Anesthesia for dental procedures
The KLV has been supplemented by the new Article 19b. The insurance covers the costs of general anesthesia for dental treatments according to the KLV Articles 17-19a, if these are not possible without general anesthesia.
In addition, general anesthesia is covered if the treatment is not possible due to a severe mental or physical disability of the insured person. The dental services remain at the expense of the patient.
(Source: SSO-Internum 6/2020)
Billing of the sleep apnea splint (KLV 19e)
The snore splint can be billed with the number 4.8170 as an analogy item. According to KLV articles 17f and 19e, the health insurer covers the costs of dental treatment. The laboratory costs are billed according to the new technician tariff and reimbursed separately with a maximum of CHF 730 (MiGeL ch. 14).
On July 1, 2014, the letter e: “sleep apnea syndrome” was added to Article 19 KLV and the sleep apnea splint was included in the MiGeL list of means and objects. The following conditions must be met for a KLV compulsory benefit:
– Diagnosis of sleep apnea syndrome must be confirmed by polysomnography
– a pulmonologist or an SSSSC-certified center for sleep medicine prescribe the protrusion orthosis
– healthy or rehabilitated dentition; no free-end situation, no periodontally weakened dentition, etc.
– effectiveness of the orthosis must be checked at least once by polysomnography
– the dentist monitors the patient regarding side effects caused by wearing the splint
If necessary, the costs for the snoring splint are alternatively covered by the patient’s private supplementary insurance for medical aids in addition to the KVG. Also in this case, have the patient referred in writing by the pulmonologist or general practitioner.
(Source: SSO Internum 6/2014 and 6/2020)
Billing the Michigan splint at the private rate
The Michigan splint is billed at code 4.1770. This includes: Impression taking, impression taking of the opposing jaw, preparation of the laboratory order, delivery to the patient including initial grinding, instruction of the patient. In addition, the bite registration (centric registration) and, if necessary, the facebow transfer can be charged.
The Federal Office of Public Health (FOPH) informed the SSO in a letter dated June 21, 2011, that the application for inclusion of the Michigan splint (dental temporomandibular joint orthosis) in the list of products and articles (MiGeL) was rejected. The federal authorities do not consider the effectiveness, appropriateness and economic efficiency of treatment with a Michigan splint to be given. The studies submitted were insufficient and not sufficiently conclusive.
The costs of the Michigan splint may be covered by a private supplementary insurance policy for medical aids taken out by the patient in addition to the KVG.
(Source: SSO-Internum 3/2011, SSO-Internum 5/2011; SSO-Internum 6/2012)
Billing of the NTI splint
The following items may be billed: Item 4.1800, additionally depending on the time required a maximum of 6 x Item 4.0250, as well as the material costs. This corresponds to a treatment time of approximately 45 minutes.
(Source: SSO Internum 1/2009)