D0150 - Comprehensive Eval
New or established patient comprehensive evaluation.
- Procedure Code
- D0150
- Clinical Category
- Diagnostic
- Primary ICD-10 Justification
- Z01.20 (Encounter for dental examination and cleaning without abnormal findings)
- Reference Fee & Claim Types
- BOTH
Insurance Verification Benchmarks & Billing Guidelines
Payer policy benchmarks, pre-submission attachment requirements, and denial prevention rules for D0150.
- Frequency Limitation
- 1 per patient every 36 to 60 months (3 to 5 years) per provider/practice (ROLLING_MONTHS)
- Age Limitation Criteria
- Covered for ages 3 and older.
Required Claim Attachments & Pre-Submission Checklist
- Full periodontal screening (PSR or 6-point charting)
- Hard and soft tissue oral cancer screening documentation
- Full-mouth caries charting and updated medical history
Bill When (Allowable Clinical Criteria)
- New patient comprehensive initial baseline examination
- Established patient returning after an absence of 3 or more consecutive years
Restrictions & Clinical Exclusions
- Do NOT bill at routine 6-month recall visits (use D0120 instead)
- Do NOT bill more than once every 3 years for an active patient
Common Claim Denial Codes & Overturn Strategies
| Denial Code | Denial Reason | Appeal & Overturn Strategy |
|---|---|---|
| CO-119 | Frequency limit exceeded (billed within 36 months of previous comprehensive exam) | Resubmit as D0120 (Periodic Evaluation) if within the 3-year frequency window. |
ICD-10-CM Justification & Crosswalk Mappings for D0150 (5)
Click any ICD-10-CM diagnosis code below to inspect its reverse procedure mappings and differential coding guide.
| ICD-10 Code | Diagnosis Name | Category | Primary Justification | Claim Type | Clinical Scenario |
|---|---|---|---|---|---|
| Z01.20 | Encounter for dental examination and cleaning without abnormal findings | Encounter for other special examination without diagnosis | ★ Yes (Primary) | BOTH | comprehensive oral evaluation – new or established patient indicated for Encounter for dental examination and cleaning without abnormal findings |
| Z01.21 | Encounter for dental examination and cleaning with abnormal findings | Encounter for other special examination without diagnosis | Secondary | BOTH | comprehensive oral evaluation – new or established patient indicated for Encounter for dental examination and cleaning with abnormal findings |
| Z13.84 | Encounter screening for dental disorders | Encounter for screening for other diseases and disorders | Secondary | BOTH | comprehensive oral evaluation – new or established patient indicated for Encounter screening for dental disorders |
| Z86.16 | Personal History of COVID-19 | Personal history of certain other diseases | Secondary | BOTH | comprehensive oral evaluation – new or established patient indicated for Personal History of COVID-19 |
| U07.1 | COVID-19 | Emergency use of U07 | Secondary | BOTH | comprehensive oral evaluation – new or established patient indicated for COVID-19 |
Frequently Asked Questions — D0150 (Comprehensive Eval)
Quick answers for dental billers and treatment coordinators submitting claims for D0150.
What ICD-10 diagnosis codes link to dental procedure D0150?▾
Common ICD-10-CM justification codes for CDT D0150 (Comprehensive Eval) include: Z01.20 - Encounter for dental examination and cleaning without abnormal findings (Primary); Z01.21 - Encounter for dental examination and cleaning with abnormal findings; Z13.84 - Encounter screening for dental disorders; Z86.16 - Personal History of COVID-19; U07.1 - COVID-19.
Can CDT code D0150 be billed to medical insurance?▾
Billing CDT D0150 (Comprehensive Eval) to medical insurance depends on the underlying clinical necessity and trauma/pathology documentation. Supported claim types across linked diagnoses: BOTH.
What attachments and documentation are required for billing CDT D0150?▾
Required claim attachments for CDT D0150 (Comprehensive Eval) include: Full periodontal screening (PSR or 6-point charting); Hard and soft tissue oral cancer screening documentation; Full-mouth caries charting and updated medical history.
What is the insurance frequency limitation for CDT D0150?▾
Standard commercial insurance frequency for D0150: 1 per patient every 36 to 60 months (3 to 5 years) per provider/practice (ROLLING_MONTHS). Age criteria: Covered for ages 3 and older..
What are common insurance denial reasons and appeal tips for CDT D0150?▾
Denial Code CO-119 (Frequency limit exceeded (billed within 36 months of previous comprehensive exam)): Overturn appeal strategy - Resubmit as D0120 (Periodic Evaluation) if within the 3-year frequency window.