CDT or Current Dental Terminology
Current Dental Terminology (CDT) codes are numbers assigned to dental services and procedures. These codes help support accurate recording and reporting of dental treatment and are part of a uniform system designed and maintained by the American Dental Association (ADA). CDT codes have a consistent format and each is unique. Every code number has a written description of the specific dental service or procedure. You will see CDT code(s) on your Explanation of Benefits form (EOB), or you can ask your dental provider for the CDT code for a procedure or service you will undergo, or have already received.
CDT® is a registered trademark of the American Dental Association (“ADA”).
A detailed bill that your health care provider (such as your doctor, clinic, or hospital) sends to your health plan. This bill shows exactly what services you received.
COBRA (Consolidated Omnibus Budget Reconciliation Act)
A federal law that lets some people who lose their group health coverage stay on their plan for a limited time, and pay for it themselves. For example, if you lose your job, you might be able to keep your health plan for a while longer by paying the premium to your employer.
Co-insurance is a cost sharing feature of many plans. It requires a member to pay out-of-pocket a prescribed portion of the cost of covered healthcare expenses. The defined co-insurance that a member must pay out-of-pocket is based upon his or her health plan design. Co-insurance is established as a predetermined percentage of the allowed amount for covered services and usually applies after a deductible is met in a deductible plan, such as deductible HMO, preferred provider organization (PPO), point-of-service (POS), and indemnity plans.
Co-payment or "Co-pay"
A form of medical cost sharing in a health insurance plan that requires the member to pay a fixed dollar amount for each visit to a doctor or for a specific service. This fee is pre-set; it will be specified in your health insurance policy and also may be listed on your insurance card.
Commercial Health and Dental Insurance Data
Commercial health and dental insurance data, which are the type in the FAIR Health Database, are based on charge amounts billed by healthcare providers, as reported by health plans and other healthcare payors in the private insurance system. FAIR Health uses these data to develop medical and dental cost estimates that reflect the fees that healthcare providers bill in different geographic areas. These fees are similar to what health insurance plans may call “usual, customary and reasonable” (UCR) charges. Cost estimates based on FAIR Health data are different from fees established by Medicare, a federal health insurance program that covers individuals ages 65 and older, as well as individuals with end-stage renal disease and certain persons with disabilities. Medicare fees are usually lower than commercial charge amounts.
The FH Medical Cost Lookup provides out-of-pocket cost estimates for individuals covered by plans that use either UCR-based or Medicare-based out-of-network reimbursement methods. Also see Medicare. The data available on the FH Consumer Cost Lookup reflect fees for services provided “out-of-network,” and not the “in-network” fees negotiated by insurers for services obtained from providers who participate in the plan’s network.
The amounts that health insurance companies will pay to healthcare providers in their networks for services. These rates are negotiated and established in the insurers’ contracts with in-network providers.
Coordination of Benefits
The process of reconciling healthcare charges when an individual is covered by more than one health insurance plan or policy. For example, if a child is insured through both parents’ employers’ plans, one insurer is generally considered the primary insurer and pays first, and the insurer considered secondary reimburses after the primary plan pays. The secondary insurer’s reimbursement, if any, takes into consideration any outstanding dollar amounts for covered services received up to the allowed amount. In any case, the secondary plan will never pay more than they would have paid had they been primary.
A requirement that insured patients pay a portion of their medical costs, either as a deductible, or a flat dollar co-payment, or as co-insurance (i.e., a percentage of the total paid claim for a covered benefit or service).
The medical services, procedures, prescription drugs and other healthcare services that your insurer pays for under your plan. Keep in mind that not all care is covered. For instance, some plans will not pay for medications that are available over the counter. And, even if a service is covered, you may still need to pay a co-payment or co-insurance, request pre-authorization, or get a referral from your primary care physician before your insurer will pay. Your policy should contain a detailed list of what is and is not covered.
A code that is used to provide additional information on a procedure or service. For example, there are modifiers that indicate that a procedure is being repeated or that multiple surgeries were performed at the same time. They can also indicate that the service is more or less complex than normal. The modifier can affect how much the plan will pay the provider.
CPT® or Current Procedural Terminology®
CPT® is a registered trademark of the American Medical Association (“AMA”). Current Procedural Terminology (CPT) codes are numbers assigned to services and procedures performed for patients by medical practitioners. The codes are part of a uniform system maintained by the American Medical Association (AMA) and used by medical providers, facilities and insurers. Each code number is unique and refers to a written description of a specific medical service or procedure. CPT codes are often used on medical bills to identify the charge for each service and procedure billed by a provider to you and/or your insurer. Most CPT codes are very specific in nature. For example, the CPT code for a fifteen-minute office visit is different from the CPT code for a thirty-minute office visit.
You will see a CPT code on your Explanation of Benefits form (EOB). You can also ask your healthcare provider for the CPT code for a procedure or service you will undergo, or have already received.
Cast (Diagnostic Cast)
a model of a patient’s teeth (usually upper and lower) that is used to help the dentist study the teeth and plan treatment when the patient is not available.
Involve creating a restoration in a laboratory setting. Cast restorations cannot be done in the mouth due to the intense heat required to work with gold, titanium or porcelain materials, which are typically used for cast restorations. Gold or ceramic crowns, inlays and onlays are all types of cast restorations.
the removal of plaque and tartar from the visible surfaces of the teeth to prevent cavities, gingivitis, and gum disease. Usually tartar and plaque are removed from the crown portion of the tooth.
an evaluation by a dental professional who is not treating the patient to provide information on the presence of disease, compromised function and potential treatment options.
a type of dental restoration made from either metal or ceramic material, which completely encircles a tooth or dental implant. Crowns are often needed when a large portion of the tooth is destroyed by decay or injury and are often used to improve the strength or appearance of teeth. Crowns are used to replace missing teeth by providing support for a bridge or partial denture (also known as prosthetic crowns). When these crowns are placed on an implant, they are called implant crowns. Crowns are usually made in a laboratory and are bonded to the tooth using dental cement.
A test to find cancer before a patient shows any symptoms, when treatment is likely to work best. Breast, cervical, and colorectal (colon) screenings are the most common types.
Carpal Tunnel Syndrome
Pain, tingling and other symptoms caused by pinching of the median nerve that runs from the arm to the hand passing through a small space in the wrist called the “carpal tunnel.” In carpal tunnel surgery, ligaments are cut to relieve pressure on the median nerve.
Is performed to remove cataracts, which are painless, cloudy areas in the lens of the eye that can interfere with vision.
(also called a C-section); a procedure whereby the baby is delivered through an incision in the mother's abdomen.
A treatment that uses drugs to kill cancer cells or prevent them from multiplying.
A therapeutic system based on the principle that many disorders, especially those of the nervous system, can be treated through hands-on manipulation of the spinal column.
Surgery to remove an inflamed or infected gallbladder. The gallbladder is an organ that stores bile, which is made in the liver. Bile aids in the digestion of fatty foods.
Chorionic Villus Sampling
A pre-natal test that looks for potential genetic disorders in cases where certain risk factors are present, such as the mother’s age or family history.
A common condition in which the cavities around the nasal passages (sinuses) become swollen for at least 12 weeks, despite attempts to treat them.
Chronic obstructive pulmonary disease (COPD)
A lung disease that makes it hard to breathe, and gets worse over time. Chronic bronchitis and emphysema are types of COPD.
A visual exam of the large intestine (rectum and colon) performed with a flexible fiber optic scope. Colonoscopies can be performed as a screening test for colon cancer, and may be used to diagnose and treat other conditions.
An evaluation by a medical professional who is not treating the patient to provide information on the presence of disease, compromised function and potential treatment options.
Sometimes called a CAT scan; x-ray technology is used to provide detailed pictures of the inside of the body. A CT scan generates a clearer image than a regular x-ray.
A laboratory test that examines a sample of blood, urine, skin or other tissue to look for potential causes of infection or disease
A visual exam of the urinary tract performed with a rigid scope which enables the physician to look into the urethra and examine the bladder.