$C@ 9&L`A :\E&ekfaa~$g;laea#u3jgEl2M^7_pvtB2m3uePM$N(];qB{K:WnIQPlnSJmy+mE F*URS6=t {v9]p[QIdsYvC&} s.tI1YbV'lmBCCDM\ e4 &UBA*n. 0000007475 00000 n With Cigna Dental Care DHMO, you get comprehensive dental coverage that's easy to use. 0000002374 00000 n Office Visit Fee . "a\[x3A LN 00 + endstream endobj startxref 0 %%EOF 230 0 obj <>stream 0000033620 00000 n 0000058744 00000 n The American Dental Association may periodically change CDT Codes or definitions. 92249 856612 02/13 K1-V9 K1-V9 cigna dental care (*dHMO) patient cHarge scHedule This Patient Charge Schedule lists the benefits of the Dental Plan including 10574 0 obj <> endobj CIGNA DENTAL CARE (*DHMO) PATIENT CHARGE SCHEDULE This P atient Char ge Schedule lis ts the benefits of the Dental Plan including covered procedures and patient charges. trailer 147 0 obj <> endobj All practitioners should advise Cigna members of the costs of any treatment (including consultations) being provided. hbbd``b`@$. Programs and Initiatives (CCF, DLP, ISYLP, Career Pathways), DC Government Benefits Enrollment Instructions, UnitedHealthcare Choice Open Access Plan Summary, SmartBenefits Enrollment Application & Change Form, Temporary Continuation of Coverage Benefits Enrollment Form, Health Insurance for Employees Hired Before October 1, 1987, Health Insurance Premiums for Employees Hired on or After October 1, 1987, DCEHBP Temporary Continuation of Coverage (TCC) Premiums, How to Enroll in Your DC Government Benefits, Coronavirus (COVID-19) Resources for DC Government Employees, Electronic District Personnel Manual (eDPM), Electronic-District Personnel Manual (E-DPM), Whistleblower Protections and Obligations, Sexual Harassment Prevention Officer Directory, Human Resource Officer - Advisor Directory, 2023 Cigna Dental HMO Patient Charge Schedule, 2022 Cigna Dental HMO Patient Charge Schedule, 2021 Cigna Dental HMO Patient Charge Schedule. dWR)]gP{ey01KGs9}eV}m#lVSfi7Gph All patient charges must correspond to the Patient Charge Schedule in effect on the date the procedure is initiated. PATIENT CHARGE SCHEDULE . 0 0000048251 00000 n 0000037057 00000 n %MFclR*4))[3nqC) w_iStv'tSX%U'R31qWDes- h$fE?/9aSSJ;b"Azo,LiWg?0z2->b> ,(s6a k04QP\NI(?* M ,hTjmsTTbrrq:0E`a I A1)A1Xb`uAYXPd3 E(@jr( pqqKKC8EM/PvWdeSA(2 0000002770 00000 n CIGNA Dental Care (*DHMO) . %%EOF 0000026712 00000 n "S} lXYMkB,.qE(PGND & /W8NjRk18>`ihf~;~y""[_&4~,}E9 s~M6jO$2'wc0l}&[Lh=l0b7r*L A TJu;leTq;%HvAt~')k'7g^ {Tdpad1G),&ZtVBo:mjVs%Yos1Q!U1*$xf/UC,lEaya)/L{^Cp`. 0000003298 00000 n 0000080015 00000 n Hh>) $"x# q7?0 vw All patient charges must correspond to the Patient Charge Schedule in effect on the date the procedure is initiated. endstream endobj startxref 0000000016 00000 n If you have PPO or Traditional Indemnity coverage, please contact your employee relations office or your provider to obtain a benefit schedule. The Cigna Dental Care (DHMO) plan includes coverage for many procedures that may not be available on other dental plans. xref How often are fees reviewed or increased? 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Use this form to request a CIGNA Dental Care patient charge schedule. 0000080253 00000 n **For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Contracted Fee Schedule. 0000021133 00000 n 0000002304 00000 n After entering basic patient and claims information, the cost estimator uses your fee schedule and your patients' benefits plans to: Show you our estimated payment to you. 66 59 SmartBenefits Enrollment Application & Change Form. 0000013269 00000 n 92249.a - 2 - CIGNA DENTAL CARE PATIENT CHARGE SCHEDULE (K1-V9) CIGNA DENTAL CARE PATIENT CHARGE SCHEDULE Code Procedure Description Patient Charge Office visit fee (per patient, per office visit in addition to any other applicable patient charges) Office visit fee $5.00 Diagnostic/preventive - oral evaluations are limited to a combined total of 4 of the following . %PDF-1.3 Cigna Dental considers infection control and/or sterilization to be incidental to . 0000008230 00000 n 0000029950 00000 n 67 0 obj <> endobj startxref 0000015088 00000 n hA 04s\GczC. Cigna Dental Care Patient Charge Schedule 1-06-2-w Code Procedure Description Patient Charge Diagnostic/Preventive D9310 Consultation (normally not the same dentist who provides the treatment) $0.00 D9430 Office Visit for Observation - No Other Services All patient charges must correspond to the Patient Charge Schedule in effect on the date the procedure is initiated. %%EOF The CCSD schedule contains industry standard codes for surgical procedures and diagnostic tests in UK private healthcare. ?2h` h 0000009706 00000 n 89 0 obj <> endobj 0000003691 00000 n 0000011173 00000 n than the limitation allows, Cigna Dental will waive the applicable limitation. 0000003348 00000 n 92260.a - 2 - CIGNA DENTAL CARE PATIENT CHARGE . 0000009930 00000 n 0000004072 00000 n 0000010068 00000 n 0000025329 00000 n Cigna Dental Care (DHMO)* Patient Charge Schedules 887393 09/15 Page 1 CDT 2016 Covered under Procedure Code1 Dental Description and Nomenclature Cigna Dental 09 PCS Cigna Dental I09 PCS Chair Time Per Y/N Minutes Code # (if different) Y/N Code # (if different) Clinical oral evaluations D0120 Periodic oral evaluation - e`ea =AG/LGtQ0q(MyPADbso{U,,? wuX,zOW8:m;5*q* F!Q',3s`RRRh CDHfc0BeT#L S@3-Bc=FM@Zea 7iX;\%8>pwnv7`Am H3q[20F Vg Effective January 1, 2021, Cigna Behavioral Health will begin administering two Behavioral Health for Children and Adolescents (BHCA) services, Family Support and Training and Therapeutic Mentoring in accordance with the requirements of Massachusetts Division of Insurance Bulletin 2018-07. 0000008121 00000 n 0000011053 00000 n 0000013658 00000 n "I+3o?`13}o+BY5k2\Ivw_G>U`o|V9~BxX!\NPe6 IyVD$9I8 adM::|G_,?t{C%-sM0 s4w7mmV"4hUkV%G67Cku{[Ya|uXtJ3\9U743),fKe&Y#6rPFtEixYzQsyk_,d_d>c(u#,rq m|XO?X 0'!$GSx2D 0QY9($ 0000026301 00000 n 0000003405 00000 n 0000037369 00000 n Office visit fee $0.00 Diagnostic/preventive - Oral evaluations are limited to a combined total of 4 of the . Cigna dental Care (*dHMO) . VIDEO Cigna Dental PPO 0000013571 00000 n Procedures listed on the Patient Charge Schedule are subject to the plan limitations and exclusions described in your plan book/certificate of coverage and/or group contract. Cigna does not control the linked sites' content or links. 0000004408 00000 n 0000078060 00000 n Patient Charge Schedule This Patient Charge Schedule describes the benefits of your dental plan and includes a list of covered . 0000048422 00000 n 0000015076 00000 n Patient Charge Schedules are available to CIGNA Dental Care members only. 0 Initial Consultation face to face - 205, Follow-up Consultation face to face - 145, Initial Consultation remote - 205 (where clinically appropriate), Follow-up Consultation remote - 145 (where clinically appropriate), Extended Physician Consultation - 250 (over 40 mins). CIGNA DENTAL CARE PLAN PATIENT CHARGE SCHEDULE (G1-V9) 92249.b - 3 - D0240 X-rays intraoral - Occlusal radiographic image $0.00 0000018616 00000 n hb```a``}xAb@Y(@ DnbeN`!@vt@:M\I7'O 3nN*:J{>f X8Et$>xe0Y#duR.+b,k^Nv[CsLm&jF5Db4juU 10597 0 obj <>/Filter/FlateDecode/ID[<0F3F0D1BE2BD3847B9BF5CE826221B8D>]/Index[10574 51]/Info 10573 0 R/Length 105/Prev 385298/Root 10575 0 R/Size 10625/Type/XRef/W[1 2 1]>>stream 0000004978 00000 n Search the Fee Schedule by entering a code or keyword. 0 The contracted fee schedules vary by network dentist. @L{Mbg{0LzIGv389. Procedures listed on the Patient Charge Schedule are subject to the plan limitations and exclusions described in your plan book/certificate of coverage and/or group contract. Here are a few benefits and limitations to consider when evaluating a DHMO plan: Benefits Lower premiums than PPO plans or other types of dental insurance plans No deductible Set copayments; often minimal or no copayment for diagnostic and preventive care Typically, no annual maximum for covered benefits Limitations Smaller dentist network size 0000008684 00000 n 0000025789 00000 n For further information on Consultations and all other information on how accredited practitioners should interact with Cigna, in relation to services that may not be eligible for reimbursement, please read ourTerms and Conditions section here. 0000001196 00000 n 0000025889 00000 n 0000011147 00000 n 0000002140 00000 n 92254.b. 0000009175 00000 n hb```b``{% @1v(`;af. 0000086554 00000 n 0000005847 00000 n 0000086632 00000 n 0000009694 00000 n L1I09 Code Procedure description L1I09 D0364 Cone beam CT capture and interpretation with limited field of view - less than one whole jaw (only covered in conjunction with the surgical placement of an implant; limit of a total of only one D0364, D0365, D0366, or D0367 per 0000079419 00000 n The American Dental Association may periodically change CDT Codes or definitions. H|Tj1"/l@)hkEs&+,9f7gg/y!}iNx4Un%:/erWD}!Y+bkB)r;O UGE-7Wx:Ze|%J,isr=x.>}p\G ZImzH4r@h q%t ItfKb278MJ6p8h|)@Tr ?S=?Yv yA?3HZQ;yUZ:&T7|N|o#Xv>yXk9'5V2S|ju0kU6581_Fo!>b bd `R[w#-HaEH6LPidE2L. 0000017737 00000 n 66 0 obj <> endobj All patient charges correspond to the Patient Charge Schedule in effect on the date the procedure is initiated. <<4DFFD0FAA740384DAF78994982233F75>]/Prev 268013>> 0000062208 00000 n 0000014214 00000 n 0000040004 00000 n 0000059794 00000 n Log in to our provider portal. hb```,V!] Different codes may be used to describe these covered procedures. 0000003252 00000 n %PDF-1.5 % % Lv!:$Kvh ]j "j>z 'kQ>Oxog*6 nS f%#qh ;#@C\eB~\mD/a\~G&p/7C+MA\E2*Qu@z7kRi*kuevof[d^Dt$ORnzf#g+@2XC'FEH[1#66 44K,J^0t/Rrqxtg[n}Rw~ k6S=`CaW4^7. 0000016111 00000 n of the charges for services provided and not separately chargeable. %%EOF 6 0 obj Consultation fees and surgery/anaesthetist fees represent a significant element of total claims costs in private medical insurance and subsequently, have a major effect on premiums. Sorry, you need to enable JavaScript to visit this website. 0000047800 00000 n %PDF-1.5 % 0000012346 00000 n How to protect employees mental health during COVID-19 no matter where they are in the world. 948550 09/20 DENTAL INSURANCE THAT FITS Cigna Dental Care/DHMO Plan MTI09 PLAN HIGHLIGHTS IN-NETWORK Adult cleaning (two per calendar year - each at $0) $0 Child cleaning (two per calendar year - each at $0) $0 Periodic oral evaluation $0 Comprehensive oral evaluation $0 Different codes may be used to describe these covered procedures. xZ]s|a? *O|uQ|J\DBb)oL@JCvrYmvggzzvyral=yuu@gv/geangu^kDZ,2n^x}V'cV5!3W#XQf3?6%c The application of local anesthetic is covered as part of your dental treatment. 2565 0 obj <> endobj xref 2565 45 0000000016 00000 n "` h`E(Zb3q"D"cbC. 0000011811 00000 n hb```f`` 0000021775 00000 n Health Insurance for Employees Hired Before October 1, 1987. ^ 0000016764 00000 n 0000009819 00000 n 0000030031 00000 n The information, tools, and resources you need to support the day-to-day needs of your office CIGNA DENTAL CARE (*DHMO) PATIENT CHARGE SCHEDULE . hXnF>( 0000006170 00000 n xref Saint-Lgier-La Chisaz has an area, as of 2009, of 15.2 square kilometers (5.9 sq mi).Of this area, 5.16 km 2 (1.99 sq mi) or 34.0% is used for agricultural purposes, while 6.88 km 2 (2.66 sq mi) or 45.4% is forested. 0000006539 00000 n 0000002700 00000 n 0000085902 00000 n 0000004890 00000 n At each review, new codes are added, existing codes updated and some codes deleted. If fees exceed the Cigna Fee Schedule, practitioners should advise the member to contact Cigna member servicesbeforeany treatment takes place. Important Highlights 92260 856593 02/13 Q5-00 0000013184 00000 n 0000078271 00000 n 0000013079 00000 n 0000059263 00000 n The American Dental Association may periodically change CDT Codes or definitions. ***It is important to note that, in order to support both its Members and Providers during the pandemic, Cigna has decided to reimburse remote consultations at the same level as face to face; subject to clinical appropriateness. 0000008806 00000 n Maintenance Organization (DHMO) Schedule of Benefits Effective January 1, 2021 . 0000005123 00000 n CIGNA Dental Care Patient Charge Schedule (DC-07) Code Procedure Description Patient . Cigna Dental HMO Patient Charge Schedule. With this dental health maintenance organization (DHMO) plan, preventive services are covered 100% with no deductible. All patient charges correspond to the Patient Charge Schedule in effect on the date the procedure is initiated. How often does a dentist change network? 0000078886 00000 n 0000002658 00000 n 0000029880 00000 n 0000014773 00000 n Porcelain, if used on molar teeth, will be charged to the xZr7}W1a}rdvmQb*/#rD"!iCmM$>}|>3[S3/C/~:[}>ffgfsC_zK?o^}K7JU }s{7iWaV6Zp5Q4w j} GSyKF.Yt.`uUb56{:7.o8nRxitYunU+Not~\0:%~` Z;[@%re7?:w i&;_v[w7=}ohv.WZ0'eX27*}& Gm_j@v\m*,b6 durPt. 0000048491 00000 n 0000006933 00000 n Patient cost estimator is available on our provider portal on Availity. costly service, the fee listed on the Patient Charge Schedule will not apply. Office visit fee (Per patient, per office visit in addition to any other applicable patient charges) . Easily search for DPPO network providers in the directory on Cigna.com . T2IV9 STATE OF TENNESSEE PLAN EFFECTIVE 1/1/2021 CIGNA DENTAL CARE (*DHMO) PATIENT CHARGE SCHEDULE Important Highlights This Patient Charge Schedule lists the benefits of the Dental Plan including covered procedures and patient charges. :TZ k1xv3qv$#}>>h)4P!n7%9~4^[O *E1GH!2DP'%NSS'8JxVWGu 0000017376 00000 n 0000028205 00000 n CIGNA DENTAL CARE (*DHMO) . S-A-GA-STD-VALUE-R21 Page: 1 GA16I Value BP - V21 SCHEDULE A Description of Benefits and Copayments . Different codes may be used to describe these covered procedures. 0000007192 00000 n Office visit fee (per patient, per office visit in addition to any other applicable patient charges) Office visit fee $10.00 $10.00 Diagnostic/preventive - Oral evaluations are limited to a combined total of 4 of the following evaluations during a 12 consecutive month period: periodic oral evaluations 0000002402 00000 n 0000017836 00000 n <]/Prev 575455>> Cigna is a member of The Clinical Coding and Schedule Development (CCSD) group. 0000011168 00000 n Now that's something to smile about. VV*5V1,cI;AAA@=c L3@L/Xh1533,q(3D:o@$Vfi? 0000061883 00000 n Please go toccsd.org.ukto view the schedule and to learn more about the objectives of CCSD. %PDF-1.3 Your secure provider portal for working with Cigna The information, tools, and resources you need to support the day-to-day needs of your office are all on the Cigna for Health Care Providers' website, CignaforHCP.com : Check patient eligibility and benefits Check claims, payments, and fee schedules Update your Cigna provider directory information FhZ\BgX0*\\e?Wlb+B+D$wwZKS|CM~rwI8.?2G(p ;M^xyt]~{W=|PIB'4)P96il>mhx; 0000032768 00000 n 0000001917 00000 n trailer endstream endobj 68 0 obj <>>> endobj 69 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/Rotate 0/TrimBox[0.0 0.0 792.0 612.0]/Type/Page>> endobj 70 0 obj <>stream 0000025537 00000 n Contact Cigna member servicesbeforeany treatment takes place to the Patient Charge Schedule will not apply fee on! 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