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Financial Information & Medical Codes

You may be wondering if your insurance will cover these services. The answer is that every insurance is different.

 

You can request reimbursement from medical or dental insurance. I am considered out-of-network, so you may want to be sure your insurance doesn’t prevent you from seeing an out-of-network provider. I will provide you with the medical and dental codes so you can pre-authorize with your insurance if you desire. I provide a detailed invoice and am happy to write a narrative if your insurance requests this. Many of the families I work with are successfully reimbursed (at least partially) from their insurance. Please feel free to look through the medical and dental codes, as well as estimated out of pocket costs listed below. If you have any other questions, please do not hesitate to reach out!  

Financial Information

You are able to submit bills through medical or dental insurance so it may be worthwhile to reach out to both, if you have both, to see who will cover better. Below you will find my estimated cost breakdown based on age group. There is no change in price if we need to treat multiple areas, and there is no cost for post op visits. We always have at least two of those. 

Infants

Evaluation: $200

Surgery: $700

Ages 1-17

Evaluation: $200

Surgery: $900

Ages 18+

Evaluation: $200

Surgery: $1100

Other

Red Light Therapy and Treatment: $40 per session

Medical Treatment Code 0552T

Provider Information and Medical Codes

Below you will find my provider information and medical treatment codes. You may want to have this information handy when talking with your insurance.

Providers Name: Jessika E Martin DDS 

NPI number: 1235580291 

Tax ID Number/EIN: 82-2951795 

Address: Thrive Growth and Development, 15455 Gleneagle Dr, Ste 100, Colorado Springs, CO 80921

Dental Insurance Codes:

  • The diagnostic (ICD) codes could include the following (they may not care about these): Q38.0 (lip tie), Q38.1 (tongue tie)

  • The procedure codes could include D0145 (evaluation of a child age less than three), D7961 (Frenectomy-lip or cheek), D7962 (Frenectomy-tongue)

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​Medical Insurance Codes:

  • The diagnostic (ICD) codes could include the following: Q38.0 (lip/cheek tie), Q38.1 (tongue tie)

  • The procedure (CPT) codes include: 40806 (new patient evaluation)  41010 (tongue) and 40806 (lip)

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