preclinical usage is not acceptable metal for intra-oral use. This metal is for teaching purposes only.

• For dental services that span multiple appointments such as fixed/removable prostheses, scaling/root planing, complex endodontics, etc., the total fee will be charged at the initial appointment.

If a patient terminates their association with the College, a refund for the credit balance (if applicable) will be issued.

When the creation of the Master Treatment Plan is complete, the patient will sign the treatment plan, which becomes an estimate of the total costs involved in performing the recommended treatment, and a copy will be provided, if requested, to the patient. This is a treatment plan estimate only; quoted fees may change if treatment is modified during care. 

Fee increases that occur during a patient’s treatment plan are normally honored for the initial treatment plan fees if treatment on the patient is currently in process. For any patient that has not had continual treatment for 90 days, the treatment plan will be charged at the new fee schedule.