ForwardHealth Is Clarifying Codes for Orthodontic Retention Prior Authorization
ForwardHealth recently amended many prior authorizations (PAs) for orthodontic retention. Previously, providers could indicate on PAs when appliances were removed and retainers were delivered, using one of these Healthcare Common Procedure Coding System (HCPCS) codes:
As of February 2025, providers are encouraged to use HCPCS code D8680 instead of D8670 for members in active orthodontic treatment to indicate when appliances were removed, and retainers were delivered. Providers may also use code D8680 on new PA requests for orthodontic treatment.
This amendment does not affect previously processed claims. Claims over 365 days from debanding, appliance removal and/or delivery of retainer(s) do not qualify for timely filing exceptions.
A PA does not guarantee a payment for a service. All claims remain subject to ForwardHealth policies and guidelines. For more information, refer to ForwardHealth Online Handbook Reimbursement Not Guaranteed topic #438.
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