metlife dental fee schedule 2020 for providers
You are now being directed to CVS Caremark site. This search will use the five-tier subtype. The $150 co-payment is for a plain metal crown. For general Apple Health and behavioral health guidance, visit our Information about novel coronavirus (COVID-19) webpage. Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. Orthodontia. Signing up is simple and free. Unlisted, unspecified and nonspecific codes should be avoided. WebProvider Agreement Fee Schedules (Please reference the fee schedule noted in your provider agreement, and if appropriate, check the CMS website to review the fee schedule for Medicaid and Medicare Advantage health plans.) P|!(}!h}qsPq!F#($FikLuJs?nSG^w;jp*B3&x!W x}k}l~'W)+~KZnsN1MVqy G8O,'"Gg Q WebWe would like to show you a description here but the site wont allow us. WebWhen is periodontal maintenance covered? Your benefits dont double if you are enrolled in two dental plans. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. The DMO plan doesnt have any deductibles or annual maximums. How do I notify SEBB that my loved one has passed away? \Jc sVB;xN"#~D=1GE SJ4{[HM`|x>~y\YgO_YQ la70'1!!7FY%^P\iRk*#L n~^IJ54g+Rq k (C8y}H7=s2TiUfS^|d yfGBak44\@j CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. WebProcedure Fees. hbbd```b`` Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". 0000037168 00000 n Altamonte Springs dentists Boca Raton dentists Clearwater dentists Coral Gables dentists Coral Springs dentists Daytona Beach dentists Delray Beach dentists Englewood dentists Fort Lauderdale dentists Gainesville dentists Grove City dentists This page contains billing guides, fee schedules, and additional billing materials to help you submit: Coronavirus (COVID-19) information. RNa: Visit the secure website, available through www.aetna.com, for more information. Predeterminations may not be available in all states. Aetna Inc. and itsaffiliated companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Aetna Inc. and itsitsaffiliated companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. Network dentists are paid contracted fees. Some subtypes have five tiers of coverage. Each DMO member must select a PCD. MetLife Vision contracted providers allow full and equal Direct Referral Dental Plan* MET185A. Please see your plan documents. Disclaimer of Warranties and Liabilities. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). You can find a network dentist with our online directory. Depending on your plan, you may pay for dental care in one of two ways: There are no deductibles or annual dollar maximums. 0000038707 00000 n Download the free app today. You can view and print your ID card from your member website. It describes the services you have coverage for under your plan. HW$WtM7GmFx4;c}""ztl3*_}"_^_Vkj*[iBK+i?n~/_-la6l{^}m>lq><9n?[{*w^G{e7+Q1V\tm8Vxp7%^t9u(28~Z6v{uf{T% 59Wv_[\}#=a.E1hqYM"8dT1!`9~]hGuDKGgyQ\knr[{tEr:Ad^KbP\9RuCn,sSvjkP(G#OJt3ooQc 1(*@v License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. If so, most services will be considered separately. If you had coverage under a previous insurance carrier, youll have coverage for certain services by that plan even after your Aetna coverage begins. 4792 0 obj <> endobj WebMetLife's Preferred Dentist Program allows you to select from a network of dentists who have agreed to charge discounted fees. Treating providers are solely responsible for medical advice and treatment of members. 0000029561 00000 n In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. August 1, 2022 to present Neurodevelopmental centers billing guide, July 1, 2022 to July 31, 2022 Neurodevelopmental centers billing guide, July 1, 2021 to June 30, 2022 Neurodevelopmental centers billing guide, View all neurodevelopmental centers billing guides, July 1, 2022 to present Neurodevelopmental centers fee schedule, July 1, 2021 to June 30, 2022 Neurodevelopmental centers fee schedule, January 1, 2021 to June 30, 2021 Neurodevelopmental centers fee schedule, View all neurodevelopmental centers fee schedules, January 1, 2019 to March 31, 2019 Nondurable medical supplies and equipment billing guides, July 1, 2018 to December 31, 2018 Nondurable medical supplies and equipment billing guides, View all nondurable medical supplies and equipment billing guides, January 1, 2019 to March 31, 2019 Nondurable medical supplies and equipment fee schedule, April 1, 2023 to present Nursing facilities billing guide, January 1, 2023 to March 31, 2023 Nursing facilities billing guide, October 1, 2022 to December 31, 2022 Nursing facilities billing guide, View all nursing facilities billing guides, April 1, 2023 to present Orthodontic services billing guide, January 1, 2023 to March 31, 2023Orthodontic services billing guide, October 1, 2022 to December 31, 2022 Orthodontic services billing guide, View all orthodontic services billing guides, August 1, 2022 to present Outpatient hospital services billing guide, July 1, 2022 to July 31, 2022 Outpatient hospital services billing guide, April 1, 2022 to June 30, 2022 Outpatient hospital services billing guide, April 1, 2023 to present -- OPPS fee schedule, January 1, 2023 to March 31, 2023 OPPS fee schedule, October 1, 2022 to December 31, 2022 OPPS fee schedule, July 1, 2022 to September 30, 2022 OPPS fee schedule, April 1, 2022 to June 30, 2022 OPPS fee schedule, January 1, 2022 to March 31, 2022 OPPS fee schedule, October 1, 2021 to December 31, 2021 OPPS fee schedule, August 1, 2022 to present Outpatient rehabilitation billing guide, July 1, 2022 to July 31, 2022 Outpatient rehabilitation billing guide, January 1, 2022 to June 30, 2022 Outpatient rehabilitation billing guide, View all Outpatient Rehabilitation Program billing guides, July 1, 2022 to present Outpatient rehabilitation fee schedule, July 1, 2021 to June 30, 2022 Outpatient rehabilitation fee schedule, January 1, 2021 to June 30, 2021 Outpatient rehabilitation fee schedule, View all Outpatient Rehabilitation Program fee schedules, July 1, 2022 to present Pharmacy Special Services fee schedule, July 1, 2021 to June 30, 2022 Pharmacy Special Services fee schedule, July 1, 2020 to June 30, 2021 Pharmacy Special Services fee schedule, View all pharmacy special services fee schedules, May 1, 2023 to present - Physician-related services/health care billing guide, April 1, 2023 to April 31, 2023 Physician-related services/health care billing guide, January 1, 2023 to March 31, 2023 Physician-related services/health care billing guide, View all physician-related/professional services billing guides, April 1, 2023 to present Physician-related services fee schedule, January 1, 2023 to March 31, 2023 Physician-related services fee schedule, October 1, 2022 to December 31, 2022 Physician-related services fee schedule, View all physician-related/professional services fee schedules, January 1, 2023 to present Enhanced pediatric fee schedule, July 1, 2022 to December 31, 2022 Enhanced pediatric fee schedule, October 1, 2021 to June 30, 2022 Enhanced pediatric fee schedule, View all enhanced pediatric fee schedules, January 1, 2023 to present Enhanced adult primary care fee schedule, July 1, 2022 to December 31, 2022 Enhanced adult primary care fee schedule, October 1, 2021 to June 30, 2022 Enhanced adult primary care fee schedule, January 1, 2023 to present Opioid use disorder fee schedule, July 1, 2022 to December 31, 2022 Opioid use disorder fee schedule, July 1, 2021 to June 30, 2022 Opioid use disorder fee schedule, View all medication for opioid use disorder fee schedules, July 1, 2022 to present Conversion factors, July 1, 2021 to June 30, 2022 Conversion factors, July 1, 2020 to June 30, 2021 Conversion factors, Centers of Excellence: organ transplant facilities directory, April 1, 2023 to present Planned home births and births in centers billing guide, January 1, 2023 to March 31, 2023 Planned home births and births in centers billing guide, October 1, 2022 to December 31, 2022 Planned home births and births in centers billing guide, View all planned home births billing guides, January 1, 2023 to present Planned home births and births in centers fee schedule, July 1, 2022 to December 31, 2022 Planned home births and births in centers fee schedule, July 1, 2021 to June 30, 2022 Planned home births and births in centers fee schedule, View all planned home births fee schedules, July 1, 2022 to present Prenatal diagnosis genetic counseling fee schedule, July 2021 to June 30, 2022 Prenatal diagnosis genetic counseling fee schedule, July 1, 2020 to June 30, 2021 Prenatal diagnosis genetic counseling fee schedule, View all prenatal diagnosis genetic counseling fee schedules, January 1, 2023 to present Prescription drug program billing guide, April 1, 2022 to December 31, 2022 Prescription drug program billing guide, October 1, 2021 to March 31, 2022 Prescription drug program billing guide, January 1, 2023 to present Expedited authorization codes and criteria table, June 1, 2022 to December 31, 2022 Expedited authorization codes and criteria table, December 1, 2021 to May 31, 2022 Expedited authorization codes and criteria table, February 21, 2023 to present Private duty nursing for children billing guide, July 1, 2022 to February 20, 2023 Private duty nursing for children billing guide, October 1, 2020 to June 30, 2022 Private duty nursing for children billing guide, View all private duty nursing for children billing guides, January 1, 2023 to present Private duty nursing fee schedule, January 1, 2020 to December 31, 2022 Private duty nursing fee schedule, July 1, 2016 to December 31, 2019 Private duty nursing fee schedule, April 1, 2023 to present Professional administered drug fee schedule, January 1, 2023 to March 31, 2023 Professional administered drug fee schedule, October 1, 2022 to December 31, 2022 Professional administered drug fee schedule, View all professional administered drugs fee schedules, July 1, 2022 to present Prosthetic and orthotic devices billing guide, April 1, 2022 to June 30, 2022 Prosthetic and orthotic devices billing guide, October 1, 2021 to March 31, 2022 Prosthetic and orthotic devices billing guide, View all prosthetic and orthotics billing guides, July 1, 2022 to present Prosthetic and orthotics fee schedule, October 1, 2021 to June 30, 2022 Prosthetic and orthotics fee schedule, July 1, 2021 to September 30, 2021 Prosthetic and orthotics fee schedule, View all prosthetic and orthotics fee schedules, August 1, 2022 to present Respiratory care billing guide, July 1, 2022 to July 31, 2022 Respiratory care billing guide, October 1, 2021 to June 30, 2022 Respiratory care billing guide, July 1, 2022 to present Respiratory care fee schedule, October 1, 2021 to June 30, 2022 Respiratory care fee schedule, July 1, 2021 to September 30, 2021 Respiratory care fee schedule, April 1, 2023 to present Rural heath clinics billing guide, January 1, 2023 to March 31, 2023 Rural health clinics billing guide, October 1, 2022 to December 31, 2022 Rural health clinics billing guide, April 1, 2023 to present RHC encounter rates, January 1, 2023 to March 31, 2023 RHC encounter rates, October 1, 2022 to December 31, 2022 RHC encounter rates, April 1, 2023 to present RHC enhancement rates, January 1, 2023 to March 31, 2023 RHC enhancement rates, October 1, 2022 to December 31, 2022 RHC enhancement rates, October1, 2022 to present SBHS billing guide, July 1, 2022 to September 30, 2022 SBHS billing guide, October 1, 2021 to June 30, 2022 SBHS billing guide, July 1, 2022 to present SBHS fee schedule, October 1, 2021 to June 30, 2022 SBHS fee schedule, July 1, 2021 to September 30, 2021 SBHS fee schedule, January 1, 2023 to present Sleep centers billing guide, July 1, 2022 to December 31, 2022 Sleep centers billing guide, October 1, 2020 to June 30, 2022 Sleep centers billing guide, April 1, 2023 to present Sleep centers fee schedule, January 1, 2023 to March 31, 2023 Sleep centers fee schedule, July 1, 2022 to December 31, 2022 Sleep centers fee schedule, January 1, 2023 to Present Sterilization billing guide, October 1, 2022 to December 31, 2022 Sterilization billing guide, July 1, 2022 to September 30, 2022 Sterilization supplemental billing guide, Physician-related/Professional Services Billing Guide, Sterilization Consent Form (HHS-687) (English), Sterilization Consent Form (HHS-687) English large print, Sterilization Consent Form (HHS-687-1) (Spanish), Sterilization Consent Form (HHS-687-1) Spanish large print, 1, 2023to present Substance use disorder billing guide, January 1, 2023to March 31, 2023 Substance use disorder billing guide, October 1, 2022 to December 31, 2022 Substance use disorder billing guide, View all SUD (FFS outside BHO process) billing guides, July 1, 2022 to present Substance use disorder fee schedule, October 1, 2021 to June 30, 2022 Substance use disorder fee schedule, January 1, 2021 to September 30, 2021 Substance use disorder fee schedule, View all substance use disorder fee schedules, January 1, 2023 to present Substance-Using Pregnant People (SUPP) Program billing guide, February 26, 2023 to present Telemedicine billing guide, January 1. To receive maximum benefits, members must choose a participating primary care dentist to coordinate their care with in-network providers. All services deemed "never effective" are excluded from coverage. Links to various non-Aetna sites are provided for your convenience only. It sets what they can charge for covered services. The ABA Medical Necessity Guidedoes not constitute medical advice. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. "CYhpEObbG`aH??iQSj*{rfLbEdv va[?UZ.Nna!gI\ ,X]5 Others have four tiers, three tiers or two tiers. Virginia members: In Virginia, DMO is called DNO (Dental Network Only). 825 0 obj <>stream G $10 to $50 to extract a tooth. HTn0?N$vt.taQ"]QI~}kGvc:PXJ ,DDIuEE}%uDp'QMXzm:h?cZH;%*E[*& Some plans exclude coverage for services or supplies that Aetna considers medically necessary. The PCD has primary responsibility for managing your dental care. RLaVHQB-JS=*ccYqE,cD98q:A-H}D+&\jC80n 3"Dtd(DDhy +pE8ai:H,[9"XX$'8ZD` t'+"1:wu0.Zg*e ^Eya}uqUUF)j^c[d8unIq:J_|u[#,gNj[bS }|2"X$^=O\.agtV|1`G~eY)ez_!+!:v*J Q(v~RppZpccCSZgc3p7~{1^zVEQ5+c1 ;{ycu$g@y&A|d(:6e FkG=^:s`P$aq/lX}N970/k For language services, please call the number on your member ID card and request an operator. Click home to navigate to home.. Click reset to reset the application.reset to reset the application. Verify the spelling of the provider's last name or office name. Links to various non-Aetna sites are provided for your convenience only. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. $10 to $50 to extract a tooth. 2023 MetLife Services and Solutions, LLC CMS develops fee schedules for physicians, ambulance services, clinical laboratory services, and durable medical equipment, prosthetics, orthotics, and supplies. Notice: Past billing guides may have broken links. For questions about billing guides, contact Medical Assistance Customer Service Center (MACSC) online or at 1-800-562-3022. (For example, a change made on April 16 will take effect June 1.). hb``d``c``e`kgg@ ~'a >/*g3,>Ib1h(ettt4@ ceY A dentist's reimbursement is a combination of: We have an arrangement with our DMO providers. What types of services does the plan cover? The member's benefit plan determines coverage. You can also view and share your digital ID card from the Aetna Health app. For other specialists, a referral may be necessary. To find out additional fee information on common procedures in your area, the process is simple 0000113149 00000 n If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. 1-855-MET-EYE-1. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). endstream endobj 4800 0 obj <>stream In case of a conflict between your plan documents and this information, the plan documents will govern. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). 0000136999 00000 n The secondary plan acts like a supplement to the primary plan. How are claims 0000032811 00000 n Select one of the SafeGuard DHMO Plans or one of the MetLife It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. 0000021213 00000 n Click home to navigate to home.. Click reset to reset the application.reset to reset the application. See Physician-related/professional services for information regarding vision exams and related services. 20% PPO and out-of-state; 30% non-PPO. Aetna Inc. and its affiliated companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. In Illinois, DMO plans provide limited out-of-network benefits. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna). See Physician-related/professional services. For questions about rates or fee schedules, email ProfessionalRates@hca.wa.gov. Have your dentist send a pretreatment estimate (predetermination) to us. See Physician-related/professional services.). H|y\GozfKQgxDxk5Q"E[/P# GYf>WWU]z #Fv;t|*DDG&)07"jnlM&r3fLIsg@L?2t&&:r@p>_hwxwm!1IcNp,<6nfT^IAI. CPT is a registered trademark of the American Medical Association. Use our billing guides and fee schedules to determine if a PA is required and assist in filing claims. You can reach them at the number on your ID card. HQK0+.y+B")RaO m!n[d]{1|9s}Z2t6BIe)U$}C`u! The member's benefit plan determines coverage. By contacting the Payor, a provider can identify which network fee schedule is being utilized for claim reimbursement and verify participation status with the plan. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Verify the spelling of the street name or city. By clicking on I accept, I acknowledge and accept that: Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. metlife dental claim form NCFlex MetLife Triple Options Booklet and FAQs NCFlex MetLife Dental International Travel Assist Flyer MetLife Dental Low Option Certificate 01 01 20 MetLife Dental Low Option Certificate UNC Chapel Hill 01 01 20 MetLife Dental Classic Option Certificate 01 01 20 Find a dental plan thats right for you and your family, based on your needs and budget. 0000050892 00000 n WebDental insurance helps you plan for the costs of dental care. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. This applies to services for: For more details, review your plan documents. How do providers identify the correct payer? Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. You are now being directed to the CVS Health site. Call Customer Service at 0000001677 00000 n DNO (Dental Network Only) in Virginia is not an HMO. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Illinois DMO is not an HMO. The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. 4828 0 obj <>stream MetLifes Preferred Provider Organization (PPO) plans feature the MetLife Preferred Dentist Program, which is designed to save you money on dental services.1 You can choose from thousands of participating general dentists and specialists nationwide. 0000037280 00000 n Reprinted with permission. %PDF-1.7 % Find individual dental insurance plans near you with budget-friendly coverage options and get a quote. hbba`b``30 Ga 0000043626 00000 n Choose a primary care dentist who participates in our network. WebSchedule of Benefits . 0000035971 00000 n 0000035839 00000 n endstream endobj 4804 0 obj <>stream It is only a partial, general description of plan or program benefits and does not constitute a contract. rxo @ e(m#GIByY6Cs|@5'C/9GL[sN`8!@d2j The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. Discontinued 3/31/2013. The ADA anticipates that the costs of providing care will substantially increase for many dental procedures. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. 0000038958 00000 n Do you need a barcode cover sheet? Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Aetna's conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna). WebAll Other Dental Services You Pay $0 In-Network $50 Out-of-Network $50 The maximum amount Guardian will reimburse you for dental services received Limitations and Exclusions (see your policy for further details) We will not pay Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. ;j183 Treating providers are solely responsible for medical advice and treatment of members. 163 44 0000016556 00000 n All Rights Reserved. <<5AE96FDB43CC14498BFAFB7B8207E05A>]/Prev 310465/XRefStm 1499>> Applicable FARS/DFARS apply. 4812 0 obj <>/Filter/FlateDecode/ID[]/Index[4792 37]/Info 4791 0 R/Length 101/Prev 537656/Root 4793 0 R/Size 4829/Type/XRef/W[1 3 1]>>stream Every enrolled family member may select their own primary care dentist.