Silver Diamine Fluoride (SDF) Coding and Billing

In 2022, silver diamine fluoride was assigned a Category III current procedural terminology (CPT) code (0792T) which went live in July of 2023. This designation is given to emerging technologies, services, procedures, and service paradigms for the purposes of data collection, evaluation of service delivery, and development of policy. The launch of this code presents the opportunity for data collection that will inform potential future payment when offered in the medical home and allows pediatricians to be paid to provide treatment. 

Coding and Payment for the 2023 Category III Temporary Code 0792T  

Valuation and payment for SDF applied by physicians under Code 0792T are not widely established. Availability and amount of payment will vary from state to state and by type of payor. Below are links to coding guidance that has been developed in the following states.

• Illinois Chapter, American Academy of Pediatrics Silver Diamine Fluoride Application in the Pediatric Primary Care Setting
  Billing and Coding for Fluoride Varnish and Silver Diamine Fluoride Application in Illinois
• Maine: From The First Tooth, Reimbursement Information

The following are links to information on coding and payment for both dental and medical application of silver diamine fluoride.

• AAP Pediatric Coding Newsletter™ Connecting Coding and Clinical Reports: Oral Health Care: Scroll down to Coming Soon? Silver Diamine Fluoride.
• Guide to Reporting Caries Preventive Medicament Application (American Dental Association)
• CPT® Category III Codes: Addition of 20 Category III Codes (0791T - 0810T) (American Medical Association)
• Reimbursement for Dental Services for Children Covered by Medicaid
  2024 American Academy of Pediatric Dentistry survey of state recognition and reimbursement for select dental services for children – 2023 data
• Medicaid Policy on SDF by State 2022
  State policy and payment information to dental professionals by state from the Medicaid | Medicare | CHIP Services Dental Association

Coding and Payment for Oral Health Services 

Pediatricians are using a variety of existing diagnosis and treatment codes as they integrate SDF into practice. A variety of resources on payment for oral health services in the medical setting are available on the AAP Oral Health patient care website. Consult the AAP Oral Health Coding Fact Sheet for Primary Care Physicians for current procedural terminology (CPT) and Dental Procedures and Nomenclature (CDT). The information here does not yet include SDF.  

Coding for Preventive Medicine 

Preventive medicine service codes may be used if findings meet the following definition from Coding for Preventive Pediatric Care 2022, Bright Futures™ and American Academy of Pediatrics. “If an illness or abnormality is discovered, or a preexisting problem is addressed, in the process of performing the preventive medicine service, and if the illness, abnormality, or problem is significant enough to require additional work to perform the components of a problem-oriented evaluation and management (E/M) service (i.e., using medical decision making or time spent), the appropriate office or other outpatient service code (99202–99215) should be reported in addition to the preventive medicine service code. Append modifier 25 to the office or other outpatient service code (e.g., 99392 and 99213 25).”