ADA Pushes Back Against Payer Downcoding

In response to increasing reports of downcoding by third-party payers, the ADA is ready to support states and dental providers in addressing the practice and preventing it from becoming a universal policy. Downcoding occurs when a payer uses a procedure code that is different from the one reported on the claim by the dentist so that the reimbursement amount is less than it would be for the submitted code. The ADA adopted a policy in 2016 strongly opposing forms of claims payment abuse by payers, including downcoding.