Policy on Third-Party Reimbursement for Management of Patients with Special Health Care Needs

Policy statement

The AAPD recognizes that the population of people with special health care needs is increasing and that additional time and skills are necessary to provide optimal care to those individuals in a dental home setting. Care coordination activities for patients with SHCN that are more systematically proactive, rather than reactive, and allow for comprehensive management could reduce hospitalizations and avoid emergency department visits. Furthermore, reimbursement for the use of additional personnel or advanced behavior management techniques could reduce the need for costly general anesthesia and facilitate the delivery of medically-necessary oral health care to which these patients are entitled. Therefore, the AAPD advocates that third-party payors and managed care organizations review their capitation policies to provide adequate reimbursement for dental case management – patients with special health care needs (CDT code D9997), care coordination (CDT code D9992), and behavior management (CDT code D9920).