Policy No: 50
Originally Created: 03/01/1997
Section: Oral and Maxillofacial Surgery
Last Reviewed: 01/01/2019
Last Revised: 01/01/2018
Excision of benign lesion
- up to 1.25 cm (D7410)
- greater than 1.25 cm (D7411)
- complicated (D7412)
Excision of malignant lesion
- up to 1.25 cm (D7413)
- greater than 1.25 cm (D7414)
- complicated (D7415): requires extensive undermining with advancement or rotational flap closure.
Excision of malignant tumor
- lesion diameter up to 1.25 cm (D7440)
- lesion diameter greater than 1.25cm (D7441)
Removal of benign odontogenic cyst or tumor
- lesion diameter up to 1.25 cm (D7450)
- lesion diameter greater than 1.25 cm (D7451)
Removal of benign nonodontogenic cyst or tumor
- lesion diameter up to 1.25 cm (D7460)
- lesion diameter greater than 1.25 cm (D7461)
Destruction of lesion(s) by physical or chemical method, by report (D7465)
- Examples include using cryo, laser or electro surgery.
Procedure is in accordance with generally accepted standards of dental practice.
Process to contract benefits.
Procedures may be subject to review by the dental consultant.
Procedures D7440 and D7441 – considered medical as a malignant condition is systemic and therefore considered medical. D7410 - D7412 process dental. Process to medical benefit. Submit on medical claim form with applicable medical CPT code and diagnosis code.
CDT - D7000-D7999 - see above
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