The CPT describes many different levels of exams. DDSs should select the code that
most closely matches the complexity of the exam being ordered. For example, the DDS
might choose to use CPT code 99243 for most of their exams. However, if the DDS orders
less comprehensive exams (e.g., limited or brief), locate an exam in one of these
sections with a description and lower level of decision making to match the exam,
such as 99241. Less comprehensive exams have lower Medicare fees.
If a particular exam requires more extensive decision making and documentation (e.g.,
Neurological or Orthopedic), consider using a higher level of exam which relates to
a higher Medicare fee, such as 99244.
DDSs sometimes “bundle” ancillary tests with exams and order the entire package. DDSs
should maintain a crosswalk between the individual components of these packaged examinations
to the Medicare fee schedule. The package price should not exceed the sum of the Medicare
fees for the individual parts (e.g., a cardiological packaged exam could include an
examination, a chest x-ray, and a treadmill test).
NOTE: Medicare assigns different fees to each level of exam depending upon the complexity
of the exam and the medical decision making.
The “Evaluation and Management Services Guidelines” section in the CPT provides guidance
in selecting the appropriate level of service for each exam requested by the DDS.
The codes listed in the “Consultation” and “Office or Other Outpatient Services” sections
of the CPT are recommended.