“Are you already scanning or are you (still) taking impressions conventionally?” In fact, the latest-generation intraoral scanners offer promising diagnostic and treatment options. When purchasing an intraoral scanner, the following criteria play a role: Accuracy of the digital impression, the possibility of reworking the scan, the availability of data, the availability of interfaces, software tools, would I like lab-side or chairside fabrication, do I prefer a cart or laptop version or should the scanner be integrated into the dental chair, and finally, last but not least, handling and hygiene play a major role. In the end the question remains: Is the investment of an intraoral scanner worth it? What about the return on investment? The Böhm Council is therefore taking up the issue of billing for optoelectronic impressions. In Part 1 the legal fundamentals are presented, which in Part 2 are explained in greater detail with examples.

First, we succinctly state that, apart from impressions with individual spoons, conventional impressions are basically not separately billable. They are part of the billing rules for crowns and bridges. This applies both to the services listed in the fee schedule for dentists (GOZ) and for the services provided in the uniform assessment standard (BEMA). However, in 2012 a new service for digital impressions was included in the fee schedule for dentists (GOZ): the fee no. 0065, which we will take a closer look at below.

The description of services for the GOZ 0065 states: Optoelectronic impression taking including preparatory measures, simple digital bite registration and archiving, per jaw half or anterior tooth area.

The billing determination provides us with further explanations:

In addition to the service according to the fee no. 0065, conventional impressions are not billable according to this fee schedule for the same half of the jaw or the same anterior region.

The evaluation of GOZ 0065 is also in Table 1:

GOZ-Code Point value 1.0x 2.3x 3.5x
0065 80 4,50€ 10,35€ 15,75€

 

Comment on the service description

In this context, it is worth taking a look in the commentary of the Federal Dental Association (BZÄK) on the fee no. 0065:

“The service describes the three-dimensional data acquisition of intraoral structures using optoelectronic devices for the purpose of producing a restoration or reconstruction directly or indirectly after the production of a CAD/CAM model.

The simple registration of the bite conditions by digital means is not separately billable. Bite registrations in addition to that are not included.

The service is billed for each half of the jaw or the anterior region and may be incurred up to four times per session. Preparatory measures such as, e.g. the optical processing of the teeth or models to be taken for impressions, as well as the archiving of the data are included. The simultaneous billing of this service and a conventional impression in the same session for the same treatment area is not allowed.
The fee no. 0065 may be additionally billed in addition to a service which includes impressions along with other service components.
Conventional impressions in the sense of the following billing regulations are exclusively the impressions according to the fee nos.  5170, 5180, 5190 of the GOZ. The simultaneous billing of these services and the fee no. 0065 for the same jaw is not allowed. The PC-based evaluation for diagnosis and planning is not included in this fee number and must therefore be billed analogously.”

In summary, we can determine that the service is billed 

  • per jaw half or anterior tooth area and it may possibly arise up to four times per session, can 
  • not be billed in addition to the conventional impression, even next to the fee nos.  5170, 5180, and 5190, does 
  • not include the PC-based evaluation for diagnosis and planning. These must be billed analogously

PC-based evaluation

According to the BZÄK, the PC-based evaluation for diagnosis and planning must be billed analogously in accordance with section 6 para. 1 of the GOZ. The commentary on section 6 para. 1 states that the independent service, which is not included in the fee schedule, can be billed according to a service of the fee schedule that is equivalent in terms of type, cost, and time. The regulation thus points to equivalence and not to similarity. The equivalence check therefore does not necessarily have to be based on the service content. For the determination of equivalency, the dentist has to compare the type, cost, and time expenditure of the new service with the analog service selected in the alternative for billing. 

In the following I would like to give you three possible examples for the analog billing of the PC-based evaluation for diagnosis and planning, but you are free to select any other fee number. Table 2 shows the corresponding ratings:

PC-based evaluation of an optoelectronic impression acc. to section 6 para. 1 respectively 

... Application of methods for the analysis of jaw models (three-dimensional, graphical, or metric analyses, diagrams) GOZ 6010

... Transplantation of a tooth including surgical creation of the bone bed (GOZ 3160)


... Implant-related analysis and measurement of the alveolar process, the body of the mandible, and the adjacent bony structures and the mucous membrane, including metric evaluation of radiological findings, models, and photographs to determine the implant position, if necessary with the help of an individual template for diagnosis, including implant selection, per jaw (GOZ 9000 )
 

 

Evaluation:

GOZ-Code Point value 1.0x 2.3x 3.5x
6010 180 10,12€ 23,28€ 35,43€
3160 650 35,56€ 84,08€ 127,95€
9000 884 49,72€ 114,35€ 174,01€

 

Optoelectronic impressions also with CB

There is no question that optoelectronic impression taking is also used for splint therapy instead of conventional impression taking. A service according to the fee no. 0065 is compatible with insured persons of the GKV [statutory health insurance], since a comparable service is not included in the BEMA. In addition, the splint can be billed as a non-cash service in accordance with BEMA, provided that the requirements of the relevant BEMA item and the guidelines of the G-BA are met.

While in the area dentures the fee no. 0065 as well as PC-based evaluation can be billed using Part 2 of the HKP [therapeutic and cost schedule], with the splint therapy the services must be met in an agreement in acc. with section 4 para. 5 of the Bundesmantelvertrag or section 7 para. 7 of the Ersatzkassenvertrag.

Models in 3D printing

Last but not least, it’s worth taking a look at 3D models. The position of the KZBV [National Association of Statutory Health Insurance Dentists] is clear: “Computer-aided manufacturing (CAM) models using electronic data such as sintering, three-dimensional printing, milling, and similar only correspond to the scope of service of the fee no. 001 0 (model of hard plaster or super hard stone) of the Federal Uniform List of Performances of Dental Services (BEL II-2014), if a model of hard plaster or super hard plaster arises, which has the same level of detail as the conventional method. The production of a model from materials other than hard plaster or super hard plaster is not content of the contract dental care and to is to be billed as non-contractual service.”

 

Dr. Stefan Böhm

Picture source: 3Shape