Reimbursement Info

Your patient's medical and dental insurance benefits should not dictate the standard of care that you provide. 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.

Dental Insurance

The American Dental Association has established a dental insurance procedure code that applies to the ViziLite Plus exam. This code is the CDT D0431 code.  Be sure to include this specific procedure and code with each submitted claim that included a ViziLite Plus exam.  Increasingly, many more patient's dental plans provide coverage for the D0431 code.  So be sure to include this code for every claim that includes the ViziLite Plus exam.  For additional dental claim information, please use the Dental Reimbursement Reference Guide.

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

Your patient's medical insurance company may also cover the ViziLite Plus exam.  There are several medical insurance codes that have also been used to obtain insurance reimbursement for the ViziLite Plus exam.  These codes are as follows:

CPT/HCPCS code	ICD-9 diagnosis code
82397, Chemiluminescent assay	V76.42    special screening for malignant neoplasms, oral cavity
99211, for established patients	V76.42   special screening for malignant neoplasms, oral cavity
99201, for new patients	V76.42   special screening for malignant neoplasms, oral cavity

You can provide the necessary information to your patient so that they can submit a medical claim to their medical insurance company or you may submit a medical claim on behalf of your patient.  To assist you, we’ve 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  

Your patient's medical insurance company can also provide you with a plan-specific claim form.

Several leading dental practice management systems are enhancing their claims processing features by adding the capability to create medical claims.  Please check with your practice management system provider on this.

MSA/HSA Option

Medical Spending Accounts or MSAs, if offered by your patient's employer, are an excellent option for patient's to use for reimbursement of the ViziLite Plus examination. Healthcare Savings Accounts, HSAs, can also be an option for reimbursement of the annual ViziLite Plus exam. In any case, be sure to provide the patient with documentation of the ViziLite Plus exam and instruct them to submit a copy of this, along with your payment receipt, for reimbursement.

What if the patient's claim is denied?

Zila Pharmaceuticals has also prepared sample practice appeal letters for you to send to the insurance company in the event that your submission for reimbursement has been denied.  Simply download the letter by clicking here (or request a letter by calling 866.945.2776), add your practice information to the letter, and mail it 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 Pharmaceuticals 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 Pharmaceuticals Inc., that these codes will be appropriate or that reimbursement will be made.