Normally we bill dentally for most of our dental procedures. There are the few medical but set fee schedules help determine the over all out of pocket cost for patients. In billing medical for Orthognathic surgery, mainly Tricare, if we have the authorization/approval letter, how do I bill out for the procedure and know it will cover costs even though the fee schedule used for reimbursement for code 21189 is considerably less then what the zip code fee book states as appropriate fees for our area? I know Tricare will only cover $ 2,500. I have approvals for codes 41899, 00170 and 21085. I’m just trying to wrap my head around the main CPT code not covering hardly any costs.

Any input in MUCH appreciated!

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