Oregon  |  Winter 2017
2017 CDT changes and processing policy updates
On January 1, 2017, Delta Dental of Oregon (DDOR) will implement the new codes that the ADA has outlined in CDT-17. The table below shows how the DDOR standard contract will cover these new CDT-17 codes. 

Please refer to the group limitations of each patient's plan in Benefit Tracker for specific benefit information as some plans may handle the codes differently than the DDOR standard contract.
Also, code D0290 (posterior anterior or lateral skull and facial bone survey radiographic image) will be deleted with CDT-17. This means that DDOR will no longer accept this deleted code after March 31, 2017. 

CDT-2017 code books can be purchased through the American Dental Association at ada.org

New CDT codes covered under DDOR Standard Commercial plans. No other new codes will be covered by Standard plans.

Distal shoe space maintainer - fixed - unilateral.
a. Limited to children 8 and younger.
b. Fees for repairs and adjustments by same dentist/dental office are DISALLOWED.
Scaling in the presence of generalized moderate or severe gingival inflammation - full mouth, after oral evaluation.
Same frequency as D1110, D1120 and D4910.

Please contact the Delta Dental of Oregon Dental Customer Service department toll-free at 877-277-7280 or email us at dental@modahealth.com.
Pain management therapy and non-narcotic analgesics

There are many post-procedural analgesic agents available for customized management of outpatient
dental pain. General pain management rules of thumb include prescribing low doses for short amounts of time and minimizing opioid prescriptions. Given the recent increase in opioid abuse and overdoses, it is critical to be aware of and utilize non-narcotic pain control management strategies. While short courses of opioids can be effective and necessary in some patients, other pharmacologic therapies such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) can be useful alternatives.

Selecting which non-narcotic analgesic can depend on numerous patient-specific factors. For example,
NSAIDs may be a good choice in patients who may take other medications that contain acetaminophen to avoid going over the acetaminophen maximum daily dose of four grams. Patients with gastrointestinal concerns can use alternatives to conventional NSAIDs such as the selective cyclooxygenase 2 (COX-2) inhibitor celecoxib. A third consideration may be to use acetaminophen
instead of NSAIDs in patients with heart failure. NSAIDs can cause fluid retention and edema. Keeping in mind patient-specific factors when choosing therapy can help provide the best pain management and minimize adverse effects.

1 Burgess, J. "Pain Management in Dentistry." Medscape. Ed. Arlen D. Meyers. 19 Nov. 2014. Web. 01 Sept. 2016.
2 Becker, DE. "Pain Management: Part 1: Managing Acute and Postoperative Dental Pain." Anesth Prog 2010; 57:67-79.
3 Drug Facts and Comparisons. Facts & Comparisons [database online]. St. Louis, MO:Wolters Kluwer Health, Inc; March 2005. Accessed August 30, 2016.
4 DRUGDEX. Micromedex Solutions [database online]. Ann Arbor (MI): Truven Health Analytics; 2016. Accessed August 30, 2016. Available from: micromedexsolutions.com.

Example dosing
Acetaminophen (Tylenol) 650-1000 mg every 4-6 hours as needed
30-60 minutes 4-6 hours * Risk of hepatotoxicity at doses higher than the FDA max
* Use with caution in patients who may be on other
medications that contain additional acetaminophen
* 4 g max/day or 3g for Tylenol Extra Strength
Ibuprofen (Motrin)
200-400mg every 4-6 hours as needed
30-60 minutes 4-6 hours _______________________

* Take with food to avoid GI upset
Diclofenac 50 mg three times daily as needed (immediate release tablets) 30-60 minutes
~4-6 hours

* Potential to cause GI bleed, avoid in patients with GI problems

* Use caution in patients with kidney problems 

Naproxen (Aleve) 220 mg every 8-12 hours (OTC)
or 550 mg every 12 hours (Rx)
<12 hours

* Avoid use in patients with heart failure


Celecoxib (Celebrex) 200 mg twice daily as needed
2-3 hours
~12 hours
* Potential option for patients with GI problems
who cannot take other NSAIDs
* Do not use in patients with a sulfa allergy

Section 1557 of the Affordable Care Act - the final rule

The effective date of the final rule issued under Section 1557 of the Affordable Care Act was Oct. 16, 2016. This section protects individuals from discrimination in healthcare on the basis of race, color, national origin, sex, age or disability. An individual or entity that receives certain types of financial assistance from Health and Human Services including Medicaid, CHIP, Meaningful Use and Medicare Part C is covered under Section 1557.

Covered dental practices must prepare and post a notice of nondiscrimination and a tagline indicating language assistance is available. These notices must be posted on the practice website, in the office, and in publications and communications. The nondiscrimination notice must be posted in English and
provided in another language upon request. The tagline must be translated in the top 15 non-English languages spoken in the state and indicate that translation services are available.

The dental practice must also ensure access to qualified interpreters for languages most likely encountered in the office. If translation services are provided via remote video connectivity (not required), the defined connection protocol must be implemented.

The following websites provide information about implementing the Section 1557 final-rule
guidelines in your dental practice:
> American Dental  Association:  ada.org
> Health and Human Services:  hhs.gov

Please contact Nancy Avery at nancy.avery@modahealth.com or by phone at 503-948-5568 for assistance with your implementation.

Take the pledge to end opioid use

Healthcare professionals are joining the Turn the Tide campaign to help curb widespread abuse of opioid pain medications. Please visit  turnthetiderx.org to take the pledge.
Updated OHP covered and non-covered list

On July 1, 2016, we updated our pre-determination services to prevent delays in treatment and
promote quicker access to care for our ODS-OHP members. Pre-determinations will continue to
be an option for partial dentures, endodontics services and oral surgery. They are neither a requirement
nor a guarantee of payment.

To help you determine benefits for these members, we have created a comprehensive covered and non-covered codes list. For assistance with ODS-OHP member benefits, please contact ODS dental customer service at 503-243-2987 or 800-342-0526.
Provider Handbooks

503-265-5720 | dpr@modahealth.com | modahealth.com
601 S.W. Second Avenue
Portland, OR 97204