Biopsy of Oral Tissue

Policy No: 47
Originally Created: 03/01/1997
Section: Oral and Maxillofacial Surgery
Last Reviewed: 05/30/2023
Last Revised: 06/01/2021
Approved: 06/22/2023
Effective: 07/01/2023

This policy applies to all dental providers.

Biopsy of oral tissue – removal of a small amount of hard or soft oral tissue for microscopic analysis.

Biopsies of hard or soft oral tissue are a non-covered dental service and are considered medical when the condition being diagnosed and/or treated is non-contiguous to the teeth and/or gingival tissue (gums).

Pathology studies for oral biopsies non-contiguous to the teeth and/or gingiva (gums) are also non-covered dental services and are considered medical.

Medical services should be submitted as a medical claim with applicable medical Current Procedural Terminology (CPT®) code and diagnosis code.

American Dental Association, Current Dental Terminology (CDT®)

Administrative Guidelines to Determine Dental vs Medical Services