Please note: Beam requires all documentation to be dated and labeled with the patient's name
Beam recommends pre-treatment estimates prior to completing services.
PERIODONTAL
Non surgical Periodontal Scaling and Root Planing
- Current pre-op periodontal chart that is dated & labeled with patient's name
- Complete, current pre-op full arch x-rays that are dated & labeled with patient's name
- Written detailed narrative of medical necessity
Osseous Surgery
- Complete, current pre-op full arch x-rays that are dated & labeled with patient's name
- Current pre-op periodontal chart that is dated & labeled with patient's name
- Dates of previously completed periodontal procedures (D4341, D4342 or other qualifying procedures)
- Written detailed narrative of medical necessity
Periodontal Maintenance
- Dates of previously completed periodontal procedures (D4341, D4342 or other qualifying procedures).
Full mouth debridement
- Complete, current pre-op full arch x-rays that are dated & labeled with patient's name
- Operative note from claim date of service
Scaling in presence of gingival inflammation in absence of periodontitis
- Current pre-op full arch x-rays that are dated & labeled with patient's name
- Current pre-op periodontal chart that is dated & labeled with patient's name
- Operative note from claim date of service
Localized delivery of antimicrobial agents
- Dates of previously completed periodontal procedures (D4341, D4342 or other qualifying procedures)
- Current pre-op periodontal chart that is dated & labeled with patient's name
Gingival Grafting
- Complete, current and dated pre-op periodontal charting
- Written detailed narrative of medical necessity
RESTORTIVE
Crowns (Including Implant restorations):
- Current pre-op x-rays that are dated and labeled with patient name
- The placement date/age of the existing crown/inlay/onlay (if applicable) or if this is initial placement
- The date the crown was seated, if seated on claim date of service please indicate
- Written detailed narrative of medical necessity
- Intra oral photos (if applicable)
Bridge:
- Complete, current pre-op full arch x-rays that are dated & labeled with patient's name
- The placement date/age of the existing crown/inlay/onlay (if applicable) or if this is initial placement
- Written detailed narrative of medical necessity
- The date the bridge was seated, if seated on claim date of service please indicate
Intra oral photos (if applicable)
Core Build Up:
- Pre-op x-rays that are dated & labeled with patient's name
- Written detailed narrative of medical necessity including long-term restorative treatment plan
- The placement date/age of the existing crown/inlay/onlay (if applicable) or if this is initial placement
Post/Core:
- Pre-op x-rays that are dated & labeled with patient's name
- Post operative x-rays that are dated & labeled with patient's name & shows post in place
- The placement date/age of the existing crown/inlay/onlay (if applicable) or if this is initial placement
Written detailed narrative of medical necessity including long-term restorative treatment plan
ENDODONTICS
Root Canal
- Pre-op x-rays that are dated & labeled with patient's name
- Post operative x-rays that are dated & labeled with patient's name & shows endo completion. Working length x-rays will not be considered as endo completion.
PROSTHODONTICS
Implants
- Documentation of all missing teeth in the form of dated & labeled pre-op x-rays that show entire arch
- Post operative x-rays that are dated & labeled with patient's name & shows implant in place. Working guide pin x-rays are not considered post-op.
- Written detailed narrative of medical necessity
Denture/Partials
- Documentation of all missing teeth in the form of dated & labeled pre-op x-rays that show entire arch
- Prior date of placement/age of existing partial. If initial - please indicate.
- The date the partial/denture was seated, if seated on claim date of service please indicate
Immediate Dentures
- Written detailed narrative of medical necessity including date of planned extractions.
ORAL SURGERY
Extractions
- Pre-op x-rays that are dated & labeled with patient's name
- Written detailed narrative of medical necessity
Bone Grafting
- Documentation of all missing teeth in the form of dated & labeled pre-op x-rays that show the entire arch and opposing teeth.
- Written detailed narrative of medical necessity including treatment plan for replacement of tooth
PREVENTATIVE
Mouthguards
- Written detailed narrative of medical necessity
DIAGNOSTIC
Xrays
- Written detailed narrative of medical necessity if preformed within 6-11 months
Palliative (emergency) exam
Written detailed narrative of minor procedures performed to alleviate patient's pain/discomfort including area of treatment.