Question

Can I bill for a crown that the lab delivered but was never seated?

Yes, you can bill the payer for the crown, but you will need to provide an explanation as to why the crown was not seated. In addition, send a brief narrative and supporting documentation as evidence of medical necessity.

Include a narrative explaining the clinical necessity for the crown and, at a minimum send diagnostic preoperative radiographs and pre-operative photographic images, if available. Send a copy of the laboratory prescription and bill for the crown. The date of service is the date the tooth was prepared for the crown (prep date).

If the crown was not seated because the patient failed to keep scheduled appointments to complete the treatment, explain what was done to encourage the patient to follow through with treatment. Also include a copy of any documentation of the failed or cancelled appointments. It is helpful to send a certified letter to the patient and provide a copy of this letter for documentation.

The payer may reimburse the contracted amount or pay a prorated amount to compensate for the laboratory bill and chair time. Some payers will pay nothing. The practice can report the full amount, explain the circumstances, and let the payer decide what is payable based on the terms of the plan document. The“incurred liability date” of the plan document often requires “delivery” (e.g., cementing or bonding thecrown) for payment. Most PPO contracts or the Payer’s Processing Policy Manual require that crowns be reported on the seat date, not the preparation date.

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