Dental Provider Newsletter - July 2019

Billing with unclassified or miscellaneous codes

We often receive questions regarding unclassified or miscellaneous codes--whether they are reimbursable by an EMI Health dental plan or whether they may be billed directly to EMI Health members. While we cannot give coding advice, we can share with you some general information and EMI Health's policies regarding payment for unclassified or miscellaneous codes:

  • They are intended for use when there is no existing specific CDT code that adequately describes the item or service being billed and are typically used during the period of time that a request for a new specific code is under review.
  • They are not intended to obtain supplemental payment for more specific CDT codes on the EMI Health fee schedule or to unbundle items or services that are inherent to the primary procedure, such as lab services.
  • In order to receive payment, from the plan or the member, the codes require additional information, such as a description of the item or service, and may require further supporting documentation.

If you have questions about a specific claim, benefits, or eligibility, please contact our provider assist team at 800-644-5411. The EMI Health dental provider manual is available online at www.emihealth.com.