Insurance Coverage

Patient medical and dental insurance benefits should not dictate the standard of care that is provided. This is especially important for screening procedures, such as the ViziLite® Plus examination. Practices that offer ViziLite® Plus exams to their patients want their patients to receive the highest quality standard of care available. 

CDT Code: D0431

In 2005, the American Dental Association approved a CDT code for adjunctive tests intended to aid in oral mucosal examinations. The relevant passage reads: "Adjunctive pre-diagnostic test that aids in the detection of mucosal abnormalities including pre-malignant and malignant lesions not to include cytology or biopsy procedures." The ViziLite® Plus oral cancer screening examination falls under this definition.

Increasing numbers of dental and medical insurance plans are covering CDT code D0431. While not all insurance companies are currently reimbursing for it, many insurance carriers are seeing the value and cost savings of early detection and diagnosis. Please check with your patient's individual plan for policy coverage. We recommend that you submit every ViziLite® Plus exam to the patient's insurance company for payment. Even if the insurance company does not reimburse at this time, your submittal is what influences insurance companies to begin covering CDT code D0431.

Another resource for coverage is to include a reimbursement narrative letter with each D0431 claim. To download an Insurance Reimbursement Narrative template, click here. 

Medical Insurance

Patient medical insurance may also cover the ViziLite® Plus exam. Several medical insurance codes have been used to obtain insurance reimbursement for ViziLite® Plus exam. These codes are as follows: 

Dental professionals can provide necessary information to patients so that they can submit a medical claim to their medical insurance company, or dental professionals may submit a medical claim on behalf of their patient. Below are links to prepared, downloadable and printable medical claim forms containing the three code combinations listed above and a blank standard medical claim form. 

Download the 82397/V76.42 form (Recommended)

Download the 99211/V76.42 form

Download the 99201/V76.42 form

Download a blank standard medical claim form

Patient medical insurance companies can also provide plan-specific forms.

MSA/HSA Option

Medical Spending Accounts (MSAs), if offered by patient employers, are an excellent option for patients to use for reimbursement of a ViziLite® Plus examination. Healthcare Savings Accounts (HSAs), can also be an option for reimbursement of the annual ViziLite® Plus exam. In any case, it is important to provide patients with documentation of the ViziLite® Plus exam for submittal, along with payment receipt, for reimbursement. 

What if a patient claim is denied?

Zila has also prepared sample practice appeal letters for to be sent to insurance companies in the event that a submission for reimbursement has been denied. Simply download the letter here, fill in practice information, and mail to the insurance company.

Disclaimer – The reimbursement information contained here is provided to help you understand the reimbursement process. It is intended to assist providers in accurately obtaining reimbursement for dental health care services. It is not intended to increase or maximize reimbursement by any payer. We strongly suggest that you consult your payer organization with regard to local reimbursement policies. The information contained here is provided for information purposes only and represents no statement, promise or guarantee by Zila, Inc., concerning reimbursement, payment or charge. Similarly, all CDT, CPT/HCPCS and ICD-9 codes are supplied for information purposes only and represent no statement, promise or guarantee by Zila that these codes will be appropriate or that reimbursement will be made.