Understanding Dental Code D0605

When to Use D0605 dental code

The D0605 dental code is designated for antibody testing related to public health pathogens, including coronavirus (COVID-19). This CDT code is used when a dental practice performs a point-of-care antibody test to determine if a patient has developed antibodies to a specific pathogen. It is not for diagnostic testing of active infection, but rather for identifying past exposure or immune response. Dental offices should use D0605 only when the test is medically necessary, aligns with public health guidelines, and is performed in-office by qualified personnel.

Documentation and Clinical Scenarios

Accurate documentation is critical when billing for D0605. The patient’s chart should clearly indicate the reason for testing, such as recent exposure to a public health pathogen or as part of a community health initiative. Documentation should include:

• Medical necessity for the test (e.g., patient history, symptoms, or public health recommendations)
• Date and type of antibody test performed
• Results of the test
• Any follow-up actions or referrals

Common clinical scenarios include screening dental staff or patients after a known exposure, or as part of a broader infection control protocol. Always ensure that the test kit used is FDA-authorized and that your state regulations permit dental offices to perform and bill for this service.

Insurance Billing Tips

Billing D0605 requires attention to detail to avoid denials and delays in accounts receivable (AR). Here are best practices for successful claim submission:

• Verify coverage: Before performing the test, confirm with the patient’s insurance if D0605 is a covered benefit. Many dental plans do not routinely cover antibody testing, so pre-verification is essential.
• Use correct coding: Ensure D0605 is listed as a separate line item on the claim form, and include supporting documentation as required by the payer.
• Attach clinical notes: Submit detailed clinical notes and medical necessity documentation with the claim to support reimbursement.
• Monitor EOBs: Review Explanation of Benefits (EOBs) carefully for payment status or denial reasons. If denied, check if additional documentation or a claim appeal is warranted.
• Coordinate with medical insurance: In some cases, medical insurance may cover D0605. Coordinate benefits and submit cross-over claims when appropriate.

Following these steps helps minimize claim rejections and keeps your revenue cycle management (RCM) process efficient.

Example Case for D0605

Consider a scenario where a dental hygienist is exposed to a patient who later tests positive for COVID-19. The dental office decides to test all staff members for antibodies using an FDA-authorized kit. For each staff member tested, the office documents the exposure, obtains consent, performs the antibody test, and records the results. The billing team verifies with the group health insurance that D0605 is covered for occupational exposure, submits the claim with supporting documentation, and follows up on the EOB. If the claim is denied, the office prepares a claim appeal with additional clinical justification and resubmits.

This example illustrates the importance of clear documentation, insurance verification, and proactive follow-up for successful reimbursement when using the D0605 dental code.